Performance Excellence Story Template

Graphics are optional

Performance Excellence Story Cover Page The cover page is the title page

This template is a tool for assisting you in preparing your stories. Please note Stories need to be customized for each situation and must be written in a manner that

successfully tells your story. Please use this template as a guide as you develop a document that tells your story to others.

This template is a tool for assisting you in preparing your stories. Please note Stories need to be customized for each situation and must be written in a manner that

successfully tells your story. Please use this template as a guide as you develop a document that tells your story to others.

M = Items needed in all Stories

O = Optional items

Updated February 18, 2003

Practical Quality Services, Inc.Management and Motivational Assistance

PQS

What is a Performance Excellence Story?

The Performance Excellence Story is the documentation of work as it is performed in PQS’s 7 Step Problem Solving Process. The story captures the thought process and the data of the team, or individual, as they analyze and solve a problem. It is similar to the DMAIC Process.

What are the 7 Problem Solving Steps?

1. Set Direction - In this step the purpose for the analysis is shown. Likely content would be the information found on the charter such as; mission statement, project goals, project schedule and the performance indicator. In this process, a “problem” is defined as a gap between the present and desired performance as measured by the performance indicator. The performance target is defined as the desired level of performance in the identified performance indicator. A Process System Chart may also be appropriate for this section.

2. Stratify & Define Problem - Here the problem is “stratified” to clearly pinpoint the “where, what, when, how and who” of the problem. In order to efficiently solve the problem, we must clearly understand exactly what is broken, and prioritize these items by the magnitude of their contribution. We want to eliminate the large contributors(s) first. Likely content would be a series of pareto charts, and one or more problem statements clearly describing what is contributing to the performance gap.

3. Identify Root Cause - After the major contributor(s) to the problem have been identified, the root cause of them must be determined. The root cause is that activity that, if removed, will eliminate the contributing factor to the problem, thus improving performance as measured by the indicator. Likely content would be identification of potential root causes and verification of these causes.

4. Identify, Test & Select Solution - After the root cause is identified, some change in process must be identified to eliminate the root cause from the process. This is defined as a solution. Likely content would be likely solutions and a solution selection matrix, testing plan, financial analysis, a process map showing the “before and after” process and an estimate of the impact on the performance indicator.

5. Implement - The plan for implementing the solution is found here.

6. Ensure Results - This section contains the performance indicator to evaluate the success of the implemented solution(s). Likely content would be the performance indicator, charts and graphs.

7. Remaining Issues and Future Plans - A description of future acts suggested by this team. Suggestion could include future problem solving activities, reviews, or future technologies to consider.

Show whatever data is needed to tell your story to others.

Reading the Problem Solving CI Story

Introduction

Page 1

Tools You May See in the Performance Excellence Story

Performance Indicator

The Performance Indicator is the core of the Problem Solving process. It is usually a line graph of a process or outcome indicator that is regularly used to measure the ability of a work process to meet customer needs or expectations. The Performance Indicator must be something that can be counted and plotted on a line graph. A line graph is used as it depicts performance over time, thus allowing the identification of performance trends. The objective of the 7 Step Systematic Problem Solving Process is to“Drive the Indicator” in the good direction. Other types of charts may also be used when appropriate.

Stratification - Pareto Charts

There are many contributing factors to most problems. Stratification is the process used to identify and prioritize these specific contributors. The Pareto Chart is the tool used to conduct stratification. The Pareto Chart is an advanced bar chart that aligns the contributing factors in order of magnitude of contribution from the left of the chart to the right. The chart also shows percentages of contribution to the problem. After identifying the major contributors, the remaining contributors are grouped and place in the “Other” bar. One important rule to remember about the “Other” bar is that each contributor grouped here has a frequency of occurrence that is less than the bar to the left. Therefore they are the less significant contributors.

Problem Statement(s)

The problem statement provides the focus for the remaining analysis. All future analytical activity will focus on the items quantified in the Problem Statement. The Problem Statement is derived from the data on the pareto charts and thus is a statement of the largest contributor(s) to the stated problem, the performance gap shown on the indicator chart.

Cause & Effect or “Fishbone” Diagram

The Cause and Effect Diagram is a tool used to identify potential root causes to the problem identified in the problem statement. It is a method of organized brainstorming. Potential root cause can be found on the “bones” furthers away from the “head” and are circled are otherwise noted on the diagram.

