Train the RIE Team

At the first meeting, the Lean Advisory Board provided an overview of LHE to the Team. In the subsequent two multi-hour meetings, the facilitator provided additional LHE training. This included process mapping (i.e., how to map the C&AI process from both provider and student perspectives), establishing performance metrics and gathering data to evaluate the process (e.g., “cycle time” for the C&AI process, defined as the time from the student’s initial contact with the Center to the assignment of a counselor and scheduling of the first therapy appointment), and identifying waste and impediments to flow in the C&AI process (e.g., all the waiting that occurs from students’ first calls to the Center until the students sit down for their initial therapy sessions). Throughout the remaining meetings, the facilitator provided “just- in-time” training on Lean practices and tools to reinforce earlier training and support specific tasks that were part of the RIE experience (e.g., prioritizing and implementing recommendations). The facilitator used multiple modes of training, including brief lectures and demonstrations, slides and handouts, video clips, and hands-on exercises completed by the Team.

Gather Information on the Process before Conducting the RIE

The Team began the planning phase of the RIE by sharing their initial perceptions of the C&AI process from both the perspectives of service provider (Center staff) and service beneficiary (the students). This task identified several potential areas of focus:

■ Perceptions of unmet student/client expectations (e.g., students want immediate service, too much paperwork).

■ Waste that could be targeted for elimination (e.g., students waiting for appointment, staff waiting for files to be completed, waiting for meetings to assign student clients for individual counseling).

■ Factors that impeded the flow of services (e.g., handling paperwork multiple times for entry into the electronic database, non-standardized steps for completing and forwarding paperwork).

Create a Visual Map of the “Current State” Process

The Team then conducted a walkthrough of the C&AI process to observe all the steps experienced by students seeking therapy and all the steps required of Center staff. Confidentiality of medical information and ethical concerns prevented the Team from observing actual students during the C&AI process. Therefore, Team members role-played students seeking therapy services to model the major steps in the C&AI process. Members of the Team individually documented process steps based on their own observations. In addition, the facilitator urged Team members to ask questions as the process unfolded to ensure their clear understanding of the process. This walkthrough of the C&AI process allowed the Team to make visible for the first time all of the steps, for both student clients and Center staff members, of the entire C&AI process (including the Client Assignment sub-process). This effort provided immediate insights into the process. For example, the Team observed during the early minutes of C&AI meetings that the counselor was flipping back and forth through the paperwork completed by the student while the student watched and waited. When asked to explain, the counselor shared that important pieces of information needed to assess whether students were at risk for hurting themselves or others were located across different forms. Team members were instructed to document any early recommendations they had (e.g., organize information on student forms to provide counselors with the critical information they need in one spot) for consideration at a later RIE meeting when the Team recommended a new C&AI process. Following these walkthroughs of the C&AI process, Team members compared and discussed their lists of steps, reaching consensus on a single “current state” C&AI process map.

Review Archival Data to Establish Baseline Performance of “Current State” Process

With Team consensus on the key steps of students and Center staff in the C&AI process, Center staff began collecting data from a sample of actual student visits. They sampled student visits across different days of the week, different times of day, and different Center counselors to more accurately represent student experiences. Data on multiple metrics were collected based on the goals of the project (e.g., time from student contact to the C&AI appointment, “no-show” rates for scheduled C&AI appointments, cycle time from student contact to first therapy appointment). Tables 2.1 and 2.2

Table 2.2 Examples of Summary Statistics for the Current Consultation and Assessment Interview Process

Note: Data presented are limited to the earliest steps of the C&AI process.

show examples of the data collection instrument and summary statistics of the CAI current state process, respectively. Figure 2.1 depicts the “current- state” C&AI process map, providing the visual flow of the individual steps in the process as well as detailed review of the forms used, flow of people and information through the processes, and key performance metrics.¹¹