Quality Fables Competition

Mr. & Mrs. Goswami were in my office on a Monday morning, and as they narrated their experience in an emotional outburst, there was a strong message for the hospital.

“Our 2 year old son Arnav had high fever and diarrhoea for two days and on the third day, i.e. 10^th March, he became drowsy and we rushed him the hospital to Dr. N. Shah. On his advice for immediate admission we rushed to the admission counter at 12 noon only to be informed “sorry, no beds available”. In utter despair we waited in the casualty, with a sick child in my lap who was started on an IV antibiotic drip. We were unprepared for a casualty stay and were drained taking care of our child and ourselves. At 10 pm a bed was given for Arnav! After a comfortable hospital stay, completing seven days of antibiotic course on 16^th March, with improvement in Arnav’s condition, we eagerly awaited discharge. But in spite of enquiring, we were not given a fixed discharge date.  Finally on 18^th March morning suddenly the doctor confirmed discharge at 11 am. We happily arranged for a car by 12 noon, giving an hour for the usual discharge formalities. However, the reality was far more complex!  We were waiting till 4 pm as the discharge summary wasn’t ready. We kept asking the nurses for updates, but were only told that ‘doctors are informed’. Then when the summary was ready, the medicines took another hour to be delivered. Finally, we were called for bill payment, only to realize half day bed charges were added to the bill! Discussions, arguments and finally intervention of customer care; a refund was worked out! We were exhausted. My baby restless. Even our relatives at home were worried because we were taking so long to come home! After nine long hours, we finally left the hospital, taking with us bad memories of the hospital despite the fact that the medical care was beyond par and our child had recovered well. Will we come back if needed…? I don’t know!”

We are a 66 year old multispecialty, tertiary care hospital with 400 beds. During 2016, we admitted more than 33,000 patients with over 1, 30,000 inpatient days.

Lessons Learned:

• We have long waiting list for admissions
• Process inefficiency is leading to underutilization of hospital resources and evident patient dissatisfaction
• We need patient’s involvement in the care plan
• In this case patient’s hospital stay could be easily reduced by 30-35hrs with a proper discharge planning, proactive approach, team effort and simpler processes

The hospital management reviewed the above mentioned and other similar cases to improve our performance.

We decided to undertake a project to reduce Average Length Of Stay (ALOS) of patients by 3.6% from 3.91 to 3.77. This was done by improving both core clinical and non-clinical processes like the admission and discharge processes. This in turn will improve bed availability and also ensure a happy and memorable patient experience.

The backlogs were mounting for the vendor payments and for PO releases. There was lot of noise, that "the head count available is not adequate to meet the input volumes". This opinion was fuelled by the fact that head count was not released from the plant locations (parent company), during inception of our company, as per the pre-transition study done by an external consultant.

Also, the volumes have been continuously increasing since inception and are more than the volumes estimated before transition by about 25%. The opinion thus created, is that due to this lot of backlogs are being created in the process resulting into emergencies and firefighting. The overall situation looked unmanageable. The employees were spending extended hours in office to make the ends meet, and a stage had come, where the entire team had got highly frustrated, and had started complaining that their health and personal life is getting out of gear.

Above all this, the company’s Annual Operating Plan (AOP) required an increase in productivity by 20%, (as management expected some benefits from transition to take place), which at that time looked as an impossible task.

Considering AOP as the “Voice of Customer”, and in order to find a resolution to mounting pressures, our CEO, Navneet Bansal, set a challenging goal to save the situation from failure. He floated the idea of undertaking this project, across the Procure to Pay process.

A cross-functional project team was selected including stakeholders from plant locations and all verticals of the process. Persons from IT were also roped into the team, so that they can help where technology can be of use. The best of the talent was chosen, to ensure that no stone is left unturned to bring the desired change.

The project was launched and:

• Monitoring through data was started at granular level to control the process fully
• Standardisation and simplification of the processes was done
• Where possible, technology and digitisation was used
• Communication processes were strengthened, by installing help desk, portals
• Governance was strengthened through VCs and personal visits
• Load balancing and concepts of mass production were used.

In-view of the criticality of the project to business existence, the CEO took keen interest in its success.