Corporate ComplaintsSeattle District

Barrier Type

# C

omp

lain

ts

770

62 44

152

42

72%78%

82%86%

100%

0

200

400

600

800

1000

Refe

rral

s

Not

Cov

ered

Ben

efit

Bill

ing

Erro

r

Cla

ims

Proc

essi

ng

Oth

er

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

N=1070

Annualized Medicare Appeals/1000

02468

1012141618

95 96 97 98 J 99 M M J S N J 00 M

Month/Year

# of

App

eals

Tampa Market1995 through 3-2000

Good

Introduction

Page 2

Set Direction

Graphics are optional

Page 3

Background data needed can be found on the Team Charter form. That may be inserted here.

O

O(Insert name of team) Team Charter

Created/updated on: (date)Developed by/Contact person: (name)

Problem or Need:

Background:

Link:

Scope:

Objective/Goal:

Methodology:

Interdependencies:

Time Commitment:

Time Line/Key Milestones:

Historical Data/Trends:

Team:RoleSponsor…………..

Leader…………….

Team Members:….

Project Manager…

Facilitator………...

Name DepartmentTeam:RoleSponsor…………..

Leader…………….

Team Members:….

Project Manager…

Facilitator………...

Name Department

M

O

Suppliers & Inputs Key Process and Sub-processesCustomer(s) & Output

Next in Process Recipient& Output

Internal Support Processes & Inputs

Process Purpose:Process System Chart

Process Name ________________________________

Revised Date: _____________

Feedback Mechanisms Outcome IndicatorsCustomer/Next in Process Recipient & Business Reqt’s

Set Direction

Suggested Items for Set Direction

Project Schedule

Page 4

Process Step 5/8-5/12 5/22-5/26 5/28-6/2 6/5-6/95/15-5/19

Reason forImprovement

ProblemDefinition

Root CauseAnalysis

SolutionSelection

Implementation

Next Steps

ResultsBefore & After

M T W Th F M T W Th F M T W Th F M T W Th F M T W Th F

Legend:

Original Plan

Actual

Plan Extension

Legend:

Original Plan

Actual

Plan Extension

Original PlanOriginal Plan

ActualActual

Plan ExtensionPlan Extension

Team not m

eet

79% 81% 80%84%

80%82%

77% 77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18-Dec 19-Dec 20-Dec 21-Dec 22-Dec 25-Dec 26-Dec 27-Dec

GoaL15%

Good

Gap - the difference between present and desired level of performance

Targetdesired level of performance

Actual/Current Performance

Performance Indicator

M

Baseline Map ofcurrent process

O

Financial Impact

Financial Impact

M

- Contracts- Benefits- Claims

- ss#- patient name- reason for call

"CALL HANDLING"

Title: CALL HANDLE TIME

File Name: Jax Call Handle Time

Origination Date: August 21, 2000

Revision Date: August 21, 2000 Revision Time: 01:32 PM

SEATTLE CALL HANDLING

CUSTOMER

Phone Rep

BASELINE DRAFT

Customerrespondswith issueand detail

CSR inputinto system

Verifyinformation

Go back tocaller anddetermineMember orProvider

Gather infofrom caller

CSRanswersphone

Listen Askquestions

Write downkey points

ResearchDetermine if

you canresolve isse

Resolveissue?

Relayfindings tocustomer

Takingresolution

stepsPut in ICSPut caller on

hold/muteYes

Wait

Relayfindings tocustomer

No

Det fordaytimephone

number forcall back

DocumentICS and

Pend

Thank callerand

disconnect

Tellcustomer to

hold

DocumentICS from

previous call

Customerproviding

info

Customerprovidingresponse

Customerhangs up

A

Det if callerneeds to betransferred

Transfer

Ask if there isanother issue

Addl issues?

Thank callerand disconnect

No

A Yes

Det if needto transfer

Transfer

Determine ifneed to

transfer call

Transfer

No

Det ifcustomeracceptsresponse

Accepts?

Cust put onhold

No

Transfer tonext level

Transfer?

Transfer

Yes

B

B

Yes

No

Yes

Transfer?

Yes

No

TEAM LEAD

Identify andreiterate

issue

Resolveissue? Close ICS PendYes

No

Stratify & Define Problem

Suggested Items for Stratify & Define Problem

Show the stratification that leads to your problem statement, and any other key Paretos (may answer a popular question). Place all other Paretos in the appendix so people can see what you looked at in your analysis.

