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Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. I 0
Harnessing the Power of Lean
Six Sigma: Military Medical Evaluation
Institute of Industrial & Systems Engineers
Engineering Lean Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA
Lean Six Sigma Applications Track: Healthcare
Jeffrey Voth, Jennifer Derhaag, and Peggy Timmer October 1, 2015
FEDSIM – WMATA PHASE II (SYSTEM INTEGRATOR)
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 1
Agenda
Introduction
Optimizing Military Medical Evaluation
− Rethink current operations
− Redesign core processes
− Realign the business model
Summary
Presentation Agenda
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AgendaIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 2
Introduction
We have been here before
Air Mobile
Operations
Deep Attack
Operations
Peace Keeping
Operations
Budget $229,908 $101,491 $180,520 $104,712 $155,733 $94,944 $256,109
Active 1,596,419 858,622 1,570,343 758,852 780,980 479,426 566,045
Reserves 349,649 695,603 633,421 536,964 732,050 562,580 567,296
Korean WarDesert Shield
Desert Storm
Operation Iraqi and
Enduring FreedomVietnam
FU
TU
RE
$M
* Budget figures represented in constant dollars (inflation adjusted) I Source: The Army Capabilities Integration Center
IntroductionIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 3
The total Army has a vital role to the Nation
Active Guard Reserve
475,000 342,000 198,000Capable of many missions, at many
speeds and sizes, under any condition
40% of the Army’s
Combat Capability;
Rapid response for States
35% of the Army’s
Support Capability
= 50,000
75%
Operational
Institutional
Other
3/4 of the Army stand trained, equipped, and ready for deployment
while the remainder provide critical institutional support for these troops
IntroductionIntro | Rethink | Redesign | Realign | Summary
Source: U.S. Army FY2016 Budget Request
Introduction
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 4
Operations have increased and will continue to diversify
Soldiers deployed and forward stationed
143,540 soldiers in over 150 locations worldwide
Intro | Rethink | Redesign | Realign | Summary Introduction
Introduction
Number of Operations Since 1990
29 36 43 46 48 51
HaitiBalkans
Hurricane
Mitch
Noble
Eagle
Continuous support to civil authorities includes:
wild fires, hurricane, flood, tornado relief, etc. Source: 2015 Army Posture Statement
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 5
Agenda
Introduction
Optimizing Military Medical Evaluation
− Rethink current operations
− Redesign core processes
− Realign the business model
Summary
Presentation Agenda
..……………….……..…………………………………………………….
...…………………...……………………...
…….…..…………………………………………..
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.……………………….……………………….…….
..………………………..…………………...………….…………………..….
2
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24
31
AgendaIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 6
Most process optimization efforts begin with a common set of imperatives
Optimization Objective
Processing time and cost significantly increasing
Reduce the complexity,
time, and cost of
medical evaluation
Optimizing Military Medical EvaluationIntro | Rethink | Redesign | Realign | Summary
Optimization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 7
Identify potential
opportunities
Conduct high-level
assessment
Prioritize
opportunities
Strategic initiatives to address this imperative were surfaced in a systematic and focused front-end effort
Strategic
Initiative
(A)
Strategic
Initiative
(A)Strategic
Initiative (A)
Prioritization of opportunities
− Benefits to Medical Evaluation− Benefit Timeline (in-year results)− Risk (no operational impact or quality reduction)− Early visible successes using existing resources− Interdependencies with external agencies
Conduct top-down profile of
opportunities – how large and
what changes are necessary
at the individual treatment
facilities
Generate initial set of
unconstrained
hypotheses
What:
Leadership
Senior management
Cross-functional team, SMEs,
and stakeholders from
treatment facilities
Cross-functional teamWho:
Collective discussion Targeted best practice
benchmarking
High-level Baselining
Interviews and
embedded knowledge
of team
How:
Most
Attractive
Least
Attractive
Cost: Resources
Benefit
High
Low
High Low
Optimizing Military Medical EvaluationIntro | Rethink | Redesign | Realign | Summary
Optimization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 8
Strategic
Initiative
(A)
Approaches to
Process Optimization
Strategic
Initiatives
Strategic
Initiative
(A)Strategic
Initiative (A)
Confusion
BPR
Lean
Management
Kaizen
Six
Sigma
TQM
Which
Approaches
For Which
Initiatives
In translating initiatives from ideas into action while remaining focused on delivering in-year results, we confronted an array of methodologies and tools
Design and
deploy a
solution using
only existing
resources
Optimizing Military Medical EvaluationIntro | Rethink | Redesign | Realign | Summary
Optimization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 9
We incorporated lessons learned from previous initiatives…committing to a “one size fits all” approach does not always yield the best outcome
Some approaches to process optimization are effective at solving well defined, narrow
problems (reducing waste or non value-added activity) but not at driving breakthrough thinking
Other methodologies assume that the existing process design is fundamentally sound and just
needs minor adjustments to perform more efficiently --- these approaches do not challenge
whether there may be an entirely different way to perform the process