The results were widely unexpected, as these were against the common belief that the situation cannot be managed without adding headcount. The project team was rewarded in the Quarterly Rewards function, and the success story was also published in the JSW group news-letter.

Once upon a time somewhere in the middle east desert was a large construction company. They had several projects in hand worth millions but alas all were delayed mainly due to quality and safety issues. Re-work was the order of the day and lack of adherence to processes a common issue. Moreover there was blame game and scapegoats after every incident.

They had instructions from their key  customer  to instill a culture of quality and safety failing which they were told that they will not be considered for  future projects and. They tried all  conventional methods like   training the staff on quality awareness and HSE workshops.

A strange pattern and phenomenon was observed that despite the training sessions the number of quality issues, non conformities and HSE violations had not decreased.

A Qualitist was enlisted to find out the root cause of the problem. And once the qualitist appeared he decided to visit the employees in the labor camp ! The qualitist found that the main issue was the quality of life in the labor camp where the employees stayed. Camp  was in shambles with very poor quality accomodation, amenities and support provided to the employees. There were electrical wires hanging everywhere, broken sinks, faulty and leaking pipes, people tripping on bathroom floors, bad quality food served, no housekeeping services, conflicts and lack of trust amongst them  etc.

The qualitist found that the best solution lay in first addressing the multiple quality issues in the labor camp versus the project sites. A safe and quality environment to live in was essential for the mental well being of such workers. The management was told that the plan involved first no training sessions  but addressing the root cause of the issue. Making their accommodation habitable, enabling a quality oriented and safe  life style was essential. As it all starts with our daily habits from home!

The CEO was convinced and the company invested significantly in upgrading all the facilities. Quality and HSE was now witnessed in the way they lived, they were looked after, their relationships, their basic needs were taken care of and the environment in general.

The upgradation of the facilities with a quality champion in the camp  who used quality improvement tools at the camp site made it easier to educate the employees. Management was now walking the talk. There were no liquid spills, no injuries and no HSE issues at the camp for a month. Quality and HSE messages were broadcast in the camp using R k laxman cartoons procured from the National Safety Council  India and in different languages.

This initiative made it easy for the Qualitist and the Quality manager to increase quality awareness training and inculcate the quality discipline. The employees could easily relate it  to their personal lifestyles and the camp.

This company went on to receive the best quality award from its prestigious customer and demonstrate the highest levels of safety by having a record for no LTI.

It has been another crowded and hectic Monday and Mr. Mohanty was already beginning to feel exhausted. Suddenly, a loud knock broke into his reverie. Mrs. Smitha stormed into his room dragging a boy pulling him by his arms. The Principal came towards his desk in his nonchalant way expecting another usual complaint.

Mrs. Smitha spoke in the same infuriated tone, “Sir, you have to take a severe action this time.” She explained that on being asked about the greatest emperor during the Mughal reign, the boy replied that it’s the Nine Gems; renowned as the Navaratna in the court of Emperor Akbar. Sanjeev has joined the school eight months ago and has been scoring far below the qualifying marks. The parents are deeply saddened and anxious looking at the wide differences in their academic performance.  

Spotting Sanjeev sitting alone under the banyan tree in the school playground during the lunch time, the Principal got curious and walked towards him. He was diligently creating his favorite characters and also gifting them with words. Bound by the conventional norm where recognition and achievements were only awarded to academic excellence, Sanjeev was considered to be a ‘failure’. Mr.Mohanty was struck with the chord of epiphanic realization.

The ‘Emperor’ summoned the school’s Think Tanks and passed an order to devise a strategy in identifying the different aptitudes of each student Each child is gifted and if their skills are identified and molded at the right time, they could be carved as the best gems epitomizing the Navaratna in the Mughal court. A learning model “9 GEMS” was developed with 9 different parameters like performing arts, sports, leadership, creative skills, community service, drama, entrepreneurship, and ethics along with academics which would enable a holistic development of the child and bring in a balanced progress of the child.

The story did not end here. “9 GEMS” gave ample opportunity for each child to shine in his forte rewarding them with confidence and recognition. The children, whose academic performance labelled them as underperformers, slowly started rising as soccer superstars, art masters, theatre directors and many more, winning various laurels from different inter-school competitions.

