In this post, we’ll look at a company that had some pretty significant challenges. A new director, hired by the CEO to fix the problems, launched a project relying on Lean Six Sigma approaches and consulting expertise to lead her organization to the desired future state. She was able to achieve only one of her key goals but missed on others. Was she successful? Absolutely! Read further to find out how.
Thanks to J.Y. for the details on this case.
This company was a for-profit provider of personal home care services for those with both chronic and acute illnesses. The company had been under attack by clients and the local community and press for poor service. Investors had also been challenging the CEO to reverse revenue declines and improve bottom line results which had been on a downward path for four years.
The CEO concluded that the negative press was the primary cause of the revenue and bottom line declines. So, he fired the Director of Client Care and hired a replacement to turn company performance around. The new director’s claims to fame were a passion for Lean Six Sigma practices and the turnaround of a chronic care facility she had managed previously. Lean Six Sigma is a methodology that relies on a collaborative team effort to improve end to end performance by systematically removing waste. The CEO hoped that the application of that discipline would improve client service and turn around the company’s flagging fortunes.
The CEO challenged the new Director to achieve four goals:
- Improve the client satisfaction scores from 2. 4 in the last completed survey to 3.8 in all segments at the end of the six months. The survey assessed client views on perceived professionalism, convenience, support for client needs, responsiveness, satisfaction with staff and willingness to recommend the company to others.
- Improve the perception of the company in their clients’ eyes, the community and the press from 80% negative to 60% positive. That would be measured by the number of unsolicited letters, emails and articles praising the company, its staff and its services versus the total received.
- Reduce the costs of Client Care operations by 10% within six months through streamlining, productivity gains and cost reductions.
- Achieve these results in six months.
The new Director immediately announced to her staff and the company’s clients that she was launching a program to improve the company’s client care and asked for their help and support to bring the improvements about over the next six months. However, she didn’t tell them about the plan to reduce operating costs by 10%. She hoped that the reductions would come about as a result of the service improvements that would be implemented and wouldn’t have to be targeted directly.
Next, she contracted with the Lean Six Sigma consultants who had been instrumental in helping her improve operations at the chronic care facility. She had reviewed the complaint letters received from clients and their families over the last two years as well as the negative reports that had made it into the press and concluded that there were three primary challenges:
- Professionalism – some of the company’s staff had not dealt with clients in a professional manner or had not had the necessary skills to treat the client’s needs
- Timeliness – staff were often late for appointments and there were a number of no-shows that put clients in jeopardy
- Scheduling conflicts – where more than one service was being provided to a client, staff often showed up at the same or overlapping times, annoying clients and wasting valuable resource.
The Director reviewed her findings with the consultants and asked for their recommendations. They did some digging of their own and proposed the following approach:
- Identify product lines and their priorities in terms of achieving the project’s goals
- Develop value stream maps for each product line to find out what was actually happening in the delivery of the services, from start to finish.
- Measure process performance in terms of time, costs and client perception
- Identify opportunities to improve performance
- Update value stream map to reflect improvement opportunities
- Plan and implement process improvements
- Monitor performance and revise as needed
- Implement on a product line by product line basis to gain experience, accelerate service improvements and reduce risks.
The Director, together with the consultants, identified five product lines: Home & Personal Support, Nursing, Physiotherapy, Occupational Therapy and Social Work. She picked Home & Personal Support as the priority line to study first because it accounted for almost 40% of revenue and over 65% of complaints.
The consultants brought together the managers and staff involved in that product line to help map out the process from the request for service to the discharge of a client. To get the client’s perspective, the consultants visited a number of current and past clients and asked them for their views on how the process worked from their point of view, the things that worked well, the things that didn’t and their suggestions for improvement.
Over a two week period, the consultants worked to get the process mapped accurately. All managers and staff involved in the process were asked to sign off on the accuracy of the portrayal, and they did. Armed with the process map, the consultants then started to measure the existing process, using actual process instances. They tracked the time each step took, all the way out to the client, calculated the costs and identified errors and the time and effort it took to remedy them.
