Background

In hospitals, one of the key performance issues is recruiting and retaining nurses.  There is a national nurse shortage.  The Human Resource Department at this VA Medical Center was not meeting it’s goals in recruiting timeliness.  In the past they blamed their problems on the government bureaucracy and internal customers not providing complete information.

Instead of looking outside, we re-focused on the HR department’s own inefficiencies.  Lean is the identification and elimination of Non-Value-Added steps in a process.  We used the following Lean / Process Improvement tools to improve HR performance:

Performance Scorecards
5S Visual Workplace
Process Flow Mapping

At the end of this white-paper we will show you the results of our efforts.

The HR Performance Scorecard

The first step of a Lean implementation is to make sure we are linking the project to improving measureable performance.  Lean should not be done to “make the workplace better”, “improve customer satisfaction” or any other number of un-measured slogans.  Therefore, our first step is to make sure the area we are streamlining has a working Performance Measurement System.

At Supply Velocity, we use a variation of the Balance Scorecard, called Performance Scorecards.  Performance Scorecards tend to be simpler than Balanced Scorecards and use fewer measures.  They keep score of a few (always less than 10) non-financial leading performance indicators.

To create your scorecard, start with the purpose, or mission, of the department.  This HR department brainstormed the very elegant statement, “Assure an Effective Workforce.”  Then they came-up with 5 measures that describe if they are achieving that mission.

Performance Scorecard

% Vacancies filled in 90 days = 80%
Employee 3 year retention rate = 80%
% Supervisors completing 20 hours of training = 90%
% of disciplinary actions issued within 3 weeks of infraction = 90%
% of employees who obtain 16+ hours of non-mandatory training per year = 75%

Perhaps the most important part of the Performance Measurement System is the Action Plan.  This is a list of projects that are happening in the department.  This action plan has action item owners and expected completion dates.  We try to limit the number of action items/projects to 5 or fewer.  The fewer actions the department is working on at one time, the more likely they are to get them done.  Below is HR’s Action Item List.  Note, that all action items are linked to specific performance measures.

By having an action item list, you will make the scorecard more than a communication tool.  It will tell associates in the department how they are doing, but more importantly, what the department is doing to improve performance.

Human Resource Department – Performance Action Item List

Implement 5S in HR Offices – Oct 2008 (HR Director)
Nurse Recruiting Project – Complete when goal is met (HR Director)
Nurse Salary Survey – June 2008 (HR Secialists)
Lean of Recruiting Process – March 2009 (HR Director)
Add 3 new HR Staff – May 2008 (HR Director)

When one action item is complete, they can add another, so at all times they are working on 5 “performance-improving” projects.

Scorecard results are reviewed with all HR employees monthly at a 15 minute performance review meeting.  This meeting is quick and effective.  It reviews actual performance and an update on action items.  It gives the entire HR department status and performance update.  No one is in the Dark!

The HR staff enjoys knowing what is going on and how the department is doing.  Initially, all measures were in the Red.  This grounded everyone in the reality that they weren’t meeting their goals.  This created the foundation for us to begin using Lean.

5S Visual Workplace

Lean is the identification and elimination of Non-Value-Added steps in processes.  5S Visual Workplace is used to eliminate non-value-added looking around for information, product or supplies.  It seeks to create a standardized workplace where there is “A Place for Everything, and Everything is in its Place.”

5S got its name because it is a five step process.  The five steps are:

Sort – remove the clutter
Set-In-Order – label or mark where everything belongs
Shine – regular housekeeping
Standardize – different people doing the same work, the same way, with the same results
Sustain – continuously improve, never backslide

We used 5S to make sure every HR associates desk was organized so anyone could sit down and work at another associate’s desk.  When someone is travelling, on vacation or out sick a 5S workplace doesn’t stop functioning.  While there is room for individuality, the critical files and information needed to keep the department running is organized per specific standards.

Goto www.supplyvelocity.com/whitepapers.asp to see the White Paper containing all 5S and Process Flow Map pictures.

Current State Process Flow Mapping

Pictures of the Process Flow Map are in the White Paper mentioned above.

Process Flow Mapping is the application of Lean to business processes.  It seeks to identify and eliminate unnecessary or redundant steps.  By mapping the process we enable employees to “see” the non-value-added steps that they perform every day.

The HR Lean Team mapped the process, sorted it into:

Green – Value added to internal customers
Yellow – Non Value Added but required by government regulations
Red – Non Value Added and should be eliminated

Non Value Added Steps

We identified 22 non-value-added steps in the hiring process, that could be easily eliminated.  Note, we not only created action items to eliminate these steps, but we quantified the savings.  Below is a sample of the steps we eliminated.  To see a complete list of the 22 steps please see the White Paper referred to above.

Hiring Form routed first to HR Director = 4.1 hours per year (The Director doesn’t do anything with it, except give it to a Specialist)
HR posts hard copy of job announcement on bulletin boards around the hospital = 40.7 hours per year (create an intranet web page)
Executive Nurse requests seniority date for applicants = 20.3 hours per year (create ongoing list of seniority dates)
Applicants personal data is entered 19 times during the recruiting/hiring process = 113.9 hours per year (all data entered once and auto-populate forms/labels/letters)

Lessons Learned

When we initiated this process we focused on HR.  While internal customers can cause delays, we wanted to focus on what HR could do to improve performance before talking to other departments.  However, in retrospect, it would have been better to include representatives from internal customers, such as Nursing.  We did not make the team cross-functional.  As improvements were rolled out, we realized that we were too HR focused and should have included “internal customers” of the process on the team.

All Lean Teams should be cross functional in departments and management levels (individual contributors to executives).

Impact on People

It was difficult for some of the HR staff to make the transition.  Many had been doing it the “old way” for decades.  For these people, it took more work for the HR Director to sell the improvements we made.  Her consistency, in applying these tools, eventually brought everyone on-board.

Results

We improved the “Recruiting completed within 90 days of application” measure from 33% to 56%… still below our minimum expectation of performance, but definitely better.  The Process Flow Mapping portion of the project eliminated 411 hours per year of wasted time in the HR department.

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