De La Salle University

Ramon V. Del Rosario-College of Business

Management and Organization Department

Endorsement Form - Integrative Action Research (IAR) Defense

An Action Research on Reducing Average Handle Time for Medicare and Retirement Line
of Business in Optum

Submitted by:
Joshua Paul G. Salazar

On November 11, 2019, during the First Trimester, AY 2019-2020

Has been examined and approved for presentation to the IAR defense panel.

Atty. Frances Jeanne Sarmiento

Signature over printed name/date
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Table of​ ​Contents

Glossary 5
Abstract 6
I. Purpose and Rationale 8
II. Background and Context 11
Organizational Chart of Medicare and Retirement Line of Business 13
Where I am at the Organization? 13
III. Methodology and Methods of Inquiry 15
Constructing 16
Planning 16
Taking Action 16
Evaluating Action 16
Methods of Data Collection 18
ORJI Cycle 21
Ladder of Inference 22
Left-hand / Double Column 22
Meta-learning 23
Forms of Inquiry 23
Four Parts of Speech 24
Hypothesis Testing 25
Force field analysis 26
Lean six sigma 27
Role Duality 28
Organizational Politics 29
Change Management 29
Figure 7: Change Management Process 30
Ethical considerations 31
IV. Story and Outcomes 32
Constructing 32
Right hand/left hand 39
Four Parts of Speech 40
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Types of Inquiry 46
List of Hypothesis/Root Causes 48
Summary of Root Causes 49
Force field analysis 50
Planning and Taking Action 53
Evaluating Action 59
V. Meta-Learning after the First Cycle 63
Content 63
Process 64
Premise 65
Chapter VI Action Research Stories and Outcomes, Cycle 2 67
Constructing: 67
Planning Action 70
Taking Action 80
Evaluating Action 85
VII. Meta-Learning after the Second Cycle 88
Content 88
Process 89
Premise 91
VIII. Extrapolation to a broader context and articulation of usable knowledge 93
VI. References 98
VIII. Appendices 99
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List of Figures
Figure 1: Enterprise Call Volume for 2018 for Medicare and Retirement 12
Figure 2: Organizational Chart 14
Figure 4: Cyclical Process of Action Research 18
Figure 5: ORJI Cycle 21
Figure 6: Ladder of Inference 22
Figure 8: Process Map for Review Claim History 42
Figure 9: Process Map for Provider Look-up 43
Figure 10: Process Map for Review Medical Benefits 44
Figure 11: Fishbone / Ishikawa Diagram 47
Figure 12: Force Field Analysis for Cycle 1 pertaining to operational action items 51
Figure 13: Force Field Analysis for Cycle 1 Pertaining to Automation Intervention 52
Figure 14: Agent View of Dashboard for Average Handle Time Performance Agent View 55
Figure 15: Agent View of Dashboard for Average Handle Time Performance Weekly View 56
Figure 16: Agent View of Dashboard for Average Handle Time Performance Status View 56
Figure 17: Descriptive Statistics for the Average Handle Time per month 59
Figure 18: Descriptive Statistics for the hold time per month 60
Figure 19: Descriptive Statistics for the after call work time per month 60
Figure 20: Descriptive Statistics for the talk time per month 61
Figure 21: Net Promoter Score for May - August 2019 62
Figure 22: % of caller complaints pertaining to long hold 67
Figure 23: Time and motion study on manual process 68
Figure 24: Financial Impact Estimation 69
Figure 27: Process Flow and logic on how the automation tool retrieves the information 72
Figure 28: Preliminary User Interface Design of the 73
Figure 29: Schedule of Development of the tool 74
Figure 30: Email confirming on the date of completion of the tool development 74
Figure 31: Email asking Resources for User Acceptance Testing 76
Figure 32: Email asking for some Changes on the Participants during User Acceptance 77
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Figure 33: Email from the Business Analyst on the creation of the User Acceptance Testing
Tracker 78
Figure 34: User Acceptance Issue Tracking Form 79
Figure 35: Email Showing the User Acceptance Result to our Vice President of Operations 81
Figure 37: Sample Output of the Automation Tool 84
Figure 38:Results of the User Acceptance Testing 85
Figure 39: Time and Motion on the Current Process 86
Figure 40: Average Handle Time During Cycle 1 and 2 86
Figure 41: Summary of Identified Root Causes and Action Plans 87

List of Tables
Table 1: List of Consultations and Interventions for Cycle 1 19
Table 2: ORJI for "Review of Medical Benefit" Call Type 32
Table 3: ORJI for "Review Claim History" Call Type 34
Table 4: ORJI for "Provider Look-up" Call Type 35
Table 5: Ladder of Inference for Cycle 1 36
Table 6: Left-hand / Double Column for Cycle 1 39
Table 7: Summary of Process Waste for each call type 45
Table 8: Summary of Findings Per Issue 48
Table 9: Summary of Action Items per Issue 49
Table 10: Activities Related to First Set of Interventions 53
Table 11: Tool Description for knowledge base 57
Table 12: Automated Tool Expected Outcome 58
Table 13: List of Activities per Phase in the Six Sigma Methodology 94
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Glossary

Name Description
After Call Work Time spent working on the after call work documentation
Average handle time refers to the time starting from the agent answering the
call up to the time they finish the after call work documentation. It is the
AHT sum of the talk time, hold time and, after call work
Business process outsourcing refers to a company outsourcing it's none
BPO customer facing process to a vendor or a subsidiary
Hold time Time spent placing the member on hold
A management philosophy that focuses on elimination of waste in the
Lean process
Medicare and Retirement Medicare is the federal insurance program for Americans age 65 and over
Net promoter score is a measure of customer experience. It is a ranking from
1 to 10 on how likely the caller or customer will recommend the product or
NPS service to others
Robotic desktop automation is a solution that assists the agent in handling
RDA simple repetitive tasks.
A data driven problem solving methodology which originated in the
manufacturing industry which aims to reduce defects and variability in the
Six Sigma process
Talk time Time spent talking with an agent
User interface refers to the front end of a software and is what the user is
UI seeing when interacting with the software
Testing the software by the end user to determine whether the software is
User Acceptance Testing acceptable and is free of issues.
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Abstract

This action research aims to address reduce average handle time of call center agents within the

line of business medicare and retirement which caters to medicare members enrolled in

UnitedHealthcare, the largest healthcare, and insurance provider in the United States of America

(“UnitedHealth Group,” 2019)​. As of the end of May 2019, average handle time is running at

1130 seconds vs. the target client target of 900 seconds. This results in additional overtime,

hiring of extra headcount, calls not being answered, and callers wait for the queue for too long.

Although we are aiming to reduce average handle time, we will also be monitoring our net

promoter score. As of the month of May 2019, our NPS is running at 78. Improving NPS is

outside the scope of this action research but we will be ensuring that NPS will not be

compromised when reducing AHT. We will be aiming to retain our NPS of 78 vs. the target of

72. By doing root cause analysis, it is identified that failure to hit the target for average handle

time is due to a knowledge gap, behavioral issues, lack of standard procedures, and manual

non-value adding processes. This led to me to do this action research which was also the problem

our vice president for operations wants me to do. During my first cycle, we were already able to

implement operational action items that were low effort to implement but will yield high impact.

This includes, setting thresholds on number of tries when doing outbound calls, targeted

coaching and disciplinary actions on agents that belong to the 75th percentile in terms of hold

and documentation time during a call, creation of process guidelines which agents placed on

their work stations, designing the new hire training curriculum as well as conducting refresher

training to agents that have knowledge gaps. In addition to the implemented action items, we are

also in the process of developing a tool which will automate desktop navigation and getting of
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information from multiple sources. Development of the tool is expected to be completed by the

end of August and user acceptance testing will be done on the 1st week of September.
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I. Purpose and Rationale

The purpose of this action research is to reduce average handle time which will impact staffing,

reduction of unnecessary overtime, and overall reduce operating costs by identifying and

eliminating process waste through operational and automation action items.

Currently, we have close to 600 call center agents supporting this program which is expected to

increase till the end of the 2nd quarter of the year 2020.

As of the end of May 2019, the average handle time for these calls ended at 1150 seconds vs. the

client target of 900 seconds.

Some of the cost and negative impact due to longer handling time of the process includes the

following:

● Higher operational cost through additional headcount to handle call volume

● Overtime and too much strain for the call center agent at the end of the calls

● Potentially increase attrition due to burnout

● Negative customer experience for our callers due to longer queues

The measure of success I have identified for my research is a metric called AHT or average

handle time. AHT can be broken down into hold time which is the time callers are on hold while

agents are looking for their resolution. Talk time which is the time the agent and the caller are

speaking and lastly, after call work which is the time agents document what transpired on the call

as well as additional back-office work such as scheduling callbacks to both callers or other

respective parties.
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AHT is basically the time starting from the agent answering the phone up until the call ends.

However, aside from this metric, I would also be monitoring the net promoter score which is the

program’s priority metric. Improving AHT will also impact NPS positively. Net promoter score

is a metric that measures how was the overall experience of the caller.