Many do not align process stakeholders and their decision rights around common goals and
objectives --- they focus on using individual process optimization rather than core value
streams of the organization
Most process optimization approaches do not explicitly address the changes in culture,
performance measurement, organization structure, roles, and other management
systems necessary to support a high-performing organization
Optimizing Military Medical EvaluationIntro | Rethink | Redesign | Realign | Summary
Optimization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 10
Optimizing Military Medical EvaluationIntro | Rethink | Redesign | Realign | Summary
We tailored our approach – segmenting initiatives by design complexity
How complex is the initiative
Focus on redesigning to maximize performance of the current model
Focus on multiple treatment facilities
Redesign processes using current configuration
Standardize software reporting and information technology investment
Redesign site level policies, procedures and decision rights
Operate within the constraints of the current processes
Focus on improvements at a single treatment facility
Design and deploy a solution using only existing resources (staff, facilities, equipment)
Leverage current technology
Minimize changes to organization, policies, procedures and decision rights
Rethink
Current Operations
Redefine the operating model construct - what is done and how it is executed
Focus on the enterprise
Reconstruct and build processes “clean-sheet”
Refresh technology platforms and enabling software applications
Restructure governance, organization, policies, procedures and decision rights
Low High
Redesign
Core Processes
Realign
the Business Model
Optimization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 11
Service line operations
Individual treatment facility
HeadquartersMission
Vision
Goals/Objectives/Initiatives
Patient cycle time
Balance case workload
Standard processes
Common governance
Process Map
Process Integration
Measurement/Analysis
Tools
Forms/Templates
Job Aids
What Processes does each
strategic initiative map into?
Rethink
Current Operations
Redesign
Core Processes
Realign
the Business Model
How complex is the initiativeLow High
Incr
easi
ng
imp
act
on
th
e o
rgan
izat
ion
Frameworks for each strategic initiative were selected based on the business process or model being optimized
Optimizing Military Medical EvaluationIntro | Rethink | Redesign | Realign | Summary
Optimization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 12
Agenda
Introduction
Optimizing Military Medical Evaluation
− Rethink current operations
− Redesign core processes
− Realign the business model
Summary
Presentation Agenda
..……………….……..…………………………………………………….
...…………………...……………………...
…….…..…………………………………………..
..……………………...………….…………………..….
.……………………….……………………….…….
..………………………..…………………...………….…………………..….
2
6
13
17
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AgendaIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 13
Reduce the complexity,
time and cost of
medical evaluation
Apply smart cellular
design principles as
a proof of concept
Measure / Target
Objectives articulate components
of the overall strategy
Measures and targets track progress toward achieving
the target, and communicate the intent of the objective
Initiatives help close the gap
between current and desired
performance
Measure
Target
Turnaround
time
(# of days)
100 days
Gap
Strategic Initiative 156
100
Rethink current operationsIntro | Rethink | Redesign | Realign | Summary
Actual Target
Tim
e (
days)
Strategic initiatives were clearly defined to help close identified performance gaps
Rethink current operations
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 14
Visibility Insight Action
Baseline operations and
performance
Use process analytics and
modeling to drive optimization
Optimize, define performance
and continually improve
Applied lean principles (standardization, visual management, point of use, cellular flow) to deploy a site-level operational excellence proof of concept
Staffing Levels Process Times
Demand
Cas
es
Time
Case Complexity
High
LowMed.
Scenario AnalysisProcess Baseline Performance Dashboards
Modeling and Simulation
Rethink current operationsIntro | Rethink | Redesign | Realign | Summary
Rethink current operations
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 15
Site-level Improvements Implemented
Proof of Concept reduced case processing time by a factor of 5
People‒ Established cross organizational collaboration‒ Maximized resource utilization through predictive
modeling and simulation‒ Formed cell teams, performed team building activities
and provided hands-on training
Process‒ Maximized system throughput with scenario analysis‒ Developed Standard Operating Procedures‒ Provided on-site change management support
Technology‒ Eliminated redundancy through IT crosswalk
Performance Management‒ Eliminated individual throughput targets and
established team goals‒ Provided a performance management dashboard to
consolidate performance metrics for senior leaders
Prescribed a balanced set of improvements to achieve performance standard
-70%
-80%
Historical
Average
100 Day
Target
Proof of
Concept
Significant Cycle Time Reduction
Rethink current operationsIntro | Rethink | Redesign | Realign | Summary
Rethink current operations
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 16
Agenda
Introduction
Optimizing Military Medical Evaluation
− Rethink current operations
− Redesign core processes
− Realign the business model
Summary
Presentation Agenda
..……………….……..…………………………………………………….
