Business Process Analysis and Improvement staff assists state and local governments in becoming efficient in their work processes by using process improvement methods that are common in the private sector. We help our customers identify and address process issues and provide them with the tools to test strategies for improvement, as well as, the skills to continuously assess the impact of changes they make in their improvement efforts. By working with the SICF Business Process Analysis and Improvement staff, customers have been able to:
- Increase capacity by eliminating non-value added steps
- Reduce processing times
- Reduce or eliminate backlogs
- Reduce unnecessary phone calls
- Increase their customer’s understanding of and compliance with requirements
- Improve written and oral communication
- Define, gather and analyze appropriate data measures for assessing the impact of changes
- Reduce employee stress and improve employee morale
Business Process Analysis and Improvement Services are tailored to meet customer needs with a range of technical assistance tools and strategies focused on operational issues.
A learning collaborative is a dynamic and powerful 12 to 16 month commitment between the SICF business process experts and up to 15 teams who share the common goal of rapidly achieving improvements in a focused process area. Participating teams learn process improvement methods and are coached through the application of new skill sets to achieve organizational goals. A collaborative brings about culture change where front line workers become problem solvers and critical thinkers. Variation in work processes and outcomes is significantly reduced as participants learn to base action on evidence rather than opinion.
SICF staff instructs teams’ members during face-to-face training events. The instruction is paced for teams to learn and apply process improvement to their work environment, utilizing the effective model known as the Plan-Do-Study-Act (PDSA) approach to problem solving. This widely-recognized method for continual improvement entails:
- Plan- Develop a plan for improving the quality of a process.
- Do- Execute the plan, first on a small scale.
- Study- Evaluate results to confirm or to adjust the plan.
- Act- Based on what was learned during the test, adopt and implement the plan, make needed adjustments and test again, or abandon the plan
A former California collaborative participant said this about the effectiveness of the collaborative "The collaborative has been particularly successful in several areas. 61% decrease in Medi-Cal renewal backlog plus 24% increase in the number of Medi-Cal renewals worked timely. 50% reduction in Earnings Clearance backlog. 75% of Wood/Oil/Propane LIHEAP caseload pending applications processed as far as possible in one morning. Increased morale for improved internal culture. Increased skill level in analysis and communication for manager and supervisors in change management. Increased data gathering for more accurate picture of division performance. Improved identification of training needs for division- improved tools for aiding Eligibility Workers in desk and time management; all through skills practiced in the collaborative process."
Cheryl Camillo, formerly of the Centers for Medicare & Medicaid Services at the U.S. Department of Health and Human Services, served as a member of SICF collaborative faculty, providing national policy expertise. She confirmed the power of a process improvement collaborative, stating, "The collaborative is not only a tool to maximize enrollment but also a way to revitalize government."
Former collaborative participants can continue to receive process improvement coaching, consultation and technical assistance from SICF by partnering in consulting services engagement.
The SICF Business Process Analysis and Improvement staff provides consulting services to new clients and former collaborative participants who need assistance on specific issues. In addition, a client desiring these services also may build these activities in as a component(s) of a learning collaborative. Areas of consulting services include the following:
- Process mapping and Value Stream Mapping
- Visual walk-through and analysis of the eligibility process
- Training on testing changes for improvement
- Process data gathering, analysis, and interpretation
Process Mapping or Value Stream Mapping
Process Mapping is a technique where a business process or workflow is converted into a visual, step-by-step diagram. Process mapping is used to better understand an existing process and to help develop a more effective one. The goal of process mapping is to improve business results. To create a process map, employees who are closest to the process are engaged to identify every step within the process, including the inputs, outputs and resources used. Common information-gathering techniques include observation, brainstorming and surveys. Process mapping is a tool to help to improve productivity, increase efficiency, reduce errors, minimize rework and enhance customer satisfaction.
Value Stream Mapping (VSM) is a tool to map the operational steps of a service from end to end. A value stream map is a picture of a service from end to end. It is similar to, although not the same as a process map or a flow chart. A value stream encompasses all of the steps in a process, those steps that add value to delivering a service and those steps that do not add value to delivering the service. The value stream is how work flows and it is about the movement of people and information.
