Special Thanks… • Debra Isaac, Customer Service Supervisor – Vital Statistics • Cheryl M. Williams, Deputy Registrar – Vital Statistics • Simon Trevino, Senior Computer Operator – Vital Statistics • Vital Statistics Cashiers • Luis Carrillo • Mary Coutee • Esmeralda Gonzalez • Cathy Grant • Loretha Jimmerson • Willie “Tweety” McClintok • Juanita Velasquez • Helen Smith
Vital Statistics Quality Improvement Project Larissa Estes Julia Gee Naomi Macias Celina Garza Ridge Varsha Vakil
Public Health Department Accreditation • Measurement of performance against nationally recognized, evidence-based standards • Improve and protect the health of the public by advancing the quality and performance of public health departments • Benefits • Systematic approach to public health • Ensures quality services are provided to residents • Enhances visibility and validates commitment to residents • Means to obtain additional funding • Provides an opportunity to identify areas of performance improvement
Why Quality Improvement? • Foundation of public health accreditation • Accountability • Results of investment in public health • Declining – do more with less • Future funding requirement • Getting better all the time • Improving performance • Improving health outcomes • Improving customer satisfaction
Definition of Quality Improvement In Public Health “Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” Defining Quality Improvement in Public Health; Journal of Public Health Management & Practice: January/February 2010 - Volume 16 - Issue 1 - p 5–7, Riley, William J. PhD; Moran, John W. PhD, MBA, CQIA, CQM, CMC; Corso, Liza C. MPA; Beitsch, Leslie M. MD, JD; Bialek, Ronald MPP; Cofsky, Abbey -
Continuous Improvement The continuous improvement phase of a process is how you make a change in direction. The change usually is because the process output is deteriorating or customer needs have changed
What Is Quality? Today the most progressive view of quality is that it is defined entirely by the customer or end user and is based upon that person's evaluation of his or her entire customer experience. The customer experience is the aggregate of all the Touch Points that customers have with the organization’s product and services, and is by definition a combination of these. (RFT) “Quality is not an act. It is a habit” Aristotle 384BC-322BC, Greek philosopher and scientist, student of Plato and teacher of Alexander the Great
AIM Statement • An opportunity exists to improve the Vital Statistics Customer Flow beginning with customer receipt of ticket number from information window and ending with being called by a cashier to complete financial transaction. This effort should reduce wait time by 15 minutes for the customer.
AIM Statement • This process is important to work on now because wait times are experienced between the info desk and cashier and to provide good, efficient customer service • The baseline measurement is defined as the following metric: Average wait time per cashier window of 28 minutes by cashier by day
Methodology • Observed the customer waiting area • Multiple one-on-one discussions with supervisor and deputy registrar • Observed cashiers during several time points during the work week • Summary analysis of operational reports • Customer Wait Time • Transaction Time • Print Time • Cashier Survey
Constraints: • Language • Signage • Volume • Incomplete documentation • Printer • Database, Network • Problematic application searches • Measures: • Average Customer wait time • Cashier feedback • Customer feedback Begins with: Customer receiving ticket # from info desk Ends with: Customer call to cashier window • Process/Activities: • Customer waiting for cashier call (in lobby) • Cashier call • Inputs: • # of Customers • # of Cashiers • Supervisor triggers/alerts • Previously completed application (at home, office etc) • Availability of all needed documents • Outputs: • Check documents • Begin database search • Send to Print • Complete transaction • Customers: • General public • (Residents of Texas state) • Suppliers: • Texas State database • Network SIPOC+CM
Customer enters Vital Statistics Lobby Customer Wait Time: Unknown N N Y Y Info Desk Is a correct application section complete and required documentation available? Complete correct section Leave if cannot complete form or missing docs Customer Wait Time Avg.: 28 min Call # Assigned Cashier Call Is application information correct? Obtain Correct Information Complete Search Financial Transaction Sent to Printer Customer Wait Time, includes SOD certificates Avg.: 7 min Print Window Call Pick up Certificate at window #10 Flow Chart
Wo-Man Power Mechanical • Database • Equipment • Network, server • Software • Training, skill set • Communication Wait time of 28minutes for vital statistic customers • Staffing Adjustments • # of windows open • Supervisor moderates flow • Distribution of tasks, responsibilities • ↓ customer flow – additional tasks • ↑customer flow - ↑# of windows open PROCESS • “problem” certificates • Printing process • Signage/layout Fishbone – Cause and Effect Staffing level • Staffing level • Triggers • Supervisor calling for back up Staffing adjustments Dist of tasks, responsibilities
Pilot Test • Idea – transfer 1 person from correspondence to window #6; add lunch coverage • 4 windows open at all times • Results – June 4th – 8th
