The Balanced Scorecard & Lean Six Sigma In Us Army Medical Command

A Commitment to Strategic Performance Excellence:

The Balanced Scorecard & Lean Six Sigma

in US Army Medical Command

“Measuring Results of Organizational Performance”WCBF's 10th Annual Lean Six Sigma and

Process Improvement in Healthcare SummitMay 2011

Select SLIDE MASTER to Insert Briefing Title Here

27-Apr-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address

Commitment to Strategic Performance Excellence

US Army MEDCOM/Strategy & Innovation/703-681-5000 Slide 2 12 April 2011 Unclassified

BRIEFING OUTLINE

1. Lean Six Sigma in America’s Army

2. Army Medicine’s Strategic Management System

3. Lean Six Sigma Implementation

4. Lean Six Sigma Return on Investment

5. Lean Six Sigma Case Study





The Army’s Lean Six Sigma Program

We’re a Nation at war, and the Army is challenged to remain relevant and ready in an era of uncertainty, unpredictability, and diminishing/changing resources (money, time, people, materiel).

There currently exist non value-added activities hindering performance, and without a consistent, Army-wide framework to

best provide continuous, measurable improvement.

The Army will execute a phased, full deployment of Lean Six Sigma to accelerate Business Transformation by creating a

culture of continuous, measurable improvement that eliminates non value-added activities and improves quality and responsiveness for Soldiers, civilians, Army families,

and the Nation.

Situation

Mission





The Army’s Lean Six Sigma Program

What has the Army done?• LSS deployed in 2006

• $19.1B dollars saved through Army process improvements:

improved materiel flow in Iraq and Afghanistan

cost savings in current Army programs

cost avoidance in future programs

revenue generation from reimbursable activities

• In 2011, 2,111 process improvement projects are underway representing $3.6B in potential financial savings

• 48 LSS Deployment Directors

• Trained 5,700 Green Belts, 2,400 Black Belts and 175 MBB





So MEDCOM uses the Balanced Scorecard…





…and MEDCOM Uses Lean Six Sigma!

So MEDCOM uses the Balanced Scorecard…

…as a Performance Improvement Engine addressing BSC performance gaps





LSS “Fits” in MEDCOM’s Toolkit





•BSC defines our organizational strategyLSS “Fits” in MEDCOM’s Toolkit





•BSC defines our organizational strategy•LSS fits as a BSC Improvement Engine







– Evaluate objective targets, gaps to reach them







– Evaluate objective targets, gaps to reach them– ID initiatives to close gaps







– Evaluate objective targets, gaps to reach them– ID initiatives to close gaps– Those initiatives become LSS projects!






LSS “Fits” in MEDCOM’s Toolkit•BSC defines our organizational strategy•LSS fits as a BSC Improvement Engine

– Evaluate objective targets, gaps to reach them– ID initiatives to close gaps– Those initiatives become LSS projects

•Aligns commitment, resources, and effort against strategically-focused projects!





MEDCOM’s LSS Implementation…

NORTHERN RMC

Dir SI2 Army MBBsTng Tech

WESTERN RMC

Mil Dir SI/Army MBBContract BBMgmt Analyst

TAMC

JapanKorea

WRAMC

WAMC

BAMC

CRDAMCDDEAMCWBAMC

MAMC

Dir SI/BBContract MBBArmy BBMgmt Analyst

Dir SI/Army MBBPACIFIC RMC

SOUTHERN RMCDir SIContract MBBArmy BBMgmt Analyst

AMEDDC&S

MRMCDir SI /Army BBArmy BBContract MBBMgmt Analyst

PHCDir SIContract MBBMgmt Analyst

WARRIOR TRANS CMDDir SIArmy MBBContract MBB5 Contract BBs

EUROPE RMC

MEDCOM/OTSGHQs OneStaff

Dir SI & Mil Dpty2 Army MBBs2 Army BBsTng Coord

DENCOMDir SI/Army BBMgmt Analyst

Dir SIArmy MBB

3 Army MBBsLRMC





• Command-wide…centralized guidance…decentralized executionMEDCOM’s LSS Implementation…

NORTHERN RMC


WESTERN RMC


TAMC

JapanKorea

WRAMC

WAMC

BAMC

CRDAMCDDEAMCWBAMC

MAMC




AMEDDC&S




EUROPE RMC




Dir SIArmy MBB

3 Army MBBsLRMC





• Command-wide…centralized guidance…decentralized execution• Leverages short-term contracted experts as we “build our own bench”