The consultants then started the challenging yet exciting task of identifying opportunities to improve the process and the client experience. They involved a select number of managers and staff initially but took the same stance as with the current state map, that everyone involved would ultimately have to sign off on the revised process before it was planned and implemented.
The search for opportunities revealed a number of potential improvements, including:
- Requests for Home & Personal Support services could come from the clients themselves, from a client’s family, from insurance companies or from other social service or government agencies. The intake process was very informal and didn’t take into account the different information needs for each type of requestor. In most situations, at least one additional contact was required to obtain the needed information.
- The assignment of staff to a client was being treated as an administrative task rather than a triage function, which would have determined the priority of clients’ treatments based on the urgency and severity of their condition. As a result, clients were being assigned staff who were available rather than staff with the right skills.
- There was no linkage to the processes supporting the other product lines. Consequently, when a client required more than one service from the company, there was a good chance that two staff would arrive at the same or overlapping times because much of the scheduling was dictated by client availability.
- Linkages to the company’s support functions such as Human Resources and Accounts Receivable were, in some cases, almost ad hoc. Consequently, staffing for needed skills would not be addressed until long after the need was identified or invoices would not be sent out until long after a client was discharged, or, in some cases, not sent out at all.
Armed with these opportunities, the consultants, with the assistance of the process staff, set about to redesign the process flow to improve end-to-end performance, quality and client satisfaction. They received sign-off on the new design, developed a plan and implemented it. They monitored the new process, measured performance, revised it in a couple of spots and added additional support and training for a number of staff who were having difficulty with new roles and procedures. It took fourteen weeks from the start of the engagement to complete the first product line. They then proceeded to apply the same approach to the other four product lines.
The project was fully completed eight months after the new Director’s arrival. The CEO had given her six months. Client satisfaction scores improved to an average of 4.2 for the new processes versus the CEO’s target of 3.8. Community and client perception improved to 20% positive from the previous 80% negative but well below the target 60% positive. The actual costs of the Client Care organization actually increased a bit because of increased staffing costs to put product line owners in place to manage ongoing performance, support a more robust triage function and establish deals with temporary staffing agencies to ensure the needed skills would always be available when required. The target was to reduce costs by 10%. The Director missed three out of the four goals the CEO had set for her.
The Director argued that the six month window was too short a time to fully assess the contribution of the lean processes. She expected that the community and client perception would improve nicely as the client service improvements became more widely known and recognized. She also argued that, as those key measures improved, the cost-effectiveness of the processes would contribute positively to the bottom line beyond the targeted 10% cost reduction through increase revenue and lower unit costs.
How a Great Leader Delivered Results
Was this project successful? On the surface, it realized only one of the four goals set out at the beginning. On that basis, the project could be called a failure. However, things change during the course of a project. We learn things that influence our priorities and cause us to adjust targets and plans accordingly.
In this case, the Director kept the CEO totally tuned in to her thinking and to the project’s progress throughout. Early on, the Director recognized that there was a dichotomy between the six month target for project completion and full realization of the project goals. The CEO agreed. As well, the CEO agreed to focus on client service and process improvement on the assumption that the bottom line return would follow. The CEO was as much a decision maker as the Director. Collaboration was the key throughout. In the view of all key stakeholders – CEO, Director, managers and staff – the project was a resounding success. Success is relative!
I did an earlier post on a lean project, Ten Steps to Lean Success in November. While this is a very different case, the Director in this situation applied all of the ten steps, including sustaining lessons learned through the appointment of the product line owners. It was nicely done. I think it’s great when proven best practices, applied judiciously, yield terrific value in a wide variety of situations. I hope you do too.
So, put these points on your checklist of things to do in future endeavours so you too can be a Great Leader. And remember, use Project Pre-Check’s three building blocks covering stakeholder, process and decision area best practices right up front so you don’t overlook these key success factors.
Finally, if you have a project experience, either good or bad, past or present, that you’d like to have examined through the Project Pre-Check lens and published in this blog, don’t be shy! Send me the details and we’ll chat. I’ll write it up and, when you’re happy with the results, Project Times will post it so others can learn from your insights. Thanks
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