Identify Waste and Impediments to Flow in “Current State” Process
The Team began a detailed discussion to identify waste (i.e., those steps and activities that add no value from the perspective of the student) and impediments to flow (i.e., those activities and steps that interrupt or delay the flow) using their new understanding of the C&AI process, the visual map, and data on key performance metrics. Identified issues included the following: The C&AI Process Was Rife with Waste. The triangles in Figure 2.1 highlight the waste of waiting between steps (e.g., waste of students waiting for appointments, waste of counselor time when students fail to show for appointment). Not shown is the waste of the time of both counselors and students during the C&AI while counselors gleaned important information from the poorly organized student forms. The Client Assignment sub-process (depicted by the diamond shape contained in the provider flow) contributed
Figure 2.1 Current state process map - Consultation and Assessment Interview.
significantly to student waiting. If the intake counselor did not submit in a timely fashion the required paperwork for assigning to student to a therapy counselor, the discussion of this student at this once-weekly Client Assignment meeting was delayed to a subsequent week.
Waste and Lack of Flow Delayed Services. Students waited, on average, 5 days from their initial contact with the Center to the consultation and assessment meeting, 16 more days until assigned a counselor with whom they can schedule their first therapy session and two and one-half additional days until their first therapy session. The average total time from initial student contact to first counseling appointment to begin services/treatment (cycle time) was between 12 and 21+ days. That means, for example, that a new freshman student who was anxious, lonely, depressed, etc. and finally reached out for help (maybe with the urging of a parent or residence hall advisor) waited 2-3 weeks for therapy, a seemingly interminable amount of time for a student in distress.
Figure 2.1 Highlights Process Steps That Add No Value (i.e., Waste). The shaded boxes in Figure 2.1 highlight that only a small fraction of time in this lengthy process spanning up to 3 weeks contributed real value to students. Specifically, the value-added time for the C&AI process from the perspective of the beneficiary (student, parent, etc.) was less than 2.5 hours (i.e., scheduling appointment, completing health forms, and participating in the 45- to 60-minute consultation and assessment interview to determine what help is needed). This means that 99% of the 3-week cycle time for the C&AI process was non-value-added waste.
The C&AI Process Did Not Flow Smoothly. The large number of unscheduled Emergency Service Interviews (356 in the fall semester alone) and the 20% of students who failed to show for their initial C&AI meeting interrupted the planned schedule of services to students and contributed to the poor flow of the C&AI process. As noted above, waiting for the weekly “all-staff' meeting to complete the Client Assignment sub-process also interrupted flow. Not shown in Figure 2.1 is the lack of flow due to the inconsistent transport of student files that support the C&AI process.
Develop Improvement Ideas and Prioritize Improvement Solutions
Not all examples of waste and impediments to flow can be avoided (e.g., students’ time spent walking from the Center’s waiting room to the offices of the counselors). LHE training helped the Team identify where incremental and radical improvements could reduce waste and improve the flow of the CA&I process (e.g., eliminate unnecessary steps, reviews, and signatures; level workload throughout the day/week to synchronize with the availability of staff resources required to provide the process; standardize physical and electronic filing systems to provide ease of locating, sharing, and storing information; create and enforce standardized work). The Team brainstormed over 70 solutions to improve the process, many of which were implemented - including the following incremental improvements:
■ Streamline/reorganize student information forms to reduce the time needed by counselors to review for serious issues or concerns.
■ Standardize work for greater consistency in the C&AI process across counselors to eliminate wasted time during the process and complete meetings in a timely fashion (allowing for better scheduling and reduced waiting times). This includes standard processes for filing and retrieving student records and reviewing and approving C&AI notes completed by doctoral students on supervised internships.
■ Align the calendar of the Center to offer C&AI meetings when students need them. For example, data identified a heavy demand for services on Mondays; thus, all counselors avoided professional development and nonessential meetings on Mondays to maximize their availability to see student clients during this period of peak demand.
■ Provide visual and/or auditory signals to counselors to conclude C&AI meetings on time (so the next student client would not have to wait).
Two proposed solutions recommended radical improvements to the C&AI process: (1) eliminate the Client Assignment sub-process and (2) implement “walk-in” C&A interviews. The Team acknowledged that the weekly “allstaff” meeting to match students with counselors was intended to ensure a good counseling relationship, but the data gathered during the RIE indicated that this time-consuming sub-process was unnecessary (i.e., added no value) in the vast majority of assignments. Therefore, the Team recommended eliminating the Client Assignment sub-process, and the counselor who conducted the C&AI would continue with the student to provide therapy as needed, building on the already established relationship. This allowed the staff counselor and student client to schedule their next counseling appointment before the end of the C&AI meeting. Overall, this radical change to the process would eliminate the significant time required for assigning counselors to student clients and scheduling the first counseling meetings.
In addition, the elimination of the weekly “all-staff” meeting would free up staff hours to schedule more C&AI meetings and/or therapy/counseling sessions.
The clear “voice of the customer” (students, parents, academic advisors, etc.) led the Team to recommend walk-in C&AI meetings, with the initial counselor continuing as the student’s counselor and scheduling the next appointment prior to the end of this initial meeting. This challenged the Team (and Center staff) to radically transform the C&AI process to provide walk-in services to students without any increase in Center staffing:
■ Data indicated that providing walk-in C&AI services would reduce the number of questionable Emergency Service Interviews, because students would no longer have to escalate the severity of their issues to be seen quickly. If the number of Emergency Service Interviews could be reduced by half (i.e., 175 per semester, or over 10 per week), there would be less disruption to the flow of the C&AI process and these needed resources could be shifted to the C&AI process.
■ Data indicated that staff resources were wasted when students failed to show up for C&AI appointments scheduled an average of 5 days earlier. When students fail to show the day of their appointment (one out
of five scheduled appointments), a significant amount of counselor time was unavailable to serve other students in the queue for C&AI appointments.
