Performance Excellence Story Template

1. Performance Excellence Story Cover Page The cover page is the title page Performance Excellence Story Template Graphics are optional M = Items needed in all Stories O= Optional items This template is a tool for assisting you in preparing your stories. Please note Stories need to be customized for each situation and must be written in a manner that successfully tells your story. Please use this template as a guide as you develop a document that tells your story to others. Updated February 18, 2003

2. Introduction Reading the Problem Solving CI Story What is a Performance Excellence Story? The Performance Excellence Story is the documentation of work as it is performed in PQS’s 7 Step Problem Solving Process. The story captures the thought process and the data of the team, or individual, as they analyze and solve a problem. It is similar to the DMAIC Process. What are the 7 Problem Solving Steps? 1. Set Direction - In this step the purpose for the analysis is shown. Likely content would be the information found on the charter such as; mission statement, project goals, project schedule and the performance indicator. In this process, a “problem” is defined as a gap between the present and desired performance as measured by the performance indicator. The performance target is defined as the desired level of performance in the identified performance indicator. A Process System Chart may also be appropriate for this section. 2. Stratify & Define Problem - Here the problem is “stratified” to clearly pinpoint the “where, what, when, how and who” of the problem. In order to efficiently solve the problem, we must clearly understand exactly what is broken, and prioritize these items by the magnitude of their contribution. We want to eliminate the large contributors(s) first. Likely content would be a series of pareto charts, and one or more problem statements clearly describing what is contributing to the performance gap. 3. Identify Root Cause - After the major contributor(s) to the problem have been identified, the root cause of them must be determined. The root cause is that activity that, if removed, will eliminate the contributing factor to the problem, thus improving performance as measured by the indicator. Likely content would be identification of potential root causes and verification of these causes. 4. Identify, Test & Select Solution - After the root cause is identified, some change in process must be identified to eliminate the root cause from the process. This is defined as a solution. Likely content would be likely solutions and a solution selection matrix, testing plan, financial analysis, a process map showing the “before and after” process and an estimate of the impact on the performance indicator. 5. Implement - The plan for implementing the solution is found here. 6. Ensure Results - This section contains the performance indicator to evaluate the success of the implemented solution(s). Likely content would be the performance indicator, charts and graphs. 7. Remaining Issues and Future Plans - A description of future acts suggested by this team. Suggestion could include future problem solving activities, reviews, or future technologies to consider. Show whatever data is needed to tell your story to others. Page 1

3. Introduction Good Tools You May See in the Performance Excellence Story Performance Indicator The Performance Indicator is the core of the Problem Solving process. It is usually a line graph of a process or outcome indicator that is regularly used to measure the ability of a work process to meet customer needs or expectations. The Performance Indicator must be something that can be counted and plotted on a line graph. A line graph is used as it depicts performance over time, thus allowing the identification of performance trends. The objective of the 7 Step Systematic Problem Solving Process is to “Drive the Indicator” in the good direction. Other types of charts may also be used when appropriate. Stratification - Pareto Charts There are many contributing factors to most problems. Stratification is the process used to identify and prioritize these specific contributors. The Pareto Chart is the tool used to conduct stratification. The Pareto Chart is an advanced bar chart that aligns the contributing factors in order of magnitude of contribution from the left of the chart to the right. The chart also shows percentages of contribution to the problem. After identifying the major contributors, the remaining contributors are grouped and place in the “Other” bar. One important rule to remember about the “Other” bar is that each contributor grouped here has a frequency of occurrence that is less than the bar to the left. Therefore they are the less significant contributors. Tampa Market 1995 through 3-2000 Corporate Complaints Seattle District N=1070 Problem Statement(s) The problem statement provides the focus for the remaining analysis. All future analytical activity will focus on the items quantified in the Problem Statement. The Problem Statement is derived from the data on the pareto charts and thus is a statement of the largest contributor(s) to the stated problem, the performance gap shown on the indicator chart. # Complaints Barrier Type Cause & Effect or “Fishbone” Diagram The Cause and Effect Diagram is a tool used to identify potential root causes to the problem identified in the problem statement. It is a method of organized brainstorming. Potential root cause can be found on the “bones” furthers away from the “head” and are circled are otherwise noted on the diagram. Page 2

4. Set Direction Process System Chart Revised Date: _____________ Process Purpose: Process Name ________________________________ Customer/Next in Process Feedback Mechanisms Outcome Indicators Recipient & Business Reqt’s Suppliers & Inputs Key Process and Sub - processes Next in Process Recipient Customer(s) & Output & Output Internal Support Processes & Inputs O M Background data needed can be found on the Team Charter form. That may be inserted here. O Graphics are optional O Page 3

5. Set Direction Performance Indicator Actual/Current Performance Target desired level of performance Gap - the difference between present and desired level of performance - Contracts - Benefits - Claims Suggested Items for Set Direction M Financial Impact M Project Schedule O Baseline Map of current process BASELINE SEATTLE CALL HANDLING DRAFT Phone Rep B - ss# - patient name - reason for call Go back to CSR Tell Document caller and Determine if Relay Taking Gather info CSR input Verify Ask Write down Resolve Put caller on A answers customer to ICS from determine Listen Research you can Yes findings to resolution Put in ICS from caller into system information questions key points issue? hold/mute phone hold previous call Member or resolve isse customer steps Provider No Det if caller Det if need needs to be No to transfer transferred Det for Relay daytime Document findings to phone ICS and customer number for Pend No call back Transfer? Transfer? Transfer Det if Determine if Yes Yes customer need to Yes accepts transfer call response Transfer Ask if there is Thank caller B A Addl issues? Yes another issue Transfer No and Accepts? disconnect No Yes No Thank caller Cust put on Transfer to Transfer and disconnect hold next level CUSTOMER Customer Customer Customer Customer responds Wait providing providing hangs up with issue info response and detail "CALL HANDLING" TEAM LEAD Title: CALL HANDLE TIME No File Name: Jax Call Handle Time Origination Date: August 21, 2000 Identify and Revision Date: August 21, 2000 Revision Time: 01:32 PM Resolve reiterate Yes Close ICS Pend issue? issue Page 4