The goal of value stream mapping is to learn about your system from the customer’s perspective and from the perspective of your colleagues in the system. A value stream map allows you to highlight problems to address in developing your future state value stream map. It is a learning tool.
For example, you could map your intake process by starting with the first step when a customer submits an application and following the application through the internal processing steps to a final disposition and notification to the customer. By visually depicting the process, a team is better able to identify unnecessary hand-offs and bottlenecks that slow the process. If you map several program processes, the pictures can help you identify differences and similarities in the eligibility process across programs.
The SICF can lead one to multiple teams through detailed process mapping or high level value stream mapping of the eligibility processes for Medicaid, CHIP, SNAP, or other programs a state desires to include. Each team would work on one process and should be composed of three to six staff who represent the major functions of a particular eligibility process. For example, a team could include an eligibility worker, clerical/front office staff, supervisor, and program manager.
Requirements of your team:
- Teams representing the eligibility processes to be drawn
- Staff time to participate in a three to five day process mapping endeavor or full day VSM session and time to gather data before the session
- Data on inputs, outputs, resources, processing time, wait time, percent of work complete and accurate, and a count of work in progress
- Spacious room that is comfortable for the teams to work at tables and has wall space to draw the process map or value stream map
- Complete a detailed process map or high level value stream map of the current process to identify bottlenecks, hand-offs, batching, non-value added steps, delays, and workarounds
- Define end customer (client) requirements
- Identify differences and similarities in the processes drawn
- Begin development of a future state process map or value stream map
- Learn how to draw a process map or value stream map and how to use it to redesign work flow in the eligibility process
Eligibility Discussion and Walk-Through
Observation is one of the most powerful tools available to understand how work flows and where it stops and starts. Yet for those who work in an eligibility process daily, it can be difficult to see the barriers to smooth work flow. Long standing workarounds can be instantly rationalized and missed.
The SICF is prepared to visit a local office to lead a discussion of the eligibility process and a walk-through of the office. A walk-through is more than a tour of the office; it is highly interactive. From the perspective of an external customer, your team will follow the customer and paper or electronic documents through the eligibility office from the front door or entry point through the end of the process. The walk-through is a valuable way to hear workers' answers to the question, "Why do you do your work this way?" Or, "Have you considered doing the work this way?" While focused primarily on a specific location, a walk-through with a team can help the team understand how to review other offices to identify areas needing improvement.
A team can expect to see and learn:
- The model of assigning work and its perceived effectiveness
- How the telephone system helps and hurts workers and customers
- How the office uses data to manage and assess the process performance
- The degree of variation within the office
- How the design of the physical space affects work flow and efficiency
Training on Testing Change for Improvement
Improvement teams need to understand when diagnosis and planning should not go further without action. A common trap is the continuous group conference room discussions about the best way to implement a change. When teams move to implementation without testing their change theories, often implementation becomes a period of fixing flawed assumptions made during the planning stage. The Plan-Do-Study-Act (PDSA) method of small scale testing gives you actual experience and data to use to adopt, modify, or abandon the change ideas before implementation. It also can be used as a method of getting buy-in from staff when the ideas work and when it is time to take them to scale.
The SICF is prepared to work with teams to provide training on the PDSA method.
Your team can expect to:
- Learn how to use the PDSA method to find out about issue areas and identify strategies for improvement while developing implementation plans.
- Develop PDSAs that can be implemented immediately after the training.
Process Data Gathering, Analysis and Interpretation
Improvement teams need to guard against a common trap called analysis paralysis. It is easy for teams to get stuck in the pursuit of more data to analyze in the attempt to get answers and to sharpen diagnosis. This process of chasing the answer is often frustrating and can be fruitless after a certain point.
The SICF is prepared to work with teams to assist in defining and analyzing the eligibility data needed for diagnosis and planning.
Your team can expect to:
- Establish baseline data to understand the current system.
- Learn how to measure against baseline data during implementation.
- Learn to detect unwanted variation in a process and how to reduce it.