Net promoter score is measured through surveys. Callers are provided a survey through the

phone after the call and ask them to rate the agent on a scale from 1 to 10 on how helpful was the

agent. Scoring is 10 being the highest and 1 being the lowest. The metric is divided into three

parts. Promoters, passives, and detractors. Promoters are scores from 9 to 10, passives are 6 to 8

and detractors are 1 to 5. To get the net promoter score we get the total promoter scores and

divide it by the total surveys then subtract it by the total detractor after dividing it by the total.
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The action research project is important to the different stakeholders as follows:

For UnitedHealth Group:

The improvement in handling time will impact customer satisfaction with the overall

service. Although indirectly, customer churn may be prevented as customers are being kept

satisfied through fast and accurate resolution

For Optum:

With the reduction of handline time, the organization will be able to reduce cost. It is

estimated that the average cost per call is $0.6 per minute. With this reduction, we will also be

able to handle more call volume without asking employees to work overtime during their

lunchtime. Also with the time available, we will be able to schedule and pull out agents in order

for us to upskill them through enrollments in additional training if capacity allows us to.

For Call Center Representatives:

As we make our process more streamlined, agents will be able to complete each call

faster and will reduce the strain on their end. They will also have enough time to rest at the end

of each call once the target is met.

For the members and callers:

Queuing time to speak with a call center representative will be reduced. They will be able

to get in touch with an agent faster. Also, callers will be able to spend less time on the phone just

to get the information they need or for them to get a resolution.

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For the action researcher:

This action research is important to me as this would give me the opportunity the process

more and to interact with everyone in the program including senior leaders and call center

representatives. This would also give me the opportunity to teach other members of the support

team and operations on proper problem solving as they will be closely collaborating with me on

this project.

Aside from the financial savings that will be gained through this project, there will also be

non-tangible benefits that will be realized.

II. Background and Context

Optum Global Solution is a health information technology and services firm that is part of

UnitedHealth Group. It provides technological, operational and consulting solutions and services

to individuals, healthcare organizations, and pharmaceutical companies.

Since our organization Optum is a shared service of UnitedHealth Group. Our company handles

some of the business processes for UnitedHealth Group. Some of the processes include but are

not limited to back-office support, customer service handling, claims processing and other

non-front line business processes.

Lines of business within the organization can be classified into three major units.

1. Employers and individuals

2. Medicare and retirement

3. State and government

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The line of business medicare and retirement which will be the scope of this action research.

For the year 2018, enterprise call volume for Medicare and retirement line of business in Optum

equated to 25,926,835 with an average handle time of 18 mins. Cost per call is at $0.6 per

minute.

Calls for these concerns may include issues such as non-coverage of insurance for certain

services and medication, discrepancies on how much the member is being charged for, asking

where the nearest provider or health specialist is an overall general concern regarding their

insurance.

Eliminating some of the issues will overall increase customer satisfaction as well as decreased

operating cost within the organization

Breakdown of call types are as follows:

Figure 1: Enterprise Call Volume for 2018 for Medicare and Retirement

Source: Tableau Operational Dashboard, Medicare and Retirement, 2018 Call Reason Volume

Others = 207 Additional Call Types

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Organizational Chart of Medicare and Retirement Line of Business

The overall organization has a more complex organizational chart but the scope of this action

research is on the line of business, medicare and retirement. Major groups can be divided by

operations and support which is hierarchical and its various functions are carried out by different

groups.

Where I am at the Organization?

Optum together with UnitedHealthcare is under UnitedHealth Group. UnitedHealthcare is an

operating division of UnitedHealth Group while Optum is the business segment that supports the

business process of UnitedHealthcare with the goal of making the healthcare system work better
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Figure 2: Organizational Chart

My role as a project manager under the business process excellence department is to work with

different cross-functional teams to provide end to end process improvement using different

approaches such as Lean Six Sigma, robotic process automation, kaizen, etc.
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III. Methodology and Methods of Inquiry

Action research is a problem-solving approach that aims to solve significant issues in an

organization through direct participation of the people, directly and indirectly, experiencing the

problem. It aims to address issues through collaboration and reflection of different audiences in

the research ​(Coghlan, 2019)

Formally defined action research is an emergent inquiry process in which applied behavioral

science knowledge is integrated with existing organizational knowledge and applied to solve real

organizational problems. It is simultaneously concerned with bringing about change in

organizations, in developing self-help competencies in organizational members and adding to

scientific knowledge. Finally, it is an evolving process that is undertaken in a spirit of

collaboration and co-inquiry (Shani & Pasmore as cited in Coghlan & Brannick, 2010, p. 4)

Action research has four recurring cycles which are constructing, planning, implementing and

evaluating which is illustrated below.

Figure 3: Action Research Cycle

Source: Coghlan & Brannick, 2010, p. 8

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Constructing

Constructing is the first step in action research; during this step, stakeholders and relevant project

members engage to identify the issues (Coghlan and Brannick, 2010). During construction, the

issue may change at the succeeding cycles of action research. However, it is critical that any

changes will be documented and articulated on what were some reasons behind the changes.

Evidence and supporting data needs to be presented. During the construction phase, it is

imperative that construction of the issue is a collaborative effort and you as the researcher,

engage process owners and experts during this activity.

Planning

Next step of the cycle is planning, during this phase we plan and explore the purpose, context,

and issues (Coghlan and Brannick, 2010, p.11). During this phase, we will be able to expound

and identify potential root causes to which our action items will be based on.

Taking Action

Once the root causes are identified, the next phase is to implement the action items. During this

phase, we focus on implementing our action plans and we adjust the actions accordingly if

needed.

Evaluating Action

The last phase is evaluating our actions. Once actions are implemented, we monitor both

intended and unintended outcomes (Coghlan and Brannick, 2010, p.11). We will monitor and

evaluate whether our actions met the intended outcome. We monitor and validate if action items
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were implemented correctly. We gather information which will be fed into the next cycle of

action research.
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Below figure illustrates the cyclical process of action research.

Figure 4: Cyclical Process of Action Research

Source: Coghlan & Brannick, 2010, p. 11

Methods of Data Collection

Action research is an integrative approach which incorporates three voices and audiences. It

incorporates the first person, second person and third person (Reason and Torbert, 2001; Reason

and Bradbury, 2008).

When collecting data and information, we will be involving these three types of voice and

audiences to get a wider view of the situation and issue.

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First-person research refers to inquiry based on your own observation, judgment, and insight.

This type of inquiry leads the researcher to inquire based on their own assumptions, desires, and

philosophy of life (Coghlan and Brannick, 2010, p.7).

Data generated during inquiry were done through process mapping activities and listening to call

recordings in order for me to get a glimpse of what is actually happening. During process

mapping, no intervention or discussion made. The objective of the activity is to document the

process without any bias. Aside from this, I also collected data and did some analysis in order for

me to generate hypotheses and initial findings which I plan to present and discuss during my

second-person research.

Summary of consultation methods and interventions made per action research cycle.

Table 1: List of Consultations and Interventions for Cycle 1

Interventions and Consultation

Date
Methods Data Collected Steps in AR Cycle
Interview with quality, workforce Possible data
management and, the operations sources, limitations
on identification of data sources and scope
1st week of June
Meeting with stakeholders on Confirmation from
official kick off and discussion on project team of their
benchmarks and goal setting participation
Interview with operations on the
current state process and process Current state
value analysis activity. process map and list
Identification of potential root of potential root
causes causes
Interview with training,
2nd week of June operations, quality team to List of potential
brainstorm on potential solutions action plans
Meeting on data collection and
sampling on root causes that needs Data based on
to be validated sampling Constructing (Cycle 1)
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Meeting with stakeholders and

project team on finalizing action
items and planning of List of final action
implementation items and approval
Meeting with training, operations
and software engineering team to
discuss action items. Feasibility List of feasible
study and timelines discussion action items Planning (Cycle 1)
Confirmation from
Meeting with operation and operations and
training to implement non training team on
automation action items implementation
Meeting with software engineering
3rd week of June team on proposal of development
of automation tool Feasibility study
Sentiment on
3rd week of June Intervention with agents on operational action
feedback of action items item
Discussion with operations and
software engineering team on
4th week of June Taking Action (Cycle 1)
logic design and architecture of Draft of logic and
the automation tool. tool architecture
Side by side discussion on
1st-2nd week of
mapping of logic with subject Detailed logic of the
July
matter experts process
Discussion on the development of Costing of tool
3rd week of July
tool and costing development
Meeting with operations leaders Approval of tool
4th week of July
on costing approval development
Meeting with software engineering
team on timelines on tool Timeline of tool
development development
1st week of August
Meeting with operations leaders
Evaluating Action (Cycle
on project status and result of Feedback on action
1)
operational action items items and impact
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ORJI Cycle

To organize my thought process and facilitate reflection during the first-person inquiry, I will be

using Schein’s ORJI model. ORJI stands for Observation, Reaction, Judgement, and Intervention

(Coghlan & Brannick, 2010).