Plan Vital Statistics Check/ Study 7. Develop Improvement Theory: Create trigger system for supervisor to improve customer flow. Maintain wait time to 15mins. 1. Identify / Prioritize Opportunities: Customer average wait time more than 28 minutes 8. Develop Action Plan: Pilot Program – One additional cashier added from Correspondence and additional cashier/s when wait time exceeds 15 minutes 1. Reflect on the Analysis: Data obtained for wait time - 1 Week pilot program. Cashier Survey data 2. AIM: Reduce customer wait time to 15 minutes 2. Document Problems: Unavailability of Staff and Communication issues. Observation: Smooth running of pilot Lessons learned: Customer Wait time directly proportional to # of cashier window open 3. Current Process: Limited number of cashiers to process transactions Do 1. Implement the Improvement: Implementation of Pilot Program for a week 4. Collect Data On: Number of cashiers and the wait time per customer Act: 5. Identify Possible Causes: No. of cashier windows open, Printer/network issues, Incomplete documentation etc. 2. Collect and Document the data: Wait time reduced by 50% Adopt Standardize 3. Problems, Observations, Lessons Learned Pilot Program Implementation Day 1: Ran a snag – 4 staff out Day 2: Successfully implemented Pilot Program (5 cashier windows open) Day 2-5: Pilot Successfully implemented Adapt Do 6. Identify Potential Improvements: Increase the number of cashier windows open(especially at rush hour) Abandon Plan
Houston Department of Health and Human Services (HDDHS) aims to reduce Vital Statistics customer wait time. Situation HDHHS Vital Statistics currently experiencing average customer wait time of 28minutes. Among the reasons for these difficulties is few cashier windows open to serve customers. Inputs Outputs Activities Participation Outcomes- Impact Short term Medium Term Long Term Staff: HDHHS QI STAR Trak Team Vital Statistics Materials: Office supplies Cash boxes (Vital Statistics) Equipment: Printers Xerox machines Computers Develop: Avenues and trigger modules for Vital Statistics Supervisor/s to access other resources/manpower Prepare: Pilot program Instruct: Supervisor/s, Cashiers Identify: Supervisor, Cashier and staff roles / responsibilities Implement: Pilot program for 1 week Evaluate: Data Participants: Supervisor/s, Cashiers, and Staff of HDHHS Vital Statistics Agencies: Satellite location partners and other Affiliated partners Develop: Agreements between HDHHS Vital Statistics for implementation of pilot program Prepare: Roadmap to implement pilot program and overcome any foreseen barriers Document: Pros and Cons of Pilot program Develop: MOU’s, SOP’s Execute: Project implemented after studying the pros and cons of and fine-tuning the program , maintain any progress. Feedback: Cashier feedback (Pilot project) Customer Survey Incentive: Satisfied customers reflect job well done by HDHHS Vital Statistics. Demonstrate: Measurable improvement in HDHHS Vital Statistics customer wait time. Overcome: Language barriers and geographical (satellite location) barriers. Encourage: Staff and partners to maintain usage of available resources / manpower. Priorities: Enhance the ability to serve customers in timely fashion and reduce long wait times Goal:Build avenues to instruct supervisor/s on available resources that can be implemented to reduce customer wait time and assist them to adopt multiple trigger modules to use the available resources. Avenues created are flexible to accommodate all barriers. Assumptions Vital Statistics will work collaboratively to implement the project External factors Staff feels alienated, incentives not good enough to motivate and organizational bureaucracies. Evaluation Demonstrate measureable improvement in Vital Statistics customer wait time. Customer Feedback Survey And Cashier Feedback. Increase in customer satisfaction to access HDHHS Vital Statistics resources.
Cashier Survey Bureau of Vital Statistics - Cashier Feedback STAR Trak (Blue Team) Pilot program initiative (To be completed by Cashier) Cashier Initials (optional): _________________________________________________ Cashier Work Days and Hours: _____________________________________________ Did you like the STAR Pilot Program Initiative? Yes/No: _______________ Why? (please provide details): ___________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Please provide any suggestion/comments to improve the program: ____________________________________________________________ ____________________________________________________________ Thank you for your participation!
Customers waiting in lobby with 4 Cashier Windows Open Pilot program - Friday 06/08/12 at 2 pm Cashier Feedback (N = 6) • Q. Did you like the Star TRaK Pilot Program? A. Yes = 5 No = 0 • Cashier Comments: • “Were able to assist customers faster, continue with more windows open.” • “Compliments from customers really made me feel good.” • “One [extra] window does make a difference.” • “Need to keep more windows open.” • “Enjoyed all windows being open, made everything flow smoothly and faster.” • “Need more bilingual staff.”
Update on improvement efforts • Update Cashier Standard Operating Procedures (SOP) • Brought on board temporary staff for Vital Statistics • Streamlining tasks • Workload analysis, results • Performance expectations – improved Bureau & staff functionality • New vacation/ sick time policy • Staffing levels to improve efficiency & effectiveness
Next Steps • Employee Survey • Continue to monitor & Plan Do Check Act • Customer Survey
Lessons Learned ??? • Black box / Ripple effect • Cashiers • Great customer service skills • Efficient and FAST • Excellent troubleshooting • Control what you can control… Customer Cashier
Lessons learned from Vital • Open to change, constructive criticism • Goal improved customer services • Listen to others • Suggestions are a way to improve • Improvements ≠ failure it is an opportunity to make it even better