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

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

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

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?

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

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

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!

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

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

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 12-13 (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

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

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?”

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

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.

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

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 10-11 projects; modest monetary benefits reported so far

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

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

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

The biggest room in the world is the room for improvement