The 9 gems approach paved way to chisel each gem into a sparkling one. The school further went on to evaluate the achievement of each child in each of the parameter indicating their area of expertise. This framework of the school was well appreciated by the parent community and hence it gained more popularity even from the neighboring places which led to opening new campuses in those places.

A Stainless Steel Manufacturing major in India was facing competition from cheaper imports from China. COO was a worried man; to sustain the company’s market share he had to rework the costs to stay competitive.

During the review meeting itself a young and energetic metallurgist, Mr. X quipped that we must look at the chromium losses and do something to reduce these losses.

COO: Why Mr. X? Why do you think so?

Mr. X replied: Sir, chromium to stainless steel is like blood to human body. Its very existence depends upon the presence of chromium.

COO: Yes. I do agree.

Mr. X: Sir, if we work on other issues they may impact cost of a particular type of stainless steel. But improvement in chromium recovery we will gain cost benefit in all types of stainless steel.

COO: But Mr. X, your chromium loss occurs at different stages of production.

Mr. X: Sir, I have done a Pareto analysis of the magnitude of loss at different stages and found that significant amount of chromium is lost during Electric Arc Melting.

COO: Ok. Mr. X so you lead this project to reduce chromium oxidation at EAF.

Mr. X: Definitely Sir.

A cross-functional team was made comprising members from

1. Steel Melt Operations : Impacted Team, Main Lead,
2. R&D/QA : Process Guide/Measurements,
3. Maintenance: Equipment Health/Availability & Modifications, if required.

The team started to work immediately on the task at hand. Various technical papers and other scientific literature were browsed. Past data was analysed using advanced statistical tools like multiple regression and DOE. A comprehensive implementation plan was made and successfully completed within stipulated time frame.

COO and senior management reviewed the project status every fortnight to understand the progress and provide support and other useful inputs.

After all the hard work the results were out there for everyone to see. The team was successful in reducing Chromium oxidation i.e. loss of chromium in EAF slag by 1.5% through replacement of manual practice by injection practice. This saved Rs.3.51 Crore for the company per year, recurring.

The project got full support from the workers as the major outcome of the project was reduction in manual injection practice. Looking at the results, COO provided an opportunity to the team for showcasing this project journey to the Vice Chairman who applauded the team for the improvement and personally felicitated the entire Team.

This is a story I love to hear, again and again, from a member of the Qimpro Fraternity, about how the whale shark has been saved. And it is not fiction.

The whale shark is the largest fish in the world. It can grow to over 50 feet in length and weigh more than 10 tons. Each year, this gentle fish comes swimming all the way from the shores of Australia to those of Saurashtra, between September and May, to spawn in these waters. Whale sharks can live up to 150 years.

For years, its size and mellow temperament made it an easy prey to fisherman who profited from them. Until the turn of the century, these fishermen killed about 1,200 whale sharks each year. Not only was the whole fishing operation cruel, but by not allowing the fish to breed, survival of the species was in danger.

Thankfully, in 2001, the Government of India banned the fishing and trading of the whale shark.

Soon after, the Managing Director of a leading chemical company in Gujarat, set a challenging goal to save the whale shark along the coast of Saurashtra. But with the condition that it must become a world-class conservation project. He encouraged all employees from his company to get involved.

As a result, the ‘Save the Whale Shark’ campaign was launched, facilitated by this chemical company. The campaign had a team of logical, but unlikely, partners. The partners included: the company, Wildlife Trust of India, the Coast Guard, the Indian Navy, and the Ministry of Environment and Reefwatch. Besides providing financial assistance, volunteers from these organizations and institutions created awareness in the fishing community.

Street plays, games, posters, inflated flotillas, postage stamps, and school art competitions became the feed for building awareness. However, as always, building awareness had its own majestic pace.

Almost miraculously, the tide changed when the spiritual leader Morari Bapu, an interpreter of indic traditions, was co-opted into the campaign. In his discourses he reminded the community of the age-old Indian tradition of welcoming a ‘daughter with child’ into her parents home to give birth.

