Making the Case for Quality

November 2010

Teaming Up With Six Sigma to Improve

Accuracy and Customer Satisfaction

By Janet Jacobsen
At a Glance . . .
A Firstsource Solutions Six Sigma improvement team used the define, measure, analyze, improve, and control (DMAIC) approach to tackle accuracy issues with client enrollment forms. Using stakeholder input and a variety of quality tools, the team arrived at data-driven solutions. The solutions resulted in more than a 6-percent increase in accuracy rates and played a role in helping the client pass a regulatory audit and avoid a financial penalty. The team entered this project in the International Team Excellence Award competition and was named a finalist for 2009-10.

Accuracy levels that dip below expectations affect not only a service provider like Firstsource Solutions, but also its customers. This was the situation that Firstsource faced as a new client was not meeting regulatory standards and thus was in jeopardy of receiving a significant financial penalty if accuracy levels did not improve quickly.

About Firstsource Solutions

Firstsource Solutions (Firstsource) is a global provider of customized business process outsourcing services to the banking and financial services, as well as the telecommunications, media, and healthcare sectors. Its clients include FTSE 100, Fortune 500, and Nifty 50 companies. Firstsource has a "rightshore" delivery model with operations in India, the United States, the United Kingdom, and the Philippines. Among the subsidiaries of Firstource Solutions is Firstsource Advantage LLC, located in Amherst, NY. A case study about how Firstsource Advantage used Six Sigma to improve productivity is available at www.asq.org/2010/11/six-sigma/improve-productivity-financial-value.pdf.

Improving Accuracy Through Quality

Listening to the voice of the customer is just one of many ways that Firstsource gathers data for its continuous improvement initiatives. In 2008, Firstsource was conducting a routine weekly operational review call with a customer for whom it provides enrollment services. During this meeting, the company learned about a service issue regarding the accuracy of information entered into the clients database. The U.S.-based customera provider of healthcare planswas not in compliance with a regulatory requirement on its registration/enrollment activities prior to contracting with Firstsource. If this noncompliance were to continue, it would eventually lead to a hefty financial penalty. The client emphasized the urgency in taking all necessary steps to improve accuracy rates to ensure regulatory compliance by July 2009. From the outset of the relationship with this client, service level agreements (SLAs) targeted an accuracy rate of 92 percent for the child health enrollment process. Unfortunately, dashboard metrics at Firstsource indicated this level was insufficient to meet all regulatory measures required of the client. Accuracy rates for this enrollment process were subsequently raised to 95 percent in October 2008, but Firstsource did not reach the new SLA, as indicated by the performance gaps in the table in Figure 1. Firstsource needed to improve its quality/accuracy in the enrollment process to help its client satisfy regulatory requirements and to maintain the business relationship with the client. This process improvement

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Figure 1 Accuracy rate compared to service level agreement

June 2008 Firstsource accuracy rate Client requirement 89.2% 92% July 2008 93.47% 92% August 2008 89.25% 92% September 2008 88.97% 92% October 2008 90.72% 95% November 2008 93.4% 95%

measure and analyze phases to help identify root causes and improvement opportunities. Team members used the following tools: process mapping, measurement system analysis, process capability studies, run charts, Pareto charts, 5 Why analysis, brainstorming, and fishbone diagrams. In particular, process mapping helped the team gain a better understanding of the enrollment processa necessary step before improvement could take place. The process map began at the source from which the enrollment forms are received and continued to the point where forms are submitted in the online system. Metrics for the process came from both the client and Firstsource auditors. To avoid any inconsistency in measurements, the team conducted a gauge reproducibility and repeatability (R&R) exercise for the auditors. In this exercise the repeatability score was 97.81 percent, but the reproducibility score came in at just 75 percent. After further analysis, team members identified a knowledge and procedural gap, and with further training, the R&R scores improved to 99.17 percent and 90 percent respectively. The various stakeholders played active roles in helping identify root causes and improvement opportunities. Significant input came from client representatives who participated in the R&R study, which brought out different interpretations of procedures and instructions. Once the process mapping and R&R studies were complete, the team began using brainstorming, 5 Why analysis, and fishbone diagrams to narrow the list of 32 possible root causes. Eventually, the list was shortened to five potential causes that were validated by the methods shown in Figure 3.

