National Ergonomics Conference & ErgoExpo Using Six Sigma Methodologies to Improve Your Office Ergonomics Process Patti Rutter, RN, COHN/CM, CHC, Vice President, JPMorgan Chase Tony Silva, CPE, Director of Ergonomic Services, Atlas Injury Prevention Solutions
Copyright Atlas IPS
Agenda • JPMorgan Chase • Atlas Injury Prevention Solutions • Case Study: – DMAIC methodology involves these five phases: 1. Define – prioritize issues on VOC and state the improvement goal 2. Measure – measure the current performance 3. Analyze – identify root causes 4. Improve – improve the process 5. Control – verify improvement results and maintain the gains Copyright Atlas IPS
JPMorganChase • CEO Jamie Dimon’s statement for the 10th anniversary: – July 1, 2014 marked the 10-year anniversary of JPMorganChase and Bank One coming together - a critical part of a 200-year journey to form this exceptional company of ours. The past 10 years have seen some virtually unprecedented challenges, but they did not stop us from accomplishing extraordinary things.
Copyright Atlas IPS
Health Services Department • Specific to our domestic Health Services Department – 28 Health and Wellness Centers within 9 states – 64 Nurses who execute the program
Copyright Atlas IPS
Atlas Overview
Atlas provides the tools and the resources that guide an organization to reduce and avoid the spiraling costs of work related injuries.
Copyright Atlas IPS
Atlas Overview Case Management
Total Systems Approach
Return to Work Evaluation
Onsite Therapy Recordable Event Reactive Ergonomics
Early Intervention Discomfort Proactive Ergonomics Services/Software Wellness Stretching Pre-work Screens Job Demands Analysis
Copyright Atlas IPS
Atlas Overview Case Management
Return to Work Evaluation
Onsite Therapy Recordable Event Reactive Ergonomics
Early Intervention Discomfort Proactive Ergonomics Services/Software Wellness Stretching
Hire the right people
Copyright Atlas IPS
Pre-work Screens Job Demands Analysis
Atlas Overview Case Management
Return to Work Evaluation
Onsite Therapy Recordable Event Reactive Ergonomics
Help them avoid injury
Early Intervention Discomfort Proactive Ergonomics Services/Software Wellness Stretching
Hire the right people
Copyright Atlas IPS
Pre-work Screens Job Demands Analysis
Atlas Overview Case Management
Get them back to work quickly
Return to Work Evaluation
Onsite Therapy Recordable Event Reactive Ergonomics
Help them avoid injury
Early Intervention Discomfort Proactive Ergonomics Services/Software Wellness Stretching
Hire the right people
Copyright Atlas IPS
Pre-work Screens Job Demands Analysis
Atlas Overview
Nationwide Network of Service Providers 10,000+ cities covered Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process • Policy – Medical documentation is not a prerequisite to initiating the Ergonomic Assessment Process.
• Most requests come from one of three possibilities: – Employee – Manager – HRBP
Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process • Once Health Services is notified of the need for an ergonomic assessment, the nurse will: 1. Contact the employee to determine the extent of the evaluation. 2. Ask the employee to complete the online ergonomic survey. 3. Advise the employee to notify as soon as the survey is completed to arrange for a review telephonically.
Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process • Telephonic Process 1. Make an appointment for a telephonic consultation 2. Review the entire survey with the employee concentrating on areas that need actions. 3. Explain to the employee what adjustments need to be made and why. 4. Actions suggested and completed & purchases of equipment should be noted on the survey. 5. Inform the employee of what equipment needs to be purchased via e-Purchase.
Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process 7. Follow up the Telephonic assessment with an Email/memo to the employee summarizing the evaluation and the recommendations, copy the manager. 8. Advise the employee to notify you once all equipment ordered (if any) has been received and assist as needed with needed adjustments. 9. Inquire about comfort/status change. 10. Document all encounters on the survey to include status change. 11. If the employee continues to have issues, schedule an onsite workstation evaluation. Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process • Onsite Process – Nurse or Atlas 1. Make an appointment for the onsite consultation 2. Once evaluation is completed and recommendations received, the nurse reviews the evaluation & recommendations with the employee and assures implementation of recommendations documented by the ergonomist. 3. Inform the employee of what equipment needs to be purchased via e-Purchase. 4. It is the responsibility of the employee and manager to initiate any purchase(s) through e-Purchase. Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process 5. Advise the employee to notify you once all equipment ordered (if any) has been received and assist as needed with needed adjustments. 6. Inquire about comfort/status change. 7. Document all encounters on the survey and Omni to include status change.
Copyright Atlas IPS
JPMorgan Chase Ergonomic Assessment Process • If the employee complains of symptoms that are suggestive of a medical condition, that persists after all of the steps have been completed, (which includes an onsite evaluation) refer employee to healthcare provider for diagnosis and/or recommendation of any equipment/furniture needed for their specific condition.
Copyright Atlas IPS
JPMC Case Study • The Situation: – Greater than 200,000 employees deployed over 5,700 individual locations across the country – Regional nurses with limited availability and expertise that were required to provide reactive service on demand
Copyright Atlas IPS
Volume • 7 yr. look back at request volumes: • Over 100% increase in ergonomics and accommodation requests (normalized) Type of Request
Ergonomic
’07, # Individuals (US population 142,600) 259 (3.3%)
’13, # Individuals (US population 186,950) 1529 (8.2%)
Accommodation
673 (4.7%)
1911 (10.2%)
Copyright Atlas IPS
DMAIC 1. 2. 3. 4. 5.
Define – state the improvement goals Measure – measure the current performance Analyze – identify root causes Improve – improve the process Control – verify improvement results and maintain the gains
Copyright Atlas IPS
1. Define • Before stating the improvement goals: – What is the problem that we are trying to solve? – What is the scope of that problem? – How will we measure success?
Copyright Atlas IPS
Define: Performance Metrics • In Scope: – Discomfort resolution • 100% follow ups • Discomfort to low or no level
– Time to complete assessments • Telephonic – 2 days Onsite – 10 days
– Assessment errors • < 5% additional data collection/clarification/rework
– Track completion of recommendations • 100% of assessments
Copyright Atlas IPS
Define: Performance Metrics • Out of scope: – I/I rates – rates are low and not the concern – Time to implement solutions – out of this group’s control
Copyright Atlas IPS
The Key Metric = Discomfort
Copyright Atlas IPS
The Key Metric
Copyright Atlas IPS
Copyright Atlas IPS
2. Measure • Measure the current performance 1. Discomfort resolution • % of formal follow ups completed >90% • No quantitative follow up on discomfort levels so no verification of discomfort to low or no level
2. Time to complete assessments •
Use process / value stream map to capture this
3. Assessment errors •
Cause and effect matrix
4. Recommendation closure •
Copyright Atlas IPS
>90% of all recommendations closed
What is Value Stream Mapping • A technique used to analyze the flow of materials and information required to bring a product or service to a customer.
Copyright Atlas IPS
Value Stream Mapping 1. Draw the current state value stream map, which shows the current steps, delays, and information flows required to deliver the service. 2. Assess the current state value stream map in terms of creating flow by eliminating waste.