6. Stratify & Define Problem M Suggested Items for Stratify & Define Problem Show the stratification that leads to your problem statement, and any other key Paretos (may answer a popular question). Place all other Paretos in the appendix so people can see what you looked at in your analysis. M Problem Statement After the major contributor to the problem has been determined a problem statement is prepared. The problem statement must be very specific and must be related only to the major contributor. It usually derived by tracing the Paretos charts back through their stratification levels. The indicator should be embedded in the problem statement. Problem Statement Example: 12% of all Provider Projects are related to Tracers. (from above) M Contribution to the Gap Based on the verification you have just completed, and your best prediction of what you believe you can fix, show the contribution to the gap you estimate to achieve with this project. Page 5

7. Identify Root Cause PCP Error Systems Different codes Office staff not educated Member not linked to PCP in system Issues referral before Humana approval Too many systems Kinetra Turnover Humana not open after 5 Out of Date Normally approved anyway Out of Service One more system for Doctor Sales Process Office holds referral Humana systems antiquated No dedicated phone line Unclear explanation Don’t talk to each other Financial motive to hold MSO’s not explained Can’t match referral and claim No financial motive to send Referral requirements not explained System down Loading incorrect Hold for batch run Incorrect Materials Bad image not picked up Office Staff Error Directories Inaccurate Kinetra keying error Mismatch causes denial Hard to read Kinetra transmission Referrals unclear Don’t submit to Kinetra 15% of all Grievance and Appeals are related to Medicare Claims denied for no referral to a specialist in the service area. Accepts member w/o referral Review takes too long Knows member Member self refers Verbal received from PCP Verbal from PCP Exceeds services authorized PCP doesn’t send to Humana Normally approved anyway Not clear on what is authorized Sends different info to Humana No document More care needed – referral too complicated to get Referral incomplete when received Systems not friendly Specialist Trying to beat the system Keying errors Humana between member and doctor Multiple complex steps Form too complex Referral form implies referral approved Humana Staff Error Says referral not request People think it is approved Referrals inappropriately expire Complex Referral Process Suggested Items for Identify Root Cause The purpose of this step is to identify the root cause(s) of the problem. This can be done through organized brainstorming utilizing the fishbone diagram or other cause and effect tools. O Listed above are potential root causes, which were determined through brainstorming. The potential root causes must be verified in order to identify the true root causes. Page 6

8. Identify Root Cause M M Contribution to the Gap Based on the verification you have just completed, and your best prediction of what you believe you can fix, show the contribution to the gap you estimate to achieve with this project. Page 7

9. Identify & Select Solution Suggested Items for Identify & Select Solution Potential solutions are identified that remove the root cause from the work process. Each solution is analyzed for feasibility and effectiveness. Identifying a lasting and cost effective solution is key to having a long-term impact on the performance indicator. O M • Although the Solution Selection Matrix is optional, you must tell your story showing at least the following: • Alternatives considered • Solution(s) selected • Why were these selected? • Testing Plan • The cost effectiveness of the proposed solutions? • Contribution to the Gap O Page 8

10. Implement Suggested Items for Implement M M Change Management Plan Type of Change Actions Required Team Leader and Sponsor agree on change and new schedule Delay in implementation If not financial impact team consensus required – plan for change impl. req’d Tools/forms change needed Team Consensus and approval by all parties originally approving process Process change suggested Team, Sponsor, OIC approval required Process indicator change M Review Plan What When Who Have Leadership Team review proposed solutions Team Lead, Sponsor, OIC Completed April 4 Meet with sponsor weekly to review progress Ongoing until final sign off Team Lead, Sponsor Include indicator in the weekly OIC meetings Begin May 23, ongoing OIC Review all progress & determine next steps September 15 Entire Team, Sponsor Page 6

11. Ensure Results Target Actual Performance Implementation Date Suggested Items for Ensure Results Monitoring the before and after results evaluate the success of the implemented solutions. Results are measured using the same indicator that was used to identify the problem. M Performance Before and After Implementation There are many ways to display results information. Show the results in the manner that best tells your story. You must, however, show results in the same indicator that you used in Reason for Improvement to show you had a problem. O Page 10

12. Remaining Issues & Future Plans Suggested Items for Remaining Issues & Future Plans Next Steps * Develop a standardization plan This usually involves the standardization of the solution, having it become the normal and standard way of conducting business. * Replication Determine if others areas of Humana can benefit from this solution, if so contact appropriate parties. *Remaining Issues Unresolved issues often need to be handled by areas outside of the team. Document those issues and provide a vehicle to communicate those issues to the appropriate parties. *Lessons Learned There are lessons learned on every project that can be used to make future problem solving activities more efficient and effective. In spirit the of continuous improvement, these should be documented and shared during the review process or in any other appropriate manner. Page 11