project dovetailed nicely with the organizations strategic goal: To achieve a dominant position in the business process outsourcing industry with a strong focus on high quality delivery and innovation to add value to our clients and customers. To find the root cause and implement solutions for closing the performance gap, Firstsource chartered an eight-person Six Sigma improvement team, later coined the Child Health Plus (CHP) Enrollment Quality Improvement team. Team members included Padmini Rathnam, Shinoj Ramesh, Rama Santhanam, Sivabalan Chandrahassan, Harindranath Ramachandrana, Usha Shrivastava, Mahesh Mohandass, and Ganesh Venkatachalam. All members had earned at least a Six Sigma Yellow Belt certification and were selected based on their functional and technical skills. Also, each person brought thorough knowledge of the business processes at the heart of the improvement project.

Involving Stakeholders
Firstsource believes that stakeholder alignment is critical for bringing about improvement. The company uses the following three-step process to identify potential stakeholders: Step 1: U  se brainstorming techniques to list all stakeholders those who are impacted by the service or who have power, influence, or an interest in the projects outcome. Step 2: C  reate a hi-lo matrix of the potential stakeholders, using interest versus power as the two factors. This prioritization facilitates appropriate participation and communication. Step 3: D  iscuss participation with each potential stakeholders direct supervisor. Create a shortlist of members for nomination. Once the appropriate stakeholders were selected, a project charter was created to help ensure buy-in from all participants. The charter included as a goal statement, Improve the accuracy from 93 percent to 97 percent at the application level by April 2009. Attaining this goal would mean that Firstsource would also fulfill the SLA requirement and the client would achieve regulatory compliance and thus avoid a costly financial penalty.

Developing and Testing Solutions

During the improve stage of the DMAIC approach, the CHP team used tree diagrams and a solution matrix to develop solutions and improvement actions. The matrix helped team

Figure 2 Tools and methods used to identify possible root causes/improvement opportunities
Stakeholder identification Team charter SIPOC (suppliers, inputs, process, outputs, customers) Standard operating procedures (SOP) Dashboards
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Define

CTQ (critical to quality) tree Detailed process mapping Measurement system analysis Process capability study Data collection plan Establishing the dashboards Run chart Pareto charts Brainstorming 5 Why analysis Fishbone diagram Normality test Control charts

Con tr

asure A Me

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Solution design matrix Failure mode and effects analysis (FMEA) Piloting Pareto Test of hypothesis

Teaming Up for Six Sigma

The CHP improvement team employed the Six Sigma define, measure, analyze, improve, and control (DMAIC) approach for the project. Figure 2 shows the tools and methods used in the

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Figure 3 Potential causes and validation methods

Potential Cause Complex instructions Ineffective feedback mechanism Knowledge gap between operators Absence of structured sample switching and internal audit reporting mechanism Shared trainerstraining certification not effective R&R study Verification of changes given by client versus results of R&R study Performance reports of new agents under learning curve Training process walkthrough, gaps in certification process Validation Side-by-side monitoring

members estimate the potential reduction in errors if certain solutions were implemented. This estimate indicated that resolving the five potential causes would result in nearly a 60-percent reduction in defective fields in the clients enrollment forms. As the team moved closer to finalizing solutions, it used both failure mode and effects analysis (FMEA) and an effort-payoff matrix. By performing the FMEA, the team calculated the risk priority number (RPN) to rate severity, occurrence, and detection for a number of potential failures. For example, one potential failure mode involved instances where Firstsource agents did not follow all instructions. The effect was incorrect data in the system with one potential cause as too much pressure to fulfill production targets. This failure mode received an RPN of 150, one of the highest detected. In the effort-payoff matrix, potential solutions were sorted by impact or payoff and effort involved with specific solutions. Taking the five potential solutions, team members then calculated the expected benefits and found that client accuracy levels could improve nearly 5 percent and internal accuracy rates could potentially improve by more than 6 percent. With these levels, the client would meet regulatory requirements and Firstsource would maintain the clients business. Projected intangible benefits included potentially reducing training cycle time and creating a process to monitor agents during the learning phase. The next step for the team involved pilot testing of the solutions with groups of Firstsource agents. After just one week, improvements were significantly higher than estimated, and the performance data collected helped pave the way for full-fledged implementation of the teams solutions.