Observation refers to what have you seen or experienced. Once you have observed, researchers

react emotionally based on what they experience. Then we judge our feelings and intervene

based on our judgment. The ORJI model process a cyclical process which allows us to go

through the cycle once we have completed the intervention. Below is an illustration of the ORJI

model. The details on the use of the ORJI cycle will be discussed in the stories and outcomes

chapters for Cycle 1 (Chapter 4) and Cycle 2 (Chapter 6)

Source: ​https://mdc.life/books/notes-for-humble-inquiry/

Figure 5: ORJI Cycle

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Ladder of Inference

The ladder of inference will be used in order for me to avoid jumping to conclusions and

imposing my views to the second-person audience. The ladder of inference is used to avoid bias

and conclusions without testing out the hypothesis first. The ladder of inference illustrates how

the interpretation of the issue is attributed to selected and observable data (Argyris et al., 1985;

Ross, 1994). The details on the use of the ladder of inference will be discussed in the stories and

outcomes chapters for Cycle 1 (Chapter 4) and Cycle 2 (Chapter 6)

Figure 6: Ladder of Inference

Source: Coghlan & Brannick, 2010, p. 26

Left-hand / Double Column

Right/Left-hand column is an action science technique developed by Dr. Chris Argyris in 2004

which aims to uncover your own privately held inference (Coghlan & Branick, 2014, p.33).
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Cited by Coghlan and Branick (2014), that during conversations or discussions there are thoughts

which are being kept between the participants. The unmentioned thoughts will be written on the

left-hand side while the spoken thoughts will be on the right-hand side. The details on the use of

the left-hand/double column approach will be discussed in the stories and outcomes chapters for

Cycle 1 (Chapter 4) and Cycle 2 (Chapter 6)

Meta-learning

With any action research, 2 types of action research is running in parallel. The action research

we’re doing to address the issue we have chosen is the first cycle. The second is the reflection on

our action research. We need to reflect on what’s going right and wrong. Reflection during

meta-learning will be discussed in the stories and outcomes chapters for Cycle 1 (Chapter 4) and

Cycle 2 (Chapter 6)

Second person research refers to an inquiry involving other parties with the same concern. A

challenge on action research is to identify who will be involved in second person research as the

quality of the participants is critical and will influence of the success of the action research

(Coghlan and Brannick, 2010, p.8).

For my second-person research, information and insights were gathered through meetings with a

cross-functional team involving operations assistant managers, departmental managers, trainers

and directors. I have also involved agents and held a focus group discussion with them.
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Forms of Inquiry

During my discussion, the way I structured my focus group discussion is in the form of pure,

diagnostic and confrontative inquiries. A pure inquiry is “where you prompt the elicitation of the

story of what is taking place and listen carefully and neutrally”. The researcher may ask

questions like what is going on without you intervening or correcting the participant. A

diagnostic inquiry is “which you begin to, manage the process of how content is analyzed by the

other by exploring emotional processes, reasoning, and actions”. During this time, the researcher

may ask the participant on why do they think the issue happened? What are some factors

contributing to the issue? Do they have something in place already? If not, why is this not being

addressed? Lastly, confrontive inquiry is “this is where you, by sharing your own ideas,

challenge the other to think from a new perspective” (Coghlan & Brannick, 2010, p. 36).

A pure inquiry was first done to gather start the conversation and for me to get a better

understanding of the situation before going into diagnostic inquiry to qualitatively understand

potential root causes. Lastly, the confrontative inquiry was used to verify and align everyone on

the issue. While presenting the analysis, I also let the participants interpret the data. During this

discussion, more issues arise as different departments had a different view, assumptions, and

understanding of the process. At this point, there were more that were identified which go

beyond our primary problem.

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Four Parts of Speech

For communication to be more effective and for me to avoid manipulating or controlling the

conversation during my second person activity, I will be using Torbert’s four parts of speech

(Torbert and Associates, 2004) as defined below.

1. Framing - explicitly stating the purpose of speaking for the present occasion: what

dilemma you are trying to resolve, shared assumptions about the situation.

2. Advocating - explicitly stating the goal to be achieved, asserting and option, perception,

feeling or proposal for action.

3. Illustrating - telling a bit of the concrete story that makes the advocacy concrete and

orients the others more clearly.

4. Inquiring - questioning others to understand their perspectives and views.

Hypothesis Testing

To further validate our findings, I will be using the seven rules of hypothesis testing (Argyris et

al. as cited in Coghlan & Brannick, 2010, p. 37)

1. Combine advocacy with inquiry.

2. Illustrate your inferences with directly observable data.

3. Make your reasoning explicit and publicly test for agreement at each inferential step.

4. Actively seek disconfirming data and alternative explanations.

5. Affirm the making of mistakes in the service of learning.

6. Actively inquire into your own impact in the learning context.

7. Design ongoing experiments to test competing views. (1985: 258-261)

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The details of the hypothesis testing will be discussed in the stories and outcomes chapters for

Cycle 1 (Chapter 4) and Cycle 2 (Chapter 6)

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Force field analysis

In order for me to assess interventions and forces against the changes this research will entail, I

will be using Kurt Lewin's force field analysis. Force field analysis is a technique developed by

Kurt Lewin under the assumption that with every change there will be a force countering the

change (Coghlan & Brannick, 2010)

Below are the steps in conducting force field analysis as prescribed by Kurt Lewin.

1. Describe the change issue and the desired direction of the change.

2. List the political forces driving change and those restraining in a diagram which has the

forces in opposition to one another.

3. Give a weighting to the forces - those that are stronger and more powerful than others.

4. Focus on the restraining forces, and assess which of the significant ones that need to be

worked on, and those which can be worked on.

5. Develop plans for reducing these forces.

Details on the force field analysis will be discussed in the stories and outcomes chapters for

Cycle 1 (Chapter 4) and Cycle 2 (Chapter 6)

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Third-person research refers to inquiry beyond the second person which involves inquiry through

research journals or publications by third-party participants (Coghlan and Brannick, 2010, p.8).

For my third-person research, I will be incorporating lean six sigma tools in my action research

Lean six sigma

Lean Six Sigma is a business process improvement framework that aims to improve speed,

quality, and overall customer satisfaction. It both combines tools from both lean and six sigma.

Six Sigma was developed by Motorola in 1986 ​(George, 2003)​. Although six sigma was originally

developed for the manufacturing industry and it has seen success for two decades, the service industry is

seen to benefit from the application of the set of tools used in six sigma (Patton, 2005).

Define simply refers to defining the issue, scope, project team, and the project sponsor. During the

measure phase, this is the time we measure the current state. We quantify how the gravity of the issues as

well as factors that might affect the primary issue we are addressing. We also conduct process maps or

value stream maps in order for us to get a holistic view of the process and potential pinpoint the

bottleneck. Next phase is analyze phase. During this phase, our objective is to analyze the potential root

causes of the issue. Once potential root causes are identified, we need to validate the root causes through

various statistical methods such as hypothesis testing and designs of experiments. Once root causes are

validated, the next phase is improve. During this phase, the objective is to identify and implement action

items in order for us to address the root causes. We will also be monitoring the result of the action items.

The last phase is control. During this time, we implement controls within the process in order for us to

prevent from going back to the current state ​(Benbow & Kubiak, 2005)

Lean and six sigma are two separate methodologies since the 1980s, as mentioned above, six sigma was

developed by Motorola specific to the manufacturing setting, lean was developed by Toyota, under the

Toyota production system. Lean is simply defined as a principle that aims to eliminate waste. As defined
30

by Womack and Jones (1996) “a way to specify the value, line up value-creating actions in the best

sequence, conduct those activities without interruption whenever someone requests them, and perform

them more and more effectively. In short, lean thinking is lean because it provides a way to do more and

more with less and less – less human

effort, less human equipment, less time, and less space – while coming closer and closer to providing

customers with exactly what they want.”

Details on how lean six sigma was incorporated will be shown in the story and outcomes part of the

paper.

Role Duality

“While doing this action research I have to manage my role as a member of the organization I’m working

on and a researcher. Below is a detailed description of what are some challenges a researcher may

encounter during their research.

“Your organizational role may demand total involvement and active commitment, while

the research role may demand a more detached, theoretic, objective and neutral

observer position. This conflict may lead you to experience role detachment, where

you begin to feel like an outsider in both roles” (Adler and Adler as cited in Coghlan & Brannick, 2010, p.

138).

The main challenge I encountered was incorporating the action research framework with my

problem-solving approach. As a process excellence project manager, I did not encounter role duality

issues with regards to managing my time as a researcher and an employee within the organization since

my main role is to lead process improvement projects. However, I was having difficulty leading a project

using a framework that I don’t use. Prior to doing this action research I was already leading different

process improvement projects but using frameworks such as lean six sigma and kaizen. However, I

learned that I can incorporate different frameworks to action research cycles. Also, since I will be using
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company data, I ensured that no sensitive information will be added such as customer names, details and

other sensitive information. However, upon checking with my leaders, operational data is allowed as long

as employee and customer names are not shown.

Organizational Politics

Each one has it's political dynamics which the action researcher must understand and manage as this can

affect any actions or implementation (Coghlan & Brannick, 2010).