...…………………...……………………...
…….…..…………………………………………..
..……………………...………….…………………..….
.……………………….……………………….…….
..………………………..…………………...………….…………………..….
2
6
13
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24
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AgendaIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 17
DMAIC Define Measure I Analyze Improve Control
Activity • Engage
Stakeholders
• Review scope
and detailed
requirements
• Touch Time collection
through activity logs
• Takt time analysis
• Process mapping
• Interviews
• Process walk through
• Spaghetti diagramming
• Develop future state
• Advanced scheduling
• Critical path analysis
• Team design
• Visual management
incorporation
• Develop training plan and
materials
• Failure Modes & Effects
Analysis
• Leadership training
• Team member training
• Implement new process
• Develop sustainment plan
• Process corrections
• New process case
tracking and analysis
• Remote monitoring
Output • Current state process maps
• Touch Time analysis
• Workload and demand
analysis
• Standard Work
• RACI
• Standardized Future State
process map
• Visual Management Boards
• High Performance Team
Design
• Training materials and plan
• Day by the hour
• Process change record
• Operational definitions
• Checklists
• Cover Sheets
• New process
implementation at sites
• Sustainment plan
• Process addendums for site
unique information
Engage Build Implement Sustain
Process redesign activities will generate operational savings and improvements while exceeding established performance standards
RedesignIntro | Rethink | Redesign | Realign | Summary
Redesign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 18
Critical Path Analysis Standardization Advanced Scheduling Team Based Design
Identified four key methods to drive efficiency and effectiveness throughout the process redesign effort
RedesignIntro | Rethink | Redesign | Realign | Summary
Redesign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 19
Mapped the current process and its sequential requirements --- identified areas where process steps could be moved in parallel as opposed to in series
Critical Path Analysis
Step 1 Step 2 Step 3 Step 4
Step 4
Step 3
Step 2
Step 1
RedesignIntro | Rethink | Redesign | Realign | Summary
Redesign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 20
Replication across sites creates the foundation for system optimization
Reduced activity count Reduced handoffs
80%
Eliminated non-value added activities
Defined roles & responsibilities
20% Unique
Design
Standard
Design
Standardization
RedesignIntro | Rethink | Redesign | Realign | Summary
Redesign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 21
Calculated advanced scheduling timeline based on historical appointment lead time --- determined milestone dates based on historical actuals
Advanced Scheduling
Appointment lead time
Mile
ston
e
14 days
Appointment lead time
Mile
ston
e
Con
duct
appo
intm
ent
Con
duct
appo
intm
ent
14 days
Sch
edul
e
appo
intm
ent
Sch
edul
e
appo
intm
entWithout advanced scheduling…
14 days to appointment from milestone
Advanced Scheduling applied…
2 days to appointment from milestone
RedesignIntro | Rethink | Redesign | Realign | Summary
Redesign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 22
Developed a high performance team structure based on touch time analysis and future state roles and responsibilities
Empower Proactive Performance
Visual Management Boards
Case Manager
Case Manager
Case Manager
Admin Assistant
Case Manager
Admin Assistant
Case Manager
Case Manager
Lead
High performance team work cells were
designed to match staffing to work requirements
Designed visual management boards and
instituted daily stand-up procedure to track
leading indicators of performance
Team structure and visual management
empowered employees to be proactive about
their (and the team’s) performance
RedesignIntro | Rethink | Redesign | Realign | Summary
Redesign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 23
Agenda
Introduction
Optimizing Military Medical Evaluation
− Rethink current operations
− Redesign core processes
− Realign the business model
Summary
Presentation Agenda
..……………….……..…………………………………………………….
...…………………...……………………...
…….…..…………………………………………..
..……………………...………….…………………..….
.……………………….……………………….…….
..………………………..…………………...………….…………………..….