NORTHERN RMC


WESTERN RMC


TAMC

JapanKorea

WRAMC

WAMC

BAMC

CRDAMCDDEAMCWBAMC

MAMC




AMEDDC&S




EUROPE RMC




Dir SIArmy MBB

3 Army MBBsLRMC





• Command-wide…centralized guidance…decentralized execution• Leverages short-term contracted experts as we “build our own bench”• 249 completed LSS projects: $194.2M benefit


NORTHERN RMC


WESTERN RMC


TAMC

JapanKorea

WRAMC

WAMC

BAMC

CRDAMCDDEAMCWBAMC

MAMC




AMEDDC&S




EUROPE RMC




Dir SIArmy MBB

3 Army MBBsLRMC





• Command-wide…centralized guidance…decentralized execution• Leverages short-term contracted experts as we “build our own bench”• 249 completed LSS projects: $194.2M benefit• FY11 tipping point: sustaining our own training and execution


NORTHERN RMC


WESTERN RMC


TAMC

JapanKorea

WRAMC

WAMC

BAMC

CRDAMCDDEAMCWBAMC

MAMC




AMEDDC&S




EUROPE RMC




Dir SIArmy MBB

3 Army MBBsLRMC





Our Lean Six Sigma Program…





Source: PowerSteering 31 Dec 09

Ret

urn

on In

vest

men

t % (R

OI)

Trai

ned

Bel

ts a

nd C

ertif

ied

Bel

ts

0

125

250

375

500

625

750

875

1000

0%

100%

200%

300%

400%

500%

600%

700%

800%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

MEDCOM Lean Six Sigma Deployment - Key Metrics

ROI Target ROI Actual Belts Certified - Target

Belts Certified - Actual Belts Trained - Target Belts Trained - Actual

Our Lean Six Sigma Program…





An Army Medicine example:at a high level…

linking Organizational Strategyto Performance Improvement

usingLean Six Sigma

and

Best Practice Transfer!





We align all MEDCOM LSS projects to our

organization’s strategy…our Balanced

Scorecard…





We recognize we have a performance gap in Access to Care…





Value Stream #9: Improve Access and Continuity of CarePVC #1: Maximize Value in Health Services

• Patient Satisfaction

• Access to Care Standards (e.g., achieve acute care appt. within 24 hours)

• Support Staff to Primary Care Provider Utilization ratio

• Call Hold and Handle Times, Call Abandon Rate

• Care Appointment Availability

• Schedule Availability

• Facility Availability

• Call Volume

• # of Appts. Requested

• Type of Care Requested

• Staff Availability

• Facility Scheduling

• DOD Title 10 patients

• Non-Title 10 patients

Suppliers Inputs Process Outputs Customer

Customer Input Metrics Process Metrics Output Metrics

• Satisfied beneficiary• Accessible

appointments• Standardized, utilized

support staff• Optimized provider

productivity• Optimized referral

execution, delivery• Increased utilization of

on-line appointment system

• DOD Title 10 patients (e.g., Soldiers, retirees, families)

• Non-Title 10 patients (e.g., civilian emergencies, contractors, foreign officers and families, etc.)

• Customer Service

• Telephone Services

• Provider Support Staff Utilization

• Primary Care Exam Room Utilization

• Patient Appointing, Referral Mgt.

• TRICARE Online Appointment

• Patients

• DOD Healthcare Professionals

• IMCOM

• Need for Care (preventive, acute)

• Healthcare staff

• Facilities and infrastructure

High level process maps (SIPOCs) help us better focus on the problem/s

in our work…





Value Stream #9: Improve Access and Continuity of CarePVC #1: Maximize Value in Health Services

• Patient Satisfaction

• Access to Care Standards (e.g., achieve acute care appt. within 24 hours)

• Support Staff to Primary Care Provider Utilization ratio

• Call Hold and Handle Times, Call Abandon Rate

• Care Appointment Availability

• Schedule Availability

• Facility Availability

• Call Volume

• # of Appts. Requested

• Type of Care Requested

• Staff Availability

• Facility Scheduling

• DOD Title 10 patients

• Non-Title 10 patients

Suppliers Inputs Process Outputs Customer

Customer Input Metrics Process Metrics Output Metrics

• Satisfied beneficiary• Accessible

appointments• Standardized, utilized

support staff• Optimized provider

productivity• Optimized referral

execution, delivery• Increased utilization of

on-line appointment system

• DOD Title 10 patients (e.g., Soldiers, retirees, families)

• Non-Title 10 patients (e.g., civilian emergencies, contractors, foreign officers and families, etc.)