At the start of the research, ​I fo​resee several potential roadblocks in terms of getting credit for the action

plans and recognition of the potential success of the project. Since my members are managers from

different departments such as quality, training, and operations, each leader of the department might want

to get credit for the action plans implemented at their respective area. Also, another issue that I might

encounter was the departmental leaders might hold back on their inferences or let people know of the

issues that are happening in their department.

To remedy this, at the start of the project initiation, after discussing the objective of the project, I

highlighted the facts on the benefits for the organization and their work. Below are sample benefits for

each department if we reduce our average handle time

● Operations: Reduction of operating expense as there is no need to hire unnecessary headcount.

There will also be freed up capacity which can be used for coaching and training. Overtime will

also be reduced

● Training: ​Speed to proficiency will be reduced.

● Quality: Quality metric will increase as our action items are geared towards providing faster and

more accurate resolutions

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Change Management

Since this action research aims to reduce average handle time of the line of business our team us

supporting, the change will be necessary not only in the process but with the thinking of everyone

involved in the research. I will be using Lewin’s Change Theory framework to manage change during the

course of this research.

Developed by Kurt Lewin, the framework is a three-step process to introduce change in the process. The

three stages are unfreeze, change, and refreeze which can be seen below.

Figure 7: Change Management Process

Source: ​http://www.strategies-for-managing-change.com/

Unfreezing is the first stage of the framework and it refers to people being unready for change to being

ready and willing for change (Petrescu, 2010). It is imperative that involved people realize that there is a

need for change they understand the positive impact for them. At the course of the research, everyone

involved will be reminded of what’s in it for them.

The second part of the phase is change or the transition phase. Participants are making changes and are

moving towards the ideal state. This period is the most difficult for participants are there is uncertainty

and people are to adjust (Petrescu, 2010). During this phase, we are monitoring the actions taken as well

as the AHT and metrics associated with AHT. Weekly meetings are also being done to discuss challenges

and if there are any changes that need to be done with the actions taken.

The last phase is the refreezing stage. During this phase, stability must be instilled and the changes must

be sustained (Petrescu, 2010). As mentioned above, we are holding weekly meetings to monitor the action
33

items ensuring that they are being implemented. Also, once the project is successful and we’ve met our

target, control points in the process will be placed. A control plan will be created.

Ethical considerations

Doing this action research goes beyond financial savings and efficiency gains for the company. Since our

company is in the service industry which is highly dependent on its people, it is imperative that we

consider their well being as well. During my first person research, I have noticed that employees are being

asked to work overtime during lunch break and after their shift to cover the call volume being allocated to

us. The volume being allocated to our center is based on the calculation of average handle time and the

number of employees. Whenever the program fails to hit the AHT target, calls will accumulate and they

have to take in more calls to address the volume. A report by Manila times illustrated a study by the

International Labor Organization Asia-Pacific stating that in 2016 reports show high levels of stress

common in the BPO sector, particularly in contact centers. Call center agents entertain 78-100 calls per

day and respond to at least 91 percent of the calls within 22 seconds, and then were given five to six

minutes to address clients’ requests, the study also showed.

In the same study, health problems experienced by employees include headache, fatigue, back pain and

voice problems which are made worse by working night shifts since most BPO operations serve the

American and European markets causing disruption in work-life balance and psychological well-being.

The study further revealed the higher incidence of HIV/AIDS compared to other sectors of the labor

workforce ​(“DoH to address BPO health issues | The Manila Times,” n.d.)

Addressing failure to hit the average handle time will help the agents reduce and eliminate unnecessary

overtime on their end.

34

Ethics is a part of life and as well as research (Coghlan and Brannick, 2010, p.11), having said that, when

choosing an action research, it is critical that we consider the ethical factors and how will it affect the

people in your organization.

35

IV. Story and Outcomes

This chapter describes the activities done during the first cycle of this action research, which aims to

reduce average handle time by from 1130 seconds to 900 seconds.

Constructing

For me to understand the process better and focus on the impactful areas, I decided to look into the data to

understand the volume of the calls we receive. I extracted one year worth of call volume of the enterprise

for the year 2018.

Looking at the data, top 3 calls contributed to around 55% of call the entire call volume. I

decided to remove the call classified as “Opportunity”. The reason behind the call volume is that

for every call, agents have to do a reminder to the caller on their maintenance. This happens to

almost every call hence it’s call type with the highest volume. Instead, I will be focusing on the

top 3 call types which is review member eligibility/benefits, search provider and claim history. I

will be using Schein’s (1999, 2013) ORJI model for me to understand and organize my internal

thoughts as well as reflect on my findings.

I will be going through a separate ORJI cycle for each of the call types I decided to focus on.

Table 2: ORJI for "Review of Medical Benefit" Call Type

ORJI Step Review of Medical Benefit

Observe For review medical benefits, the primary reason for calling is caller is asking

whether their health insurance plan will cover their procedure. After the caller asks
36

their query, the agent will have to do research on their knowledge base called

“IBAAG”. The agent has to use ctrl F on their PC to look for the information. In

addition to IBAAG, they also have to go to three different knowledge sources in

order to verify the scope of the plan of the caller. Once the agent locates the article,

the agent has to explain the benefit completely and in such a way the caller will be

able to understand it.

React When I saw how agents key in the required information in their IBAAG tool and

navigating to multiple tools. I personally felt that we failed to provide them tools in

order for them to be more efficient

Judge The knowledge base is confusing to use as it is text-heavy which the agents have a

hard time understanding the content. Aside from this, agents have a tendency to

just read out the content of the article without understanding and summarizing it

for the caller which leads to the caller not understanding anything and they will ask

again. Making the caller wait just for the agent to toggle multiple screens in order

for them to provide the correct resolution is non-value adding for the caller.

Intervene Having this in mind, I reached out to our training team and operations team to

address the skill and will issue of the agents. Also, I presented my findings to the

software development team for us to automate some of the navigation of the agent
37

Table 3: ORJI for "Review Claim History" Call Type

ORJI Step Review Claim History

Observe The call starts by the caller expressing their concern on the bill that they are not

aware of. During this time, the agent has to verify the identity of the caller. Once

everything is verified, the agent has to input the claim code to different knowledge

bases to understand why the claim was denied. Once the information is gathered, the

agent will either have to reach out to the doctor or healthcare specialist to advise the

error or if there is no error, the agent will have to provide the resolution to the caller

React When keying in the required information in the claims code, agents have to go to

multiple sources as well. I felt sorry for the agents.

Judge When searching for the details of the claim such as what type and place of service,

billing details, and other relevant information, agents are having a hard time as they

have to read through multiple tabs and ranges in order for them to know which area

will the code fall under. In addition to this, attempting to reach out to doctors takes

too long as well. Aside from straining their voice taking in calls, they are also

straining their arms and fingers when doing unnecessary movement in their desktop

Intervene When I reached out to the developers, I shared with them the logic that the agents do

when searching for claims details. It’s not as simple as using CTRL F and doing a

lookup. They have to manually check where the code will fall under based on
38

alpha-numerical ranges. We will also incorporate this feature on the automation tool

that will be built.

Table 4: ORJI for "Provider Look-up" Call Type

ORJI Step Provider Look-Up

Observe For this call type, the primary reason for calling is to ask where is the

nearest accredited doctor or healthcare specialist. It starts by the caller

asking the agent whether the doctor or healthcare specialist is accredited or

not. Also, they will be asking the contact details and location of the facility.

Once the information is given to the agent, they have to input the

information within “Rally”, “Cosmos” or “NICE”. This is their database

where provider details are located. The agent also has to do outbound calls

to verify if the information in the database is updated and correct

React I felt bad that they provided agents knowledge bases that are too complex

for people without medical background.

Judge Some articles within IBAAG are too long and complex which includes

medical terminologies. Agents tend to just read out the articles within the

IBAAG without understanding and paraphrasing it to the caller.

Intervene I will be partnering up with our training team to come up with materials on

how to navigate and understand IBAAG better. Aside from the reference
39

materials, additional training to the agents on how to probe the caller for

them to understand the specific procedure the caller is asking

In order for me to avoid jumping to conclusions and imposing my views to second-person

audience, the ladder of inference will be used. The ladder of inference is used to avoid bias and

conclusions without testing out the hypothesis first.

Table 5: Ladder of Inference for Cycle 1

Steps Conclusion

I observe data and experiences I observed an opportunity for efficiency.

Looking at our AHT data, we are averaging at

1190 seconds pre-implementation of some of

our action items vs. the target of 900 seconds.

I select data from what I observe I am focusing on hold time and after call work
for my AHT study. Hold time and after call
work is non-value adding activities for our
callers.

I add meanings (Cultural and personal) I think agents are intentionally prolonging

their hold time and after-call work.

I make assumptions based on the meanings I assumed that agents are intentionally
added
prolonging their hold time and after call work

so that they can rest while taking calls

40

I draw conclusions I concluded that the long hold and after call

work time may be attributed to the

knowledge-base of the agents is quite

confusing to use and sources of information

are housed in different knowledge bases and

tools

I adopt beliefs about the person and the The issue is a combination of skill, will and
situation
technology-related issue which is caused by

lack of process governance, appropriate

training, and support and streamlining of

tools.