2
6
13
17
24
31
AgendaIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 24
Customer orientation facilitated a shift from a task force to service line, introducing the concept of horizontal value flow
Traditional View (i.e. Vertical)‒ Based on hierarchy of units, departments, etc‒ The intent of the policy is lost or is impractical
at the point of impact‒ Change is hindered by the middle layers
trying to reconcile the intent
Process Line View (i.e. Horizontal)‒ Customer perspective drives
improvement and innovation‒ Roles and responsibilities are
aligned‒ Achieves same result, more cost
effectively
RealignIntro | Rethink | Redesign | Realign | Summary
Realign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 25
Stakeholder Concerns Management Issues Performance
Measures
OutcomeIs the organization
effective?
OutputIs the organization
making progress?
ActivityIs the organization efficient?
• Are we making progress on improvement
initiatives?
• Are we meeting critical milestones?
• What is implementation status?
• How are we addressing
implementation issues?
Strategic Measures
• Link mission and strategic goals
• Provide focus for operational goals
and measures
Operational Measures
• Gauge business unit performance and
evaluate improvement initiatives
• Evaluate implementation progress
• Link organizational performance to
competency assessments/appraisals
Diagnostic Tools
• Review day-to-day operational
activities
• Support operational measures
• Are the right concerns addressed?
• Are we improving service as perceived
by the soldier?
• Are we addressing compliance issues?
• Are productivity and employee
satisfaction increasing?
• Status of case backlog?
• Customer service levels?
• Submissions processing
performance?
Link across
categories and shift
management focus
up
It was critical to design measures around outcomes and outputs rather than activities
RealignIntro | Rethink | Redesign | Realign | Summary
Realign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 26
Assessment Key Elements
Level of Competency
Lacking Initiating Progressing Refining Optimizing
People
Competency Model
Skills Assessment
Talent Strategy
Process
Frameworks
Conceptual
Executable
Performance
Measures
Defined
Aligned and linked
Used for review
Policy
Analyzed
Formal review
Performance links
Technology
Defined
Automated
Functionality
It was critical to design measures around outcomes and outputs rather than activities
RealignIntro | Rethink | Redesign | Realign | Summary
Realign
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 27
RealignIntro | Rethink | Redesign | Realign | Summary
Realign
0
5
10
15
20
25
30
People
ProcessPolicy
Performance
Measures
Technology
Current
Future
Based on the diagnostic, we implemented a series of action plans to shift from the original task force construct to a high performing service line organization
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 28
RealignIntro | Rethink | Redesign | Realign | Summary
Realign
Our detailed task analysis revealed organization was concentrated around short-term tactics at the expense of longer term strategic endeavors
Frequency
Value Added
High
Low
Low High
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 29
RealignIntro | Rethink | Redesign | Realign | Summary
Realign
Process maturity
Impr
oved
Effi
cien
cy
Process
People
Technology
OptimizedService
Line Enh
ance
d op
erat
iona
l val
ue Who supports
the processes and
technology?
How do we enable
these processes?
What needs to be done
and how do we do it?
To realize the full potential of military medical evaluation, optimization required organizational alignment of people, process, and technology
Organizational
led activities
Process
led activities
Building momentum with a blueprint for success
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 30
Agenda
Introduction
Optimizing Military Medical Evaluation
− Rethink current operations
− Redesign core processes
− Realign the business model
Summary
Presentation Agenda
..……………….……..…………………………………………………….
...…………………...……………………...
…….…..…………………………………………..
..……………………...………….…………………..….
.……………………….……………………….…….
..………………………..…………………...………….…………………..….
2
6
13
17
24
31
AgendaIntro | Rethink | Redesign | Realign | Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 31
Optimized military medical evaluation processes through the application of lean, six sigma, and industrial engineering techniques
SummaryIntro | Rethink | Redesign | Realign | Summary
Summary
Institute of Industrial & Systems Engineers (IISE) Engineering Lean & Six Sigma Conference 2015
Westin Atlanta Perimeter North I Atlanta, GA I October 1, 2015
Herren Associates, Inc. 32
Intro | Analyze | Assess | Allocate | Summary
Comments/Questions
Stay Connectedlinkedin.com/company/herren-associates-inc-
Authors
Jeffrey Voth I President Jennifer Derhaag I Associate Peggy Timmer I Associate
Office: (202) 609-8441 Office: (202) 609-7297 Office: (202) 609-7287
[email protected] [email protected] [email protected]
About Herren
Founded in 1989, Herren Associates is an engineering and management consulting firm
with a proven record of maximizing the value of every taxpayer dollar. As trusted advisors
to federal executives, we partner with clients to drive operational improvements and
manage performance - maximizing efficiency and cost effectiveness.