Copyright Atlas IPS
Time to Customer • 2 things to measure: Process and Lead time • Measure process time: – The time it takes to actually perform the work – Includes all of the doing, communicating, and analysis – Aka work time
• Measure lead time: – Time from when request is made until the service is provided – Aka elapsed time or throughput time Copyright Atlas IPS
Request Received from Employee, Manager or HRBP
Copyright Atlas IPS
Assessment Completed and Report Provided
Current State • From request to completion of assessment(s) and recommendations = 87 hrs (> 10 days target) • % of time work is being done (process) vs. overall lead or throughput time – Overall time = 87 hrs. – Process time = 6 hrs. – Percent activity = 7%
Copyright Atlas IPS
Quality metrics • On each process step: – % complete and accurate • The percent deemed “usable as is” without having to: – Correct information that was supplied – Add information that should have been supplied – Clarify information that could have or should have been supplied
Copyright Atlas IPS
Quality metrics • High quality/rework concerns – High rate of assessments not being completely accurate or with full content (26%) – Moderate percentage deemed “usable as is” (74%) – Above target of < 5% quality/rework concerns
Copyright Atlas IPS
Cause and Effect Matrix
KPIV Employee survey and 1 automated 10 recommendations Nurse 2 1 training/experience Ergonomist 1 3 training/experience Assesment tool data 4 3 and design Recommendation 5 7 detail 6 Follow up call/visit 3 Total 25 Copyright Atlas IPS
8
10
Resolution of issues
#
5 Timely response
Rating of Importance to Customer
Minimize contact time
Cause & Effect Matrix
Total
7
1
116
% Rank
12% 10
10
185
5
5
95
10
10
195
10
10
215
7 49
10 46
171 0
0
19% 10% 20% 22% 18%
Analyze Identify root causes – 5 Whys • Discomfort resolution – No SOP requiring 100% follow up – Online survey tool did not facilitate targeting individuals for quantitative follow up
• Nurse training and experience – – – – Copyright Atlas IPS
Lack of training for new nurses No defined training or schedule for existing nurses Training was generic and out of date No learning verification
Analyze Identify root causes – 5 Whys • Assessment tool data and design – No pictures for telephonic assessments – No workstation measurements – Redundant survey boxes made it difficult to quickly identify what needed to be implemented – Outdated – did not account for multiple monitors, tablet use, standing workstations
Copyright Atlas IPS
Analyze
Copyright Atlas IPS
Analyze Identify root causes – 5 Whys • Recommendation detail – Ergonomists recommending items not on standard product list – Product list did not have solutions that addressed all issues – Non prioritized list of standard products
• Recommendation closure – No SOP detailing requirement
Copyright Atlas IPS
Improve – Striking a Balance
Copyright Atlas IPS
Discomfort Resolution • Update SOP to require 100% quantitative follow up for each assessment completed • Target discomfort to low or no level • SOP also requires 100% closure of recommendations – Trigger OMNI follow up notices – Recommendation follow up @ 15 days – Discomfort survey follow up @ 30 days
Copyright Atlas IPS
Improve
Full or Discomfort Follow-up Surveys Copyright Atlas IPS
Improve
Copyright Atlas IPS
Improve • Nurse training and experience – Developed an on-demand training course for new nurses and for annual refresher training – Principle based training that applies to any type of equipment and work environment – Re-emphasis on early intervention techniques (first aid) to address issues • RICE • Stretching • Microbreaks
Copyright Atlas IPS
Training
Copyright Atlas IPS
Improve
• Developed a decision matrix for assessments requests based on ergonomic risk and discomfort in online self-survey – This will reduce the lead time because it will eliminate: • Unnecessary assessments from being performed • Telephonic assessment for high priority cases
Copyright Atlas IPS
Decision matrix
Copyright Atlas IPS
Improve - Employee Media Upload
Copyright Atlas IPS
Improve • Prioritized, standard product list from which recommendations are selected
Copyright Atlas IPS
Improve – Guided Solutions
Copyright Atlas IPS
Improve – Action Plan
Copyright Atlas IPS
Closure of Recommendations
Copyright Atlas IPS
Status of Recommendations
Copyright Atlas IPS
Control • A good control plan is necessary to "maintain the gain“ • Dashboards will be used primarily to monitor program performance • Use data to push issues upstream to facilities and designers
Copyright Atlas IPS
Track Performance
Copyright Atlas IPS
Questions • Patti Rutter, RN, COHN/CM, CHC, Vice President, JPMorgan Chase • Tony Silva, CPE, Director of Ergonomic Services, Atlas Injury Prevention Solutions
Copyright Atlas IPS