I take actions based on my beliefs I will be proposing the following potential

solutions and will partner with different

departments to plan and implement the below

actions

● Revision of new hire training

curriculum that focuses on hard to

handle review medical benefit calls.

Training will place more emphasis on

understanding medical terminologies

● Additional training for current

41

employees on probing, communication

and product and process knowledge

especially on quoting of medical

benefits to callers

● Setting a threshold of 3 tries during

outbound calls to doctors while

placing the caller on hold

● Single screen desktop automation that

pulls information from different

sources
42

Right hand/left hand

Below is an instance on how I used the right hand/left hand technique developed by Dr. Chris

Argyris for me to uncover your own privately held inference. During one of my discussion with

my stakeholders, I felt I was being pressured to complete this action research in less than a

month. The client is putting pressure on our operations leaders and that pressure is being passed

on to us. With doing action research, we cannot fast track and skip the different phases just to

place a band aid solution. Below is an illustration of my privately held inferences which was

done during one of our team meetings.

Table 6: Left-hand / Double Column for Cycle 1

What was I thinking What we said

I was thinking that we need to address this as
quickly as possible but placing band aid
solutions will only make things worse as it
will add workload to our employees only to
find out we’re back from where we started
Me: ​“Okay, I would like to propose on
leading this project. However, I’m going to
need resources and enough time to identify
the root causes and come up with actions

Stakeholder:​ “Can we expect the action plans

by next week? We need to have something
presented to the client”

I’m thinking that we can’t come up with a
proper action plan with that kind of timeline.
We would be implementing band aid
solutions if we don’t take the time to evaluate
the issue.
“​We can come up with action plans for issues
considered as low hanging fruits then we can
implement additional action plans as we go
along”

Having done this, I have set up a meeting with me and my project sponsor regarding how we do

things. I have expressed my concern that we had a tendency to present plans and

recommendations to the client without carefully planning things. I have raised that proper
43

problem solving takes time and there are steps to follow. Simply coming up with something will

now always work and it will place additional burden on people in operations. I have suggested

that we need to be firm with the client but they will be involved every step of the process.

Before conducting focus group discussions, it is imperative that the participants understand what

are we trying to achieve in this action research and for me to get their full cooperation on this

project. The way I shared the business case to the different process owners was following the

four parts of speech (Torbert and Associates, 2004)

Four Parts of Speech

1. Framing:​ The purpose of different departmental leaders being involved in the project is

for us to have different points of view of the process. We will be working together in this

action research with the goal of reducing average handle time for our line of business

while not compromising different metrics especially our net promoter score. I have

shared they are the best people to address this issue since they are closer to the project

than I am.

2. Advocating:​ I have shared that we will be targeting to reduce the AHT from an average

of 1150 to 900 seconds by October 2019.

3. Illustrating:​ I shared my initial findings during my 1st person research and my

inferences based on the data I was able to analyze.

4. Inquiring:​ We will be having a focus group discussion together with representatives

from operations, training, quality and me from the process excellence department as the
44

project lead. Findings of the focus group discussion will be seen during the confontive

inquiry.
45

With this, we decided to brainstorm as well as look into the process in order for us to identify

potential root causes. Using lean principles, we decided to do process value analysis for us to

classify each step of the process whether they are value-adding business or simply a waste.

Process waste is simply defined as any activity in the process that does not add value for the

customer (Fritze, 2016). Process waste can be classified into the following

1. Transportation: Any movement of material that does not add value

2. Inventory: Excess inventory that is not needed at the moment

3. Motion: Movement of people that do not add value

4. Waiting: Unnecessary idle time

5. Overproduction: Also known as the queen of all waste. This is the production of goods or

services in excess of the demand.

6. Overprocessing: Doing more than what is required

7. Defect: Also known as rework. Any product or service that does not conform with the

customer’s specification

8. Skill: This is unutilized talent

Having this in mind, we started by mapping out the processes of the top 3 call drivers so that we

get a holistic overview and understanding of the process. It will also allow us to visualize any

bottlenecks or pain points in the process.

46

Process map for review claim history

Figure 8: Process Map for Review Claim History

47

Process map for provider lookup

Figure 9: Process Map for Provider Look-up

48

Process map for review medical benefits

Figure 10: Process Map for Review Medical Benefits

After conducting the process mapping and process value analysis, summary of findings are

below.
49

Table 7: Summary of Process Waste for each call type

Call Type Step in the process Type of waste

Review claim history The agent has to check 3 Motion

sources just to verify
information on the medical
claim is correct

Provider lookup The agent has to check Motion

multiple sources just to get
the contact details of
healthcare specialists

Provider lookup The agent has to put the caller Waiting

on hold do outbound calls to
verify whether the
information in the database is
correct and the healthcare
specialist is within the
network

Provider lookup The agent has to schedule a Defect/Rework

call back to the caller and
healthcare specialist if no one
picks up

Review medical benefits The agent has to check 3 Motion

sources just to verify and
determine the benefit that an
agent will quote to the caller
50

Below is my discussion with different process owners and their replies using Schein's types of inquiry.

Types of Inquiry

Pure inquiry question: ​What can you say about our average handle time?

1. “​We’re not meeting the target, agents are rendering overtime just to answer the call volume”
2. “Agents are being burnt out due to overtime due to our AHT”

Diagnostic inquiry question: ​What do you think are some factors contributing to the long AHT of our
program?

1. “​Agents are having a hard time researching and understanding the benefit and medical
terminologies for review medical benefit calls”
2. “If agents are performing in NPS, they tend to have a lower AHT”
3. Agents who adhere to quality parameters tend to have lower AHT”
4. “Agents are intentionally prolonging hold time for them to take a rest”
5. “Reaching out to providers are taking too long a some of them don’t even answer”
6. “Agents are not answering the right questions when interacting with callers and there is an
opportunity on thought organization”

Confrontative inquiry A: ​Have you considered that this is not entirely the agent's issue but the
lack of controls within the process?

1. “That can be a factor. There is no written and communicated guidelines on policies

regarding average handle time.

Confrontative inquiry B: ​Why do supervisors allow long handle time by the agents? Do they
not prioritize the average handle time since this is not the focus metric of the client?

1. “That can be a reason. It really does not impact their scorecard”

2. “They might not be aware of the negative implications of long AHT. They also don’t
have visibility on which agents to focus on and what are some causes”
51

Aside from the above responses, we decided to use a lean tool called Ishikawa diagram for us to
better understand the cause and effect relationship of the issue.

Figure 11: Fishbone / Ishikawa Diagram

52

In order for us to validate our findings, we would be needing to test our hypothesis. Following
the seven rules of hypothesis testing (Argyris et al. as cited in Coghlan & Brannick, 2010, p. 37).
I have summarized and tested assumptions using the table below.

List of Hypothesis/Root Causes

Table 8: Summary of Findings Per Issue

List of
Source of
Hypothesis/Root Validation Method Findings Result
Data
Causes
Detractors tend to Reject the null hypothesis that
have a longer AHT Comparison of AHT per NPS and AHT for each type of survey are
Appen
compared to survey type to be tested by AHT raw equal. Detractors tend to have
dix A
promoters and Kruskal-Wallis H test Data longer AHT than the other survey
passives types
Accept the null hypothesis that
Comparison of AHT per Quality
Agents with a high there is no significant difference
quality quartile report and Appen
quality score tend to in AHT depending whether the
classification to be tested AHT raw dix B
have a lower AHT agent is classified as a performer
by Kruskal-Wallis H test data
in the quality metric
Complexities
understanding
Audit and
contents in IBAAG
findings
and agents have are Current curriculum does not place
Call listening by quality from Appen
have opportunity on emphasis on quoting of benefits
department quality dix C
thought organization which is our top call driver
departme
and probing when
nt
quoting medical
benefits
Getting code related Time and motion study on Reject the null hypothesis that
information from the process step to be Random AHT is less than 1 minute. Appen
multiple sources takes validated by One Sample sampling Sample mean equated to 356 dix D
longer than 1 minute T-test seconds
53

There is no threshold Random sampling on

on how many tries number of tries per call to
Random Reject the null hypothesis that Appen
agents have to do just be validated by exact
sampling number of tries in a given call is 3 dix E
to reach out to Poisson test. Validate if
providers. more than 3

Based on the findings above, below are the action items that will be implemented. Each of the
action will be evaluated and a force field analysis will be done to evaluate constraints for each
action item

Summary of Root Causes

Table 9: Summary of Action Items per Issue

Implementation Type of
Issues/Root Causes
Action Items Owner Date Action
New hire training curriculum
Complexities understanding redesign and refresher
contents in IBAAG and training on agents in
agents have opportunity on production. Module focuses Training
improving thought on review medical benefits. team and June 2018
organization and probing Curriculum includes proper operations
when quoting medical probing, exercises on quoting
benefits of benefits and thought
organization
There is no threshold on
how many tries agents have
Operational
to do just to reach out to Set a standard of 3 tries
Operations June 2018
providers. Validate whether during outbound calls
agents are trying not more
than 3 times
Create a dashboard that
separates hold time, after call
Operations
There are currently no work and talk time. View will
and
performance management include agent level, team June 2018
reporting
process in place for AHT leader, manager and site
team
level, Agents will be divided
into quartiles depending on
54

their performance. Additional

coaching and performance
management will be given to
agents under quartile 3 and 4
Multiple screens just to get Single screen desktop
Software
code and diagnostic related automation on pulling of Automation
engineerin September 2018
information. Takes around information from multiple
g team
356 seconds sources