• Customer Service

• Telephone Services

• Provider Support Staff Utilization

• Primary Care Exam Room Utilization

• Patient Appointing, Referral Mgt.

• TRICARE Online Appointment

• Patients

• DOD Healthcare Professionals

• IMCOM

• Need for Care (preventive, acute)

• Healthcare staff

• Facilities and infrastructure

…and we decided to start by improving the Telephone

Appointing Process





Project Summary: Carl R. Darnall AMC Telephone Appointing

Overall average hold time reduced to 33 secondsOverall call abandon rate reduced: 3%Peak time call abandon rate reduced: 22%Call volume reduced 20% due to less call backsCalls handled increased from 4700 to 7300 / weekAgent training time reduced from 6 weeks to 4 weeksAgent turnover reduced

• REPLICATION / WAY-AHEAD• RESULTS / BENEFITS

Agent scheduling changes to handle peak timesAgent training, area setup, shift change by SOPPhone menu tree and call handling improvedFuture ACD design requirements specified

• IMPROVEMENTS• PROBLEM / BASELINE / GOAL

BEFORE AFTER

Hol

d Ti

me

PROBLEM STATEMENTThe telephone appointing process at CRDAMC has observed low patient satisfaction scores and long process hold times. Over the last six months, it takes an average of 3:14 minutes to answer customer calls to make an appointment. This has led to numerous customer complaints which have led to lower patient satisfaction scores for telephone appointing services.

BASELINE

Decrease process hold time to less than 90 seconds per callDecrease overall abandoned call rate to less than 10%Decrease peak time call abandon rate to less than 25%

Army’s largest call center: 10,000+ calls a weekLow customer satisfaction: 68%Average wait time: 3:14 minutesCalls answered under 90 seconds: 65%Overall call abandon rate: 26%; Peak time: 49%

GOAL

Performance Action Plan Completed; Access to Care Initiative 17.2Adjust MEDCOM BSC telephone appting standards NLT 20 Apr 07Establish CMS metric for telephone appting NLT 1 May 07Publish MEDCOM Telephone Appting Policy NLT 1 May 07Replicate LSS projects across MEDCOM MTFs NLT Dec 08

…the initial project was conducted at Fort Hood’s Carl R. Darnall Army Medical Center

(CRDAMC)…

Mark Hernandez – Black Belt Candidate









BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL


…high call volume, low patient satisfaction, long process cycle

time, high variation…











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL


…the project sought to decrease process cycle time

and call abandon rate to improve patient satisfaction…











BEFORE AFTER

Hol

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me


BASELINE



GOAL


WOW!











BEFORE AFTER

Hol

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me


BASELINE



GOAL


6-Fold Improvement!











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL


10-Fold Improvement!











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL


>2-Fold Improvement!











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL

Performance Action Plan Completed; Access to Care Initiative 17.2Adjust MEDCOM BSC telephone appting standards Establish CMS metric for telephonePublish MEDCOM Telephone Appting Policy NLT 1 May 08Replicate LSS projects across MEDCOM MTFs NLT Jun 09

Disciplined, Corporate Action to

Transfer Best-Practice Across

MEDCOM











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL


And Today?











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL


Mean Hold Time at CRDAMC = 3 seconds!











BEFORE AFTER

Hol

d Ti

me


BASELINE



GOAL




Mean Hold Time at CRDAMC = 3 seconds

WOW!

Commitment to Continuous Performance Improvement!





Conclusions





Conclusions• Engaged leaders are critical!





• Engaged leaders are critical!…set urgency, walk, and talk

Conclusions






• Strategy-focused organization!

Conclusions






• Strategy-focused organization!…a rudder in the storm

Conclusions







• Commitment to continuous improvement!

Conclusions







• Commitment to continuous improvement!…enabled by data transparency & P4P

Conclusions








• Active reuse of organizational knowledge!

Conclusions








• Active reuse of organizational knowledge!…incremental to enterprise improvement

Conclusions









• Accountability throughout the organization!

Conclusions









• Accountability throughout the organization!…Leader driven!

Conclusions





For additional information on these topics in the US Army Medical Command,

ContactDirectorate of Strategy and Innovation

703.681.5000




US Army MEDCOM/Strategy & Innovation/703-681-5000 Slide 49 12 April 2011 Unclassified Slide 49

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The Balanced Scorecard & Lean Six Sigma In Us Army Medical Command

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