Problem StatementAfter the major contributor to the problem has been determined a problem statement is prepared. The problem statement must be very specific and must be related only to the major contributor. It usually derived by tracing the Paretos charts back through their stratification levels. The indicator should be embedded in the problem statement.

Problem Statement Example:

12% of all Provider Projects are related to Tracers. (from above)

Page 5

Provider Project Source Data(January 1999 - April 2000)

2498

1580

593 544 305 303 187 185 83 172

63%72%

81%86%

100%97%96%93%90%

39%

0

1000

2000

3000

4000

5000

6000

Stat

us

New

Cla

ims

Ref

erra

l

Cla

imC

heck

Prov

ider

Prov

ider

Issu

es /

Con

trac

ts

Mem

ber

Adj E

rror

Rec

over

y

Oth

er

Project Types

Num

ber

of It

ems

0%10%20%30%40%50%60%70%80%90%100%

n=6450

Provider Projects Level 2 Stratification(Stratified Status Category Jan '99-April "00)

781606

191 181 179 176 154 142 88

31%

100%96%

91%85%

78%70%

63%56%

0

500

1000

1500

2000

Tracer Contract Adj Error MemberIssues

Ref Cross InMail

Over Pay/Remit Ded

NOF/ NewClaims

Other

Provider Type

Nu

mb

er

of

Ite

ms

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

n=2498

M

M

MContribution to the Gap

Based on the verification you have just completed, and your best prediction of what you believe you can fix, show the contribution to the

gap you estimate to achieve with this project.

Identify Root Cause

Suggested Items for Identify Root Cause

The purpose of this step is to identify the root cause(s) of the problem. This can be done through organized brainstorming utilizing the fishbone diagram or other cause and effect

tools.

Listed above are potential root causes, which were determined throughbrainstorming. The potential root causes must be verified in order to identify the true root

causes.

Page 6

O

15% of all Grievance and Appeals are related to

Medicare Claims denied for no referral to a specialist

in the service area.

Systems

Sales Process

Member not linked to PCP in system

Different codes

Incorrect Materials

Hard to read

Directories Inaccurate

Referrals unclear

Unclear explanationMSO’s not explained

Referral requirements not explained

PCP Error

Kinetra transmission

Kinetra keying error

Don’t submit to Kinetra

Office Staff Error

Office holds referral

No dedicated phone line

Financial motive to hold

No financial motive to sendSystem down

Hold for batch run

Office staff not educatedToo many systems

Humana not open after 5Turnover

Specialist

Accepts member w/o referralKnows member

Verbal received from PCPPCP doesn’t

send to HumanaSends different info to Humana

Exceeds services authorized

Not clear on what is authorized

Trying to beat the system

More care needed – referral too complicated to get

No document

Complex Referral Process

Humana Staff Error

Issues referral before Humana approval

Normally approved anyway

Multiple complex steps

Form too complex

Referral form implies referral approved

Says referral not request

People think it is approved

Humana between member and doctor

Review takes too longMember self refers

Verbal from PCPNormally approved

anyway

Systems not friendly

Keying errors

Referral incomplete when received

Kinetra

Out of Date

Out of Service

One more system for Doctor

Don’t talk to each other

Can’t match referral and claim

Loading incorrect

Humana systems antiquated

Referrals inappropriately expire

Bad image not picked up

Mismatch causes denial

Identify Root Cause

Root Cause Evaluation Matrix Summary

Major Bone Potential Root Causes to Verify Verification Method

Materials

Methods

Environment

Installation

Design

None

Valves not made to spec Sample valves for compliance

None

None

Inner lip reduction reduces cushioning causing valve breakage

New product introduced in 1995 increased oil circulation causing valve breakage

Replace lip and test*

Decrease oil circulation and test

Verified?

Yes, CpK <1

Yes, no failures in test

Yes, no failures in test

Root Cause Evaluation Matrix Summary

Major Bone Potential Root Causes to Verify Verification Method

Materials

Methods

Environment

Installation

Design

None

Valves not made to spec Sample valves for compliance

None

None

Inner lip reduction reduces cushioning causing valve breakage

New product introduced in 1995 increased oil circulation causing valve breakage

Replace lip and test*

Decrease oil circulation and test

Verified?

Yes, CpK <1

Yes, no failures in test

Yes, no failures in test

Contribution to the Gap

Based on the verification you have just completed, and your best prediction of what you believe you can fix, show the contribution to the gap you estimate to achieve with this project.