Force field analysis

2 sets of force field analysis was done depending on the type of action item. The first is for the

operational action item. This type of action item is faster and requires less resources to

implement but is harder to sustain. During our meeting to finalize the action items, we listed

down the driving and restraining forces for each type of action item. I asked the team to rate each

force between 1 to 5 which 5 being the highest in terms of strength of impact. We can see below

that having a better targeted performance management has the highest impact based on the

feedback from the project team. However, resistance from performance management is also the

highest in terms of the resisting forces. The driving force scored higher than the resisting force

and we decided to move forward with the change. During the implementation, careful

monitoring will be done on the restraining force that scored the highest. Since the driving force

outweighs the opposing force, we will proceed with the action plans.
55

Figure 12: Force Field Analysis for Cycle 1 pertaining to operational action items

For the second set of action item which is the automation related, the only glaring restraining

force is the cost of development. Based on the quotation, the cost of development and

maintenance will run around $12,000 per year. However, based on our study, annual savings for

us will be at around $250,000 per year due to reduction in hires that will be anticipated the next

coming months. An equivalent of 16 full time employees will be saved through capacity creation

due to this automation annually. This saves the cost of hiring more people to handle the volume.

With automation, we have more guarantee that we will be able to reduce AHT. Similar to the

first set of action, the driving force is greater than the restricting force. Hence, we will proceed

with the implementation.

56

Figure 13: Force Field Analysis for Cycle 1 Pertaining to Automation Intervention
57

Planning and Taking Action

On the 2nd week of June, the team and I was able to finalize and validate root causes, come up with

action items, and start implementing the operational action items. First part of the action plan was making

changes on the new hire curriculum and refresher trainings for agents who are already in production. The

training will last for 4 weeks and training will be conducted by different owners.

Table 10: Activities Related to First Set of Interventions

Week Activity Audience Focus Owner Duration

Ace Focus Advocates
Communications Behavior Focus:
Group - ACE
1 Clinic - Clear and -Clarity of Speech ACE 1 hour
Focus -Answering questions
Concise
directly and quickly
Focus : AHT Outliers
correlated to high number
of of detractors

Discuss Reading benefits

Group - AHT
1 Benefit Reading Drills Benefit Reading Drills
Operations 1 hour
Focus
Benefits: Top 3 frequent
Benefits
- DME, Minor Lab,
Chiropractic,
Call Type: Dental
Advocate opp: Ownership
NPS Call Listening: and accountability (
1 Group - All outreach, Scheduling Call
Operations 1 hour
Dental
Back , providing options
for no coverage)
Sched Assist Outliers
Group - Sched
2 Schedule Assist Drill Positioning/Assumptive ACE 30 minutes
Assist Focus Delivery and overcoming
objections
Scenario - based
Call Type: Dental rider
2 Product Drill : Dental Group - All with provider outreach CapDev 1 hour
Focus Behaviors:
Ownership & Confidence
Quality Calibration : Dental IR Drivers + PE+
2 Group - All BR
CE 1 hour
Dental
58

Scenario - based
Call Type: Preventive
Care with provider
Product Drill :
3 Group - All outreach CapDev 1 hour
Preventive Care Focus Behaviors:
Ownership, Navigation
and Probing
Claims - Not on File,
3 NPS Call Listening Group - All Claims Paid - Copayment Operations 1 hour
Inquiry.
Ace Focus Advocates
Communications Behavior Focus:
Group - ACE
3 Clinic - Clear and -Clarity of Speech ACE 1 hour
Focus -Answering questions
Concise
directly and quickly
Scenario - based
Call Type: Claim not on
Product Drill : Claim
4 Group - All file CapDev 1 hour
not on File Focus Behaviors:
Navigation and Probing
Quality Calibration : Preventive Care IR
4 Group - All Drivers + PE + BR
CE 1 hour
Preventive Care
59

In addition to this, since we are planning to set a threshold on the number of tries when doing

outbound calls to three, we have verified with the client whether this will be permitted. As

advised, there are no impact on quality if ever we implement this standard. The third action item

we implemented is the performance management through visualization and quartile

management. I have designed the dashboard and asked our reporting team to implement the

dashboard on June 2019. It classified agents into quartiles based on the sum of their after call

work and hold time. The objective of this is for us to monitor which agent have opportunity in

reducing the non value adding time in the process. Also, the dashboard shows their performance

as days and weeks go by. Team leaders will be held accountable in coaching the agents that

belong to quartile 3 and 4. Sample view of the dashboard can be seen below.

Agent View

Figure 14: Agent View of Dashboard for Average Handle Time Performance Agent View
60

Weekly View

Figure 15: Agent View of Dashboard for Average Handle Time Performance Weekly View

Employee Status and Summary View

Figure 16: Agent View of Dashboard for Average Handle Time Performance Status View
61

For the automation related action items, I had a series of meetings with the software engineering

team and operations to propose and plan the development of the tool we recommended. Post

implementation, information for resolution for review medical benefit and claim history can be

sourced from three different portals which is shown below. Based on our time and motion study,

the process takes 356 seconds since agents have to toggle to multiple screens and look for the

information they need.

Table 11: Tool Description for knowledge base

TOOL DESCRIPTION
KNOWLEDGE
TOOL NAME USAGE URL CENTRAL JOB
AID ARTICLE
http://kl.uhc.com/results.a Part B and D Covered
KNOWLEDGE To determine procedure /
spx?Mode=&cat=Codes Drugs - HCPCS
LIBRARY service ​Name
&Include= 01142019 v2 MASVC

Organization
http://kl/links/Provider%
PROVIDER Determinations -
To determine if specific code 20Notification%20List%
NOTIFICATION Navigating the Prior
requires ​Prior Authorization 20Master_Medicare.htm#
LIST Notification List
SFL_Instructions
04202018 v2

http://training.uhc.com/K
M/External_Doc_Reposit
Claims Codes and To determine additional details ory/Claim%20Codes%20 Claims Codes and
ICES - Code (Billing, Claim description, and%20ICES/Claims%20 ICES - Index
Definitions (Maestro) etc...) Codes%20and%20ICES 03062015 v3 MASVC
%20-%20Code%20Types
%20MASVC.html
62

Below is the proposed view of the single screen automation tool that will be built. Agents will

just have to enter the claim code and then the tool will fetch information from different sources.

Table 12: Automated Tool Expected Outcome

AUTOMATION TOOL EXPECTED OUTCOME

PROVIDER
NOTIFICATIO
ENTER KNOWLEDGE LIBRARY ( Claims Codes and ICES - Code
N LIST ( PA
CODE CODE DEFINITION ) Definitions
REQUIRED Y/N
)
99213 ​Office or other outpatient visit Place of Service: 11 ( Office )​ - Location,
for the evaluation and management other than a hospital, skilled nursing
of an established patient, which facility (SNF), military treatment facility,
requires at least 2 of these 3 key community health center, State or local
components: An expanded problem public health clinic, or intermediate care
focused history; An expanded facility (ICF), where the health
problem focused examination;
professional routinely provides health
Medical decision making of low
examinations, diagnosis, and treatment of
complexity. Counseling and
coordination of care with other illness or injury on an ambulatory basis.
99213 physicians, other qualified health N CPT Code Range: ​99201-99499
care professionals, or agencies are
provided consistent with the nature
of the problem(s) and the patient's
and/or family's needs. Usually, the
CPT Category: Evaluation and
presenting problem(s) are of low to
moderate severity. Typically, 15 Management
minutes are spent face-to-face with
the patient and/or family. - Last
Update 7/1/2019

The tool is expected to be completed starting September 2019 and user acceptance testing will be

completed by the first week of September. If all goes well, the tool will be provided to all agents

starting the 2nd week of September 2019. Based on the feedback of the software engineering

team, the tool will be able to output the information in less than 5 seconds.
63

Evaluating Action

To evaluate the success of the action items, I monitor the movement of average handle time on a

daily basis. Currently, only the operational action items have been fully implemented while the

automation tool will be rolled out by September 2019.

Figure 17: Descriptive Statistics for the Average Handle Time per month

We can see that on the AHT decreased pre-implementation from an average of 1150 to 999

seconds post implementation. Aside from the mean, looking at the boxplots, dispersion also was

reduced. Although the data point for August only includes the 1st week of the month, the team

will make an effort in sustaining the improvement.

Aside from looking at AHT holistically, we will also monitor the hold time, after call work and

talk time.
64

Below is the descriptive statistics of hold time, after call work and talk time.

