1. Lean 6 Sigma at HHSA: Advancing the vision of Live Well, San Diego!
County of San Diego, Health & Human Services Agency
Lean 6 Sigma at HHSA: Advancing the vision of Live Well, San Diego!
Prepared by Jackie Werth
Special Projects Coordinator
Office of Business Intelligence, HHSA

2. It’s how we become an “Agency of One”
HHSA is large agency combining health, behavioral health and social services, serving a diverse community
Bold, 10-year strategy, “Live Well, San Diego!”
Critical to success is addressing fundamentals—strong work systems and processes to meet customer needs

3. Vision: Healthy, Safe, Thriving Communities
An Agenda for the Future
Action Framework
Build a Better System
Support Positive Choices
Pursue Policy & Environmental Changes
Improve the Culture Within
Advance Operational Excellence

4. County of San Diego General Management System
Where are we going?
Are we sharing goals & encouraging success?
Strategic
Planning
Operational
Planning
Motivation,
Rewards &
Recognition
General
Management
System
How do we plan to get where we’re going?
This is the diagram of the GMS – has anyone seen this before? The message has taken a while to spread throughout the county, but it is telling to see so many hands up as the GMS is really a very important part of the County culture.
You see it has 5 components and it is cyclical – meaning, it isn’t a one time event! We live this all the time and it guides what we do in our programs.
Go through the components.
Monitoring
&
Control
Functional
Threading
Are we on track?
Are we working together?

5. Fundamentals of top performing organizations
Senior leaders take action and communicate effectively and frequently to sustain the organization
Leadership
Strategic challenges addressed and strategic advantages leveraged
Strategic Planning
Actively listening to and engaging the customer, even building relationships with them
Customer Focus
Performance is measured, analyzed, reviewed and improved at all levels
Measurement & Analysis
Workforce is supported, actively managed and engaged
Workforce Focus
Work systems and processes designed, managed and improved to deliver customer value
Operations Focus
Results data available and utilized across all programs, services, processes and location.
Results
Malcolm Baldrige criteria for performance excellence

6. Operational excellence demands:
Approach is effective, systematic, fully responsive to multiple item requirements
Deployment of approach is complete, without significant weaknesses or gaps in any areas or work units
Learning through innovation, ongoing improvement efforts, analysis and sharing
Integration of approach to address current and future organizational needs, and across all process items
Malcolm Baldrige criteria for performance excellence

7. What is L6S?
Lean is about reducing waste in processes so that you get the right result in as few steps as possible
Six Sigma is about reducing variation so that you consistently produce a high quality product, service or outcome
Both sets of tools can make a difference!

8. DMAIC Improve Control Define Measure Analyze
Using the “voice of customer,” the “Big Y” is defined
Measure
Process mapping and control charts are key here
Analyze
Hypothesis testing and pareto charts help you get to root cause
Improve
Evaluating, selecting and testing solutions is next
Control
This is how you ensure improvements take and you get the results you are after

9. Why L6S is culture change
We don’t always think of what we do as a collection of processes
We tend to want to go “fix” a problem before taking the time to determine the root cause
There is always the fear of what L6S will find or reveal
We often lack the data, analytic capacity, time and discipline to undertake this type of analysis, much less do it routinely
We fail to effectively communicate project findings and follow-through by testing and implementing improvements

10. Building capacity
FY10-11
Send 2 staff to Black Belt training (external)
Hire master Black Belt consultant
Green Belt training (3 cohorts of 15 each)
White Belt training for Executives
FY 11-12
White Belt on-line training for ALL 5,000 staff
Yellow Belt training for ALL 300 managers
Green Belt training (2 cohorts of 15 each)
Black Belt training for 5
FY (proposed)
Targeted Green Belt training for corrective action and quality control staff
Green Belts teach Yellow Belt
Deploy Green/Black Belts to priority projects
Black Belts offer technical assistance to Executives

11. White Belt On-Line Training for ALL Staff
All 5,000 staff introduced to L6S basics:
Interactive with comic book theme
DMAIC explained
Illustrated by current Green Belt Projects
Resource sheet
Features Agency Director who solicits improvement ideas

12. Yellow Belt for ALL Managers
All 300 managers get additional training to encourage use of L6S and help getting solutions implemented:
Lots of team exercises using the tools
Guest Green Belt highlights project
Affinity exercise on change management priorities:
“What gets in the way of process improvement at HHSA?”

13. Green & Black Belt Training
Green Belt
Black Belt
Apply with Executive approval
5 months, 5 full days of class
5 months, 13 full days of class
Pass assessment
Conduct project (process within own department) using DMAIC
Conduct major project (major process, multi-departmental) using DMAIC
Deliver final presentation to Project Sponsors
Deliver final presentation to Executives
Project deck reviewed and approved by Master and Agency Black Belts

14. New Bench Strength: 53 Green, 2 Black
ACS
AIS/East
BHS
Central
CWS
3 Green
5 Green
Exec Office
First 5
FSSD HR
N. Central
1 Black
1 Green
1 Yellow
2 Green
N. Inland
PAPG
PHS
South
SPOS
7 Green
As of May 2012; 1 Black Belt class and 1 Green Belt class in progress.

15. Examples of projects from across the enterprise
Public health
Child welfare
Behavioral health
Eligibility
Aging services
Admin services
Improve public health lab reporting accuracy
Reduce time it takes to connect CWS clients with service providers
Increase primary care referrals to substance abuse treatment
Reduce wait times in family resource center lobbies
Increase accuracy of the intake process for In-Home Supportive Services
Reduce time it takes to process a travel claim

16. ROI Benefits just beginning to be realized
Costs kept to a minimum:
Master Black Belt trainer consultant for all training
Conduct training on site at HHSA’s The Knowledge Center
Use own Black & Green Belts staff to mentor, train in future
Benefits just beginning to be realized
Mostly timeliness, accuracy and service quality improvements
Anticipated ROI of $1.8 million for FY projects; modest monetary benefits reported so far

17. Biggest benefit is having staff with this skill set to draw upon
New pool of Green Belt staff to task to solve sensitive and complex problems
New Black & Green Belt expertise to tap to look at systems and operations with a whole new perspective
Address major risks/problems as emerge
Start building L6S into into operations

18. Profiles of early, small successes
Edgemoor Nursing Facility
Ensure staff get physical exams
San Pasqual Academy for foster kids
Increase placement
Emergency Medical Technicians
Speed up certification

19. What challenges persist?
Union concerns
Solutions are often not fully implemented
ROI takes time to show; more service quality benefits than financial benefits
No mechanism in place now to ensure Black and Green Belts are being maximized, or put to best use to advance the vision

20. The biggest room in the world is the room for improvement