M

M

Page 7

Identify & Select Solution

Potential solutions are identified that remove the root cause from the work process. Each solution is analyzed for feasibility and effectiveness. Identifying a lasting and cost effective solution is key to having a long-term impact on the performance indicator.

Suggested Items for Identify & Select Solution

Page 8

Category Potential Solution EffectivenessCost

Effective

Solution Selection Matrix

Feasibility TimelyCustomer Oriented

Keep?

FutureProduct

Retrofit

1. Redesign valves to original (pre-1992) specs

2. Improve oil management system

3. Assure CpK in plant and from supplier

4. Replace all valves that are currently in the field with newly redesigned valves

5. Replace all valves in compressors covered under warranty with newly redesigned valves

6. Replace valves on J-compressors with wave springs on a case by case basis

Legend:H = High, M = Medium, L = Low N = Not at all

H H Yes

H H H

H H

HM

H

Yes

H L H HM Yes

H L M H L No

M M L M L No

H H M H H Yes

Although the Solution Selection Matrix is optional, you must tell your story showing at least the following:

• Alternatives considered• Solution(s) selected• Why were these selected?• Testing Plan• The cost effectiveness of the proposed solutions?• Contribution to the Gap

Although the Solution Selection Matrix is optional, you must tell your story showing at least the following:

• Alternatives considered• Solution(s) selected• Why were these selected?• Testing Plan• The cost effectiveness of the proposed solutions?• Contribution to the Gap

M

O

Source: Service deviation warranty system

O

What How/ When Week To do to be ready

Macro flowchart of new changes, effect on Indicators, Expected $ changes.

Jose and Edda by presentation. 8/11/00

Week -4 Effective date

Nilda to let Lymari know to schedule the meeting, date, time and location with Jose & Edda & Team.

Macro flowchart of new changes, effect on Indicators, Expected $ changes.

For Remmers by e-mail. 8/11/00

Week -4 Effective date

Maver - get english version of the playbook into the Info Map template. Forward to R Remmers and B Snyder

Critical information from UM helps adjudicate claims first pass. Number of new 924 should go down.

Team presentation - Lead by Maribel & Including Jose Maldonado 8/14-18/00

Week -4 Effective date

After the decsion with Jose, with the PB & Map, Maribel to schedule meeting, date, time & location and hold meeting.

Implementation Plan

Implement

Page 6

Review Plan

What When Who

Have Leadership Team review proposed solutions

Meet with sponsor weekly to review progress

Include indicator in the weekly OIC meetings

Review all progress & determine next steps

Completed April 4

Ongoing until final sign off

Begin May 23, ongoing

September 15

Team Lead, Sponsor, OIC

Team Lead, Sponsor

OIC

Entire Team, Sponsor

M

M

Change Management Plan

Type of Change Actions Required

Delay in implementation

Tools/forms change needed

M

Process change suggested

Process indicator change

Team Leader and Sponsor agree on change and new scheduleIf not financial impact team consensus required – plan for change impl. req’dTeam Consensus and approval by all parties originally approving process

Team, Sponsor, OIC approval required

Suggested Items for Implement

Ensure Results

Suggested Items for Ensure Results

Monitoring the before and after results evaluate the success of the implemented solutions. Results are measured using the same indicator that was used

to identify the problem.

Page 10Source: Service deviation warranty system

O

Performance Before and After Implementation

19%

23%21%

18%

35%

42% 42%

56%

71%

77%

82%

95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

4-Dec 11-Dec 18-Dec 25-Dec 1-Jan 8-Jan 15-Jan 22-Jan 29-Jan 5-Feb 12-Feb 19-Feb

Goal 85%

Good

Implementation Date

Target

Actual Performance

M

There are many ways to display results information. Show the results in the manner that best tells your story. You must, however, show results in the same indicator that you used in

Reason for Improvement to show you had a problem.

Remaining Issues & Future Plans

Suggested Items for Remaining Issues & Future Plans

Next Steps

* Develop a standardization planThis usually involves the standardization of the solution, having it become the normal and standard way of conducting business.

* ReplicationDetermine if others areas of Humana can benefit from this solution, if so contact appropriate parties.

* Remaining IssuesUnresolved issues often need to be handled by areas outside of the team. Document those issues and provide a vehicle to communicate those issues to the appropriate parties.

* Lessons Learned There are lessons learned on every projectthat can be used to make future problem solving activities more efficient and effective. In spirit the of continuous improvement, these should be documented and shared during the review process or in any other appropriate manner.

Page 11