Hold time

Figure 18: Descriptive Statistics for the hold time per month

After call work

Figure 19: Descriptive Statistics for the after call work time per month
65

Talk time

Figure 20: Descriptive Statistics for the talk time per month

Looking at each component, all three was reduced. However, talk time and after call work was

more significant than hold time. As the AHT performance is seeing consistent improvement, the

program still haven’t hit the target. Reducing the AHT further to 900 seconds will be done

during the second cycle of this research.

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Figure 21: Net Promoter Score for May - August 2019

Since NPS will also be monitored, looking at the data above, NPS performance from May to

August have been consistent. We are exceeding the target the client target of 72. During the 2nd

cycle of this research, action plans will be evaluated that it will not impact customer experience

negatively to ensure that NPS won’t be compromised with the reduction in AHT.
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V. Meta-Learning after the First Cycle

My reflection and meta-learning can be illustrated using Mezirow’s 3 forms of reflection:

content, process, and premise (as cited in Coghlan & Brannick, 2010, p. 12):

Content

While doing this action research, I was initially unsure whether this is the right problem we

should be addressing. Average handle time is not a priority metric of our client. The client’s

priority metric is NPS. I had felt that I should be solving a problem that has more impact on the

business. Following the Lean Six Sigma equation Y=F(X), this tells us that Y is the dependent

metric and it is influenced by independent factors. Upon undergoing the first cycle, we came to

realize that AHT contributes to the success of NPS. Upon looking at the top detractor surveys,

callers are getting upset as they are waiting in the queue and on hold during a call for too long.

We realized that the length of the call or average handle time impacts net promoter score.

Whenever a call is placed on hold for too long, leads to a negative survey score. However,

influencing the talk time by shortening it drastically may also lead to a negative detractors as the

caller might feel that the agent is in a hurry and they won’t be able to explain the resolution at a

proper pace. Aside from this, they are getting incomplete or inaccurate resolutions from the agent

which results in them calling again or asking more questions during the same call. By addressing

our AHT issue, we would be potentially improving the NPS as well. Since we know NPS is a by

product on how well the caller or customer experience is, rather than addressing NPS directly,

we should look at the drivers or factors contributing to NPS which AHT is one of them. One of

the value of Lean Six Sigma is that it allows us to look into the root causes or factors
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contributing to the primary problem rather than addressing the metric itself. By doing this, we

address the underlying issue rather than the symptom of the problem.

Prior to me starting the action research, I had an underlying assumption that AHT in our case is

primarily driven by a behavioral issue as this is what I saw most of the time based on my

previous projects within different companies. We would see agents intentionally placing

customers on hold even though there is no need to, they are also ending the call intentionally and

classify the incident as a technical issue for them to shorten their AHT. From all of this

observation, I had a misconception that this might be happening in this line of business as well.

Also, what I was reflecting on prior to me undergoing the action research cycle, is that sine the

organization is in the service industry and the process is dependent on its employees, the

behavior of the employee will be the number one root cause of the problem. However, having

gone through my first cycle, I came to realize that we need to take this further and ask why are

employees having behavioral or the other issues identified. We should go beyond what the

available data and process maps are saying and involve the actual process owner itself to get

their insights and held notions.

Process

During gathering data which includes AHT reports, process maps, cycle-time related data which

was gathered through time and motion studies, and feedback from different process owners.

After doing our root cause analysis using Lean Six Sigma tools which involves applying

statistical analysis, process mapping and value analysis, I and the team have concluded that the

issue is a combination of skill, will and technology-related issues. The main challenge I

encountered was on stakeholder management. Using the action research, we need to convince the
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leaders of the line of business that we will be able to address the issue based on our findings and

recommendations. Since there will be investment coming from them in the form of allocation of

resource people that will be creating the training curriculum, conducting the training, revamping

the reports, and developing software, we need to ensure that our actions are targeted and for us to

deliver what is expected from them. Aside from stakeholder management, the buy-in of the

process owners is also critical. Since the process owners are the ones implementing, we need to

convince them about the benefits of the action items. To overcome this challenge, we ensured

that everyone including the stakeholders and process owners is part of the action research.

During the root cause analysis and solution identification, we held a focus group discussion with

the agents and different process owners and asked them if they were to change, design or

eliminate steps in the process, how would they do it. We also let them interpret the data we

analyzed ourselves to ensure that everyone is aligned. Action plans were also solicited from

them. Lastly, Lastly, action plans were communicated in such a way that it highlights the

benefits for the organization and the way the process owners do their work if ever this action

research is successful. With the stakeholders, there were weekly reviews with them so that

feedback will be real-time and everyone is aligned. During my research, I realized how critical it

is to involve other employees outside of the project team in this action research. I noticed that

once we get their buy-in and they feel involved in the whole process, implementation is more

efficient and they are more open and excited about the change.

Premise

As I have mentioned above, the challenge was getting the buy-in of both stakeholders and

process owners. Aside from approving and agreeing on the action items, the approach on how to
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solve the problem also needs to be confronted. Due to tight schedules and wanting to hit the

AHT target as fast as possible, it would be tempting for process owners to apply band-aid

solutions. I have observed this so many times in the organization. Whenever there is an issue,

they are quick to jump into solutions to address it. However, they don’t realize that there is an

underlying issue with every problem. Applying band-aid solutions might work temporarily,

however, this has a tendency to fail and we’ll end up going back to where we started.

Undergoing action research might take time since we have to go through each cycle and ensure

nothing gets skipped for us to really understand the underlying root causes of the problem.

During my brainstorming, even I was tempted to recommend and implement action items

without undergoing the action research cycle. However, I restrained myself since I convinced

myself to go through this research with a blank slate.

With this action research, I came to realize that it is not merely implemented to reduce average

handle time but to also change the perspective and the way we solve problems. We should not be

quick to jump to a conclusion just because of what the data is saying. I realized that previous

experience makes us biased when selecting data and overall directing the approach to how we

address issues. We should ensure that we participate in the research with a blank slate. In the

past, I had the tendency to tailor fit my approach based on my previous experience. This had the

tendency to implement action items which will result in little to no improvement.

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Chapter VI Action Research Stories and Outcomes, Cycle 2

Constructing:

After cycle 1, we were able to reduce average handle time from an average of 1130 seconds to

999 by August. However, our client's target is 900 seconds. Hence, we decided to enact another

action research cycle. Looking at the data, aside from reducing the average handle time, we

were also able to reduce dispersion of the average handle time. We have also seen some positive

gains on our NPS. Complaints regarding long handle time decreased from an average 9% for the

periods May to July to 7% for the month of August 2019.

Data below represents the % of complaints in terms of long hold in proportion to the overall

survey count for the months indicated on the X axis of the graph.

Figure 22: % of caller complaints pertaining to long hold

Source: Operational dashboard Jan-Aug 2019

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During cycle 1, we have identified an opportunity to implement a single screen desktop

automation tool that aggregates critical information from multiple sources such as different web

portals into one screen which is needed by the agents in order for them to provide the resolution

to the caller.

To validate this, we did time and motion study to validate how long does it take to pull up

information for our top call types which are review medical benefits and claim history.

Figure 23: Time and motion study on manual process

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During the time and motion study with did a random sampling using a sample size of 20

observations, the process takes around 350 seconds or almost 6 minutes just to get the

information needed. Gathering of information is applicable to 30% of the volume for review

medical benefits and claim history. This will impact approximately 10% of all call volume in

terms of the average handle time.

The next step is to present the findings and recommendations to the project sponsor. I partnered

up with the automation team to come up with the cost and impact of implementing this action

plan.

Figure 24: Financial Impact Estimation

Financial impact is illustrated as follows. It is estimated that with the current process, we are

spending $702,000 to cover for our inefficiencies. After implementing the automation, we

estimate that we will reduce operating expense by $363,442. Net benefit will equate to $338,558.

Financial calculation is based under the assumption that time reduced from navigating the tools
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and making the caller wait can be used to take in more calls while ensuring occupancy which is a

measure on how occupied agents are in a call is controlled to the threshold of not more than

85%.

I have presented the findings to the project sponsor and the director of operations and they are

supportive with the development of this tool.

My next step is to partner with the software engineers under the automation team to plan the

next steps with the software engineers under the automation team.

Figure 25: Email from the project sponsor expressing support on the project

Planning Action

Now that we have identified the need of developing the automation tool, we have to plan our

next steps in order to develop this tool. For our planning phase, we have to understand the logic

of the process so that we can incorporate this in our tool. Aside from this, we have to identify the

potential failure points process and technology wise. Lastly, we have to plan our timelines to

ensure that the tool will be developed and tested by the 2nd week of October 2019.

To start the development, we need to partner with our software engineers from the automation

department. For the month of August, I had a series of meetings with the software engineering

team to walk them through the identified areas of opportunity. Most of the discussions were done

to plan the logic of the tool. We want to ensure that quality of work will not be compromised.
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Below is the current manual process flow which we documented. This will be used to plan the

technical design of the tool.

​Figure 27: Process Flow on the Current Process when retrieving code related information

Diagram shown above is documented by the business analyst from the automation team.
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Once we have documented and observed how agents do the process, we had to come up with the

logic and identify potential errors we might encounter. The design of the tool is as follows.

