Our Quality Journey using Lean Six Sigma and other Quality Improvement tools

First used Six Sigma to organize and prepare for our initial Council on Accreditation (COA) accreditation. Through the use of Charter and DMAIC tools we passed with flying colors in 2007! Yellow Belt training projects (United Way): – Improve utilization of Title XX funding in Aging – Improve 1 st visit attendance in Marriage Counseling – Agency - wide Dashboard for Stakeholders – Improve Appeal Deposit Process – Improve HR Hiring Process Green Belt training projects (UB - Center for Industrial Effectiveness) : – Insurance utilization project – Better balancing of payer mix within Aging Services – Improving computer support to the 50+ offices – Streamline the referral of traumatized youth placed out of home to Child Mental Health.

Other trainings and Projects Green & Yellow Belt training projects (Canisus Center for Professional Development): – Closing the Gap – Increase percent of Core Functions – Immigration & Resettlement – Decrease non-direct service time – Monsignor Carr Institute – Reduce No Shows – Metro-District – Reduce Billing discrepancies – Older Adults – Increase percent admissions – Purchasing – Reduce cycle time & errors Other Projects: – Substance Abuse Services; a Federal NIATx Project – Appeal Cash Room Six Sigma Project

Sample of Project Tools/ Products Improved utilization of Federal funding in Aging programs – One of our first Yellow Belt training projects through the United Way trainers; William Hill PhD & Joe Rocasano

Title XX Project Team Members: James Nowak, Bill Larsen, Adrian Slocum, Maryann Deitzer & Mike Venezia

Client Engagement Project - Yellow Belt Marriage Counseling Team Members: Arlene Kaukas, Jennifer Przynosch & David Catalano Goals and impact: – Focus on improving 1 st appointment rate. – Streamlined intake method, – 6% increase in ‘show rate’.

Develop Agency-wide Dashboard - Yellow Belt Team Members: Andy Aprile, Jane Minichelli, Bill Sukaly, Erin Postulka, Barb Griesmann - Went from a low level of performance reporting compliance to nearly all. - Quality of outcome measures improved - Stronger commitment to use Dashboard/ Scoreboard tied to Strategic Plan

Appeal Deposit Process Team Members:Therese D. Bianchi,T.J. Jakubowicz,Janet Kraus, Paul Seitz, Sr. Mary McCarrick OSF Goal: Speed up reconciliation of deposits Results in days instead of months

Run Chart of Appeal Data

Green Belt Projects via a Community Health Foundation Grant (UB – Center for Industrial Effectiveness)  Impact of counselor assignment re: revenue  Better balancing of payer mix within Aging Services  Improving computer support to the 50+ offices  Streamline the referral of traumatized youth placed out of home to Child Mental Health.

Insurance Utilization Project Team Members: Tracey Miers, Lorraine Rinus, Meichle Latham, June Pamrow, Barb Griesmann, Beth Bishop, Dave Catalano Impact on lost revenue and improve the process-reduction in error rate from 25% to 17%. This project prompted the agency to seek changes in the third party payer agreements as well as a rethinking about compensation of credentialed staff. Credentialing of all eligible staff for insurance reimbursement Significantly increased revenue (estimated over $31,000 in just one department) These actions will have a direct impact on the sustainability of the system changes and ability to provide client care to a larger number of people.

Insurance Utilization Project Measure Phase - Pareto Chart

Better balancing of payer mix within Aging Services Team Members: Jim Nowak, Bill Larsen, Tony Szakacs, Susan Wollenberg, Mike Smith & Erin Pustulka Balancing payer mix with in that Aging Services to be less dependent on declining Appeal funds. The project did provide the data to negotiate a much higher reimbursement rate with hospital providers.

Improving computer support to the 50+ offices Team Members: Andrew Aprile, Dave Wirtner, Mike Sobczak, Angel Feness, Kate Hacker & Jesse Zeiders This project did identify new ways to monitor and improve internal IT services The findings and operational recommendations were presented to leadership as improved procedures and methods to monitor IT and other internal support services.

Bar Chart - Methods of Communication

Improve Mental Health services for traumatized youth placed out of home Streamlining the referral of Foster Care and Adoption children to Monsignor Carr Institute which resulted in: A dramatic reduction in wait time for children 33 to 11 days. A greater satisfaction level of internal referral sources from 33% to 100% satisfaction. This project was expanded to other populations within Catholic Charities

Team Members: Mike Venezia, Marie Andersen-Strait, Destiny Booker, Kristin Brandel, Jose Correa, Arry Green, Kelly Grimaldi, Caterina Plotnicki & Jan Schneider Pre & Post Histograms

Closing the Gap – Increase Percent Core Functions from 57% to 70% Team Members: Andrea Meyers, Cheri Alvarez, Alisha Baggiano, Jillian Miller, Susan Seawood The result of this intervention is astounding! Site Facilitators increased the amount of time they spend on 5 Key Functions to 88%!

Closing the Gap Process Map

Immigration & Resettlement Team Members: William Sukaly, Dennis Walczyk, Diana Nowak, Pat Zimmer, & Carolyn Kwiatkowski Decrease non-direct service time

Immigration & Resettlement Cause & Effect Diagram

Monsignor Carr Institute Team Members: Janice Schneider, Kristin Brandel, Bernie Arnesen & David Wirtner Reduce No-Shows The number of No-Shows decreased by 2,077 visits which represents an increase in income of approximately $186,930 and resulted in an increase of 47% in productivity!

Monsignor Carr Institute Run & Control Chart

Family & Community Services Billing Process Team Members: Marie Andersen-Strait, Jessica Schroff & Sandy Smith $19,440 represents the potential of reduction in loss/ increased revenue by completing this improvement process

Family & Community Services Decision Matrix Example

Older Adults Standardizing the Intake Process Team Members: Jim Nowak, Tara Pace, Erin Pustulka, Tony Szakacs & Beverly Eagan Standardizing the Intake Process shifted overall conversion rate for Older Adult Services from 30% to 47%

Older Adults Frequency Chart

Purchasing Team Members: Terry Bianchi, Elly Fialkowski, Angel Feness, Karen Metz & Pam Rich Goal: reduce cycle time from 43 to 36 days Realized 20.9 days, a 50% reduction!

Purchasing Process Map

Substance Abuse Services; a Federal NIATx Project Team Leader: Bernie Arnesen Used a rapid cycle PDSA improvement method  Increased the average show rate for the second clinical appointment from 33.3% to 77.7%.  Using a welcome packet, we had a net increase of 112% in income for the second clinical visit.  These percentages remained true six months after adopting the new procedure

PDSA Change Model used

Six Sigma Cash Room Project Team Members: Chuck Marra, Terry Bianchi, Cindy Scibetta & Jim McNamara Through cash room re-design and scale improved work times and significantly reduced idle times Improved the average number of days and outliers from envelope receipt to deposit by 50% – Average total work days – from 9 to 4.5 – % of outliers (>20 days) from 6% to 3%

Six Sigma Cash Room Project Room & Process Redesign

Lessons Learned Like learning to drive a stick shift – Challenge to learn Need for Charter and well scoped out charge Real problem may not be ‘the problem’ Data changes the conversation Need Leadership support It works better than ‘see what you can do’ or ‘try harder Don’t need to shoot a fly with elephant gun Great return on investment Shared vision & knowledge – Take a learning stance Trust the process – It works!

For more information, contact Michael Venezia, LCSWR, ASQ-CQM, CLSSGB Director of Quality Improvement (716) ext 2098