Making the Case for Quality

Teaming Up With Six Sigma to Improve

Accuracy and Customer Satisfaction

• AFirstsourceSolutionsSixSigmaimprovementteamusedthedefine,measure,analyze,improve,andcontrol(DMAIC)approachtotackleaccuracyissueswithclientenrollmentforms.

• Usingstakeholderinputandavarietyofqualitytools,theteamarrivedatdata-drivensolutions.

• Thesolutionsresultedinmorethana6-percentincreaseinaccuracyratesandplayedaroleinhelpingtheclientpassaregulatoryauditandavoidafinancialpenalty.

• TheteamenteredthisprojectintheInternationalTeamExcellenceAwardcompetitionandwasnamedafinalistfor2009-10.

AtaGlance...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 opera-tional 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 client’s database. The U.S.-based customer—a provider of healthcare plans—was 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 accu-racy 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 reg-ulatory requirements and to maintain the business relationship with the client. This process improvement

By Janet Jacobsen

November 2010

ASQ www.asq.org Page1of4

measure and analyze phases to help identify root causes and improvement opportunities.

Team members used the following tools: process mapping, mea-surement 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 process—a necessary step before improvement could take place. The process map began at the source from which the enrollment forms are received and con-tinued 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) exer-cise for the auditors. In this exercise the repeatability score was 97.81 percent, but the reproducibility score came in at just 75 per-cent. 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 anal-ysis, 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.

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

project dovetailed nicely with the organization’s strategic goal: To achieve a dominant position in the business process outsourc-ing 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 certifi-cation 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: Use brainstorming techniques to list all stakeholders—those who are impacted by the service or who have power, influence, or an interest in the project’s outcome.

Step 2: Create 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: Discuss participation with each potential stakeholder’s direct supervisor. Create a shortlist of members for nomination.

Once the appropriate stakeholders were selected, a project char-ter 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.

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

ASQ www.asq.org Page2of4

June2008

July2008

August2008

September2008

October2008

November2008

Firstsource accuracy rate 89.2% 93.47% 89.25% 88.97% 90.72% 93.4%

Client requirement 92% 92% 92% 92% 95% 95%

Figure 1— Accuracy rate compared to service level agreement

• Stakeholder identification

• Team charter

• SIPOC (suppliers, inputs, process, outputs, customers)

• CTQ (critical to quality) tree

• Detailed process mapping

• Measurement system analysis

• Process capability study

• Data collection plan

• Establishing the dashboards

• Solution design matrix

• Failure mode and effects analysis (FMEA)

• Piloting

• Pareto

• Test of hypothesis

• Standard operating procedures (SOP)

• Dashboards

• Run chart

• Pareto charts

• Brainstorming

• 5 Why analysis

• Fishbone diagram

• Normality test

• Control charts

Define Measure Analyze Im

prove

C

ontro

l

Figure 2— Tools and methods used to identify possible root causes/improvement opportunities

ASQ www.asq.org Page3of4

members estimate the potential reduction in errors if certain solutions were implemented. This estimate indicated that resolv-ing the five potential causes would result in nearly a 60-percent reduction in defective fields in the client’s 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 calcu-lated 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 client’s business. Projected intangible bene-fits included potentially reducing training cycle time and creat-ing a process to monitor agents during the learning phase.

The next step for the team involved pilot testing of the solu-tions 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 team’s solutions.

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.

Earlier in the project, the team identified several types of impacts that various stakeholders could experience, such as busi-ness, 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 regula-tory 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 wasn’t complete. The final step was creating a plan to sustain the increased accuracy rates. The team established per-formance dashboards to monitor both customer quality levels and internal audit trends. Figure 5 provides further details on this plan.

Potential Cause ValidationComplexinstructions Side-by-sidemonitoringIneffectivefeedbackmechanism R&Rstudy

Knowledgegapbetweenoperators VerificationofchangesgivenbyclientversusresultsofR&Rstudy

Absenceofstructuredsampleswitchingandinternalauditreportingmechanism

Performancereportsofnewagentsunderlearningcurve

Sharedtrainers—trainingcertificationnoteffective

Trainingprocesswalkthrough,gapsincertificationprocess

Figure 3— Potential causes and validation methods

Solution Control Frequency Responsibility Governance structure for sustaining results

Useofchecklistduringproduction

Side-by-sidemonitoring Daily Teamlead

Twicepermonthside-by-sidemonitoring.Findingssharedinweeklymeeting.

Updatemechanism

Gathering/reviewofnewupdatesfromclient

Verificationthroughaudits

Monthlyevaluations

Whenupdateisreceived

Afterupdatesession

Monthly

Trainer

SQauditor

Trainer

Monthlyreviewofallnewupdatesbytrainingmanager.

Reviewofsameintheinternalauditresults.

Monthlyevaluationsofalloperators.

Feedbackmechanism

Agent-leveltrackingofauditdetails

Feedbacksessions

Daily

Daily

Servicequality

Teamlead

Weeklyandmonthlyreviewsinoperationsandqualitymeetings.

Costofpoorqualityaudits.

Figure 5— Plan for sustaining results

89.2

93.47

88.97

90.72

93.494.3

94.92

96.28

97.95 98.34

89.25

84

86

88

90

92

94

96

98

100

June

2008

July

2008

Aug.

2008

Sep.

2008

Oct.

2008

Nov.

2008

Dec.

2008

Jan.

2009

Feb.

2009

Mar.

2009

April

2009

Quality percentage

Customer requirements

Figure 4— Increase in accuracy levels beyond customer requirements

ASQ www.asq.org Page4of4

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.

The project’s lead Black Belt, Ganesh Venkatachalam, says the team learned a great deal, especially, “Understanding the cli-ent’s 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 ASQ’s 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.”

For More Information

• To obtain additional information, contact Ganesh Venkatachalam, lead Six Sigma Black Belt for the project, at ganesh.venkatachalam@firstsource.com.

• Learn more about Six Sigma by visiting www.asq.org/learn-about-quality/six-sigma/overview/overview.html.

• Details on the International Team Excellence Award process are available at http://wcqi.asq.org/team-competition.

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.