The analogy melted people’s hearts, and since then, the whale shark has not just been welcomed on the shores of Saurashtra but also fiercely guarded with parent-like protectiveness.

VOICE OF CUSTOMER:

On a daily basis I am bombarded with so many offers from my bank…so many coupons…so many rewards points…loyalty points. However, when I wish to actually avail them, no offer is enticing enough.

In my experience, these alluring cash backs are never insta! I even wonder if they are ever credited to my account?

What’s the use. When I actually need to shop I find no discounts!

VOICE OF BANK:

The “Reward Programs” cost is high. I wonder if they really work? Various reports, excels and MIS show that some activity is happening. But does it is really impact the bottom line?

VOICE OF BUSINESS HEAD:

Eventually, last week, the Managing Director ordered that the current Reward Programs should be buried. The cost is much too high with negligible visible impact.

Angry, he also dictated that unless the team developed a cost-effective plan, they can pack their bags.

There was a flood of gloom. The team assembled in the boardroom. Tense. How could they resurrect the loyalty program?

This meant replanning. Quality replanning. Disruptive planning. The first step in quality planning is:
Who is the customer? The second step is: What are the customer needs?

The enlightened team realized that their customers are very confused with the current Reward Programs. The initial excitement wit offers, invariably experiences sudden death! Sad.

Consequently, the replanned loyalty program offered a differentiator – INSTA CASH BACK. The processes were designed to win customer trust.

Post roll out…VOICE OF CUSTOMER….

Wow.. This is exactly what I was looking forward to! How did the bank know? I can actually get cash back discounts instantly!! Wonderful!! This bank understands me.

Customer loyalty increased. The Managing Director reversed his dictate.

King Vikramaditya was given the duty of bringing Betal to a tantric. Each time Vikram tried to capture Betal, it told him a story that ended with a riddle. If Vikram could not answer the question correctly, Betal agreed to remain in captivity. But, if the king knew the answer and kept quiet, his head would burst into a thousand pieces. And if King Vikram spoke, Betal would escape and return to his tree.

King Vikramaditya reached the peepul tree and placed Betal on his shoulder once again. As they walked, Betal began to tell another story.

“One day, a man came into the court of King Akbar, asking to be employed as the King’s advisor. He introduced himself as Birbal and promised to improve the Kingdom. After watching a display of his skills, the King readily agreed to give him the job.

As Birbal was walking in the kingdom along with the King Akbar next day, they heard some massive noises. Suddenly a demon appeared in front of them & said “Ha Ha Ha. I am here to indulge the Kingdom. I can see the improper structure of this kingdom. There is no standardisation and the people are not caring about the information provided on daily basis.”

Birbal was shocked at this news and asked, “Is there anything I can do to save this Kingdom?”

The demon roared, “You must find a suitable alternate way to improve this Kingdom’s information management methods”

Birbal asked for a day to find a substitute and went home. After looking for various options, he came with a solution. The next morning, King Akbar arrived to chauk of the display boards to try and stop demon from taking any erroneous decisions.

Birbal till the time explained the demon his concept of Automation which includes a CFT with members from Operations, business, Excellence & an IT to work upon a solution. It had quick plan to arrive at strategy and implement the feasible solution.

“I am impressed with your concept and giving you 6 months’ time for implementation”, bellowed the demon.

“So, tell me, wise King,” began Betal. “What was the solution? Will Birbal be successful to save his kingdom?

King Vikramaditya laughed and said, “Birbal’s concept of automation with the standardisation was the great solution. The team started working on plan, ironing the technical/ budgetary challenges able to control the stations with visual display on industrial PC. Slowly the plan covered all critical / major information in the kingdom. Several trainings were conducted to educate the subjects for managing this system / interpreting output and taking timely actions. This solution was deployed in the neighbourhood kingdoms as the best practices”

“You are right! But since you have opened your mouth, I must fly away.” With these words, Betal flew away, leaving King Vikramaditya to chase him with his sword.

Cast:
Kingdom - Cummins India
Akbar: Quality Leader
Birbal: Black Belt
Demon: Customer representative

Solution - Implementation of online Statistical Process Control in machine shop.