Earlier in the project, the team identified several types of impacts that various stakeholders could experience, such as business, operational, emotional, and personal consequences. After arriving at the five solutions, the team connected the solutions to the effects each would have on stakeholders. All solutions were evaluated on whether they would eliminate, minimize, or have no effect on the stakeholder impacts. In all cases, the solutions either eliminated or minimized stakeholder impact, thus playing a major role in securing final stakeholder buy-in.

Accuracy Levels Rise Sharply, Best Practices Shared

By all accounts, the Six Sigma project was a resounding success. First, the client scored its highest marks in its next regulatory audit and was once again in compliance. Accuracy levels increased beyond the targets, improving from 91.83 percent to 98.34 percent, as shown in Figure 4. Once the solutions were implemented, the CHP team understood that its work wasnt complete. The final step was creating a plan to sustain the increased accuracy rates. The team established performance dashboards to monitor both customer quality levels and internal audit trends. Figure 5 provides further details on this plan.

Figure 4 Increase in accuracy levels beyond customer requirements

100 98 96 94 92 90 88 86 84 June July Aug. Sep. Oct. Nov. Dec. Jan. Feb. Mar. April 89.2 89.25 88.97 90.72 Quality percentage Customer requirements 93.47 93.4 94.3 94.92 96.28 97.95 98.34

2008 2008 2008 2008 2008 2008 2008 2009 2009 2009 2009

Figure 5 Plan for sustaining results

Solution Control Frequency Responsibility Governance structure for sustaining results Twice per month sideby-side monitoring. Findings shared in weekly meeting. Monthly review of all new updates by training manager. Review of same in the internal audit results. Monthly evaluations of all operators. Weekly and monthly reviews in operations and quality meetings. Cost of poor quality audits. Use of Side-by-side checklist during monitoring production Gathering/review of new updates from client

Overcoming Resistance and Securing Final Buy-In

As with any process improvement project, the team faced some resistance to its solutions, with most of the pushback stemming from the misperception that process changes run on autopilot once implemented. The CHP team used the following techniques to overcome resistance to the solutions: Demonstrating the reality of the situation through process walkthroughs. Sharing data before discussions. Capturing the power of positive peer pressure from project champions. Providing timely communication.

Daily When update is received After update session Monthly Daily Daily

Team lead Trainer

Update mechanism Verification through audits

SQ auditor

Monthly evaluations Agent-level tracking of audit details Feedback sessions

Trainer Service quality Team lead

Feedback mechanism

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Several best practices also emerged from this project and were deployed to other improvement efforts. These practices included: Simplifying complex instructions. Certifying operators by dedicated trainers. Automating the feedback process. Eliminating paper prints. Ensuring regular feedback.

For More Information

To obtain additional information, contact Ganesh Venkatachalam, lead Six Sigma Black Belt for the project, at [email protected]. Learn more about Six Sigma by visiting www.asq.org/learnabout-quality/six-sigma/overview/overview.html. Details on the International Team Excellence Award process are available at http://wcqi.asq.org/team-competition.

The projects lead Black Belt, Ganesh Venkatachalam, says the team learned a great deal, especially, Understanding the clients business goal over and above just the service level brings in more value to the entire business process. To share what they learned, the team entered this project in ASQs International Team Excellence Award (ITEA) process for 2009-10. The preliminary round judges were so impressed with the project that the team was named one of 28 finalists, all of which were invited to make live presentations at the World Conference on Quality and Improvement in St. Louis, MO, in May 2010. Venkatachalam reports that the team competition was extremely beneficial mainly due to the exhaustive criteria for evaluation. He encourages other improvement teams to participate in the ITEA process because it provides an avenue to truly understand the various phases of the project and follow the rigor to achieve the goal of the project.

About the Author Janet Jacobsen is a freelance writer specializing in quality and compliance topics. A graduate of Drake University, she resides in Cedar Rapids, IA.

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