​Figure 27: Process Flow and logic on how the automation tool retrieves the information

Diagram shown above is documented by the business analyst from the automation team.
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After designing the back end and logic of the tool, we ensured that user interface is clear and

easy to use. We have presented a recommended view to the subject matter experts and we have

received good feedback. Sample interface are as follows.

​Figure 28: Preliminary User Interface Design of the

Note that the user interface above is just a proof of concept. This is not the final UI of the tool.
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Now that the front and back end have been designed, the timeline of the development has been

finalized.

​Figure 29: Schedule of Development of the tool

Initially, it was expected that the tool will be completed by the 2nd week of October, however,

we were able to reduce the time of development and roll out will be released before the initial

timeline.

Email shown below shows confirmation that tool will be completed on the 27th. User acceptance

testing will be completed in 3 days and roll out will be done by the end of the 1st week of

October.
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​Figure 30: Email confirming on the date of completion of the tool development
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In addition to this, we need to identify the participants of our user acceptance testing. I have

identified 6 agents that can participate in our testing. I have stratified the group in terms of their

average handle time performance. I have divided the population into quartiles in terms of their

AHT then I selected 2 candidates per quartile. This is to ensure that all performance brackets are

represented. I was given a go signal to pull out the agents from call taking one hour everyday for

6 days. However, we need to consider if we can afford to do the pull outs since our pull outs

might impact some of the calls not being answered.

​Figure 31: Email asking Resources for User Acceptance Testing

To help me facilitate the user acceptance testing, I have asked the help of one of the supervisors

for the subject matter experts. He recommended that we replace some of the participants since

some of them had attendance issues. During one of my meetings with senior leaders on the 3rd

week of September, I was given approval to select any advocate that I needed for the UAT. We

decided to go with the final list sent by the SME supervisor,

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​Figure 32: Email asking for some Changes on the Participants during User Acceptance
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Now that we have identified the participants, our next step is to design the UAT test scenarios

tracker. The tracker will cover all possible scenarios which needs to be tested in order for us to

identify potential bugs in the tool. One of the business analysts in the automation team assisted

us with the creation of the tracker. Email below shows the business analyst seeking approval

from the SME to ensure that they were able to cover all the scenarios.

Figure 33: Email from the Business Analyst on the creation of the User Acceptance Testing Tracker

Sample view of the tracker can be seen in the next page.

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Figure 34: User Acceptance Issue Tracking Form

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Taking Action

User acceptance testing started on September 26, 2019, we requested the agents to install the tool

on their computers. On the same day, only one out of six agents was able to install the tool due to

access issues. The 5 agents had profile restrictions and was not granted access on the same day.

For the one person with the access, she was able to work on the UAT. The same day, we have

two issues with the tool. For test case TC-010 the tool should open the Knowledge Library which

is one of the websites the agent retrieves information from and display the retrieved data on

output panel. However, when we replicated the issue, the scenario is not an issue as one feature

of the tool is that there is no need to open the website if it has cached the content if the agent

have searched for the code before. The next issue the tester was able to identify was the filter

button on the tool is not working. A lesson we learned on the 1st day of UAT was some errors

that might be encountered might not be an actual issue but is an incorrect understanding from the

side of the tester.

To address this, me and the SME supervisor held a demo session and provided them a demo to

educate them how to fill out the UAT scenarios tracker.

The testing was done from September 26 to October 10. During this period, we have tracked

bugs and made changes in the tool within the day.

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Below is a summary of the progress of the tool. Below email is sent to our vice president of

operations for status update.

Figure 35: Email Showing the User Acceptance Result to our Vice President of Operations
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Below is the final version of the tool based on multiple revisions and instructions on how it
operates.

​Figure 36: MA Automation Tool

1. Status Bar

Once you launched the tool, please wait until the status bar is ready as it is still loading all the
codes that needed to be searched. The loading bar will be removed if the loading is already
completed and it will show as “Ready”. There’s KL Status which is to alert the user that the KL
is running or not. If the icon is Red, it means the KL is not running otherwise, it will show the
Green icon.

2. Website Links

Provides easy access to the website which the tool is using but for ICES and Provider
Notification List is optional which is the Knowledge Library is mandatory when using the tool.

3. Search Fields for Code and Place of Service

You can add multiple codes (CPT, HCPC, ICD 9 Diagnosis, ICD 9 Procedure and ICD 10
Diagnosis Codes) in the Code field and Place of Service field for each line. The number of Codes
should also be the same with the Place of Service. The maximum limit of Code and Place of
Service that you can search is 20.

4. Search and Clear All Button

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Once you click the Search button, it will start searching in ICES, Knowledge Library and in
Provider Notification List. The tool will search for both the Code and Place of Service per line.
The word “Search” should show as “Searching…” once you clicked it. If you search for a code
in the first time, the tool should run the KL and search the definition inside of it otherwise; the
KL Definition should show up quickly on your screen. Once it is done searching it will show all
the information in Search Result Area and will also show the Codes that you have entered in the
Filter field. The Clear All button will remove all the information in Code, Place of Service and in
the Search Result area.

5. Filter and Font Size

The use of Filter field is to help you in showing only the specific Code that you wanted to check
after the Searching is done, otherwise, you can just select the “Show All Codes”. The Font Size
helps you resize the font of the Search Result in case you cannot see the information properly.
The minimum Font size is 8 while the maximum Font size is 16.

6. Search Results

Once the tool is ready with the search code, it will show all of the related information in their
specific columns so that, user can have all of the information in one screen.

Note: User can also search multiple CPT / HCPC / ICD9 / ICD10 Code if it is required and will
get the data in the same format.

● Code Column – This will show the specific code that you have searched.
● Knowledge Library (Code Definition) – The information provided is from Knowledge
Library Website.
● Provider Notification List (PA Required Y/N) – This will show you if the code is found
in PNL Website and if found, it will count how many codes found. For Codes ICD 9 and
ICD 10, it will not show the information.
● Claims Codes and ICES - Code Definition – The information provided is from ICES
website which you have search from the Code and Place of Service you have entered.
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Figure 37: Sample Output of the Automation Tool

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Evaluating Action

To assess the success of our cycle 2, we want to measure the pass rate during user acceptance

testing. 100% accuracy during UAT is required before deploying any tool in production. We can

see below that on October 9 and 10, we have seen that we are at 100% for two consecutive days.

No bugs or issues were identified during testing.

Figure 38:Results of the User Acceptance Testing

In addition to this, we have timed the focus group agents to do the process manually without the

tool and compare the time while using the tool. An additional 20 samples were taken which the

focus group had to do. On average, the process takes around 345 seconds if they were to do it

manually as opposed to inputting the code in the tool which takes less than 5 seconds.
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Figure 39: Time and Motion on the Current Process

Figure 40: Average Handle Time During Cycle 1 and 2

As action items from cycle 1 are continuously being implemented, we can see that the average

handle time is decreasing every month. Data for October is as of the 11th. Once the automation

tool is deployed, the average handle time is expected to reach 900 seconds or below based on the

time and motion study that was completed. Production deployment is scheduled to be started on

October 16, 2019. However, the focus of this cycle 2 is to develop the automation tool and

ensure that there will be no issues once deployed in production. Deployment of the tool is an
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entirely different cycle as different audiences will be engaged and different issues will be

addressed.

The summary of the results and outcomes are presented below.

Figure 41: Summary of Identified Root Causes and Action Plans

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VII. Meta-Learning after the Second Cycle

Content

At the start of my 2nd cycle, I was unsure whether developing the automation tool which is my

action plan would be feasible given the time constraints. Developing the tool is dependent on

multiple teams such as the automation team and operations. One of my concerns initially was my

recommendation would not be developed on time as it might not get prioritized. Another issue

that I anticipated was the support I’ll be getting from operations. With the development process,

it is critical that we understand the process itself in order to design the logic of the tool. This

entails that we need a subject matter expert from operations which is time spent away from doing

their actual job. However, in the course of my action research project, the sponsors showed

support as we are both aligned on what area of the business needs to be prioritized which is the

average handle time. I was given a dedicated resource person that will be helping me document

the process, identify the business rules, and provide support on some of the activities related to

the development of the tool. When I had a series of meetings with the automation team, I was

also given full support by the leaders of the automation team when I presented the

recommendation to them. This is due to the fact that the tool we developed is expected to yield

significant cost savings while expected effort to build the tool is low. These are the kind of

projects the automation team is looking for. Projects are prioritized if expected output will yield

high impact and complexity or resources needed would be low. Now that resources are

identified, we just needed to ensure that the tool will be developed and tested on time in

preparation for full scale production roll out. The manager of the automation provided support on
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ensuring that the tool will be developed on time by planning the steps and identifying and

allocating the resources needed for the project. To keep track of the project and to ensure we are

on track with each milestone, we have a daily meeting to do a report out of what are the actions

taken and if there are any challenges. Challenges that were identified were communicated in real

time to the senior leadership team in order for us to get support with the roadblocks we are

encountering. At the course of this action research, I have realized the importance of

communication, especially in such a large organization.

Process

Since my main concern with my second cycle of this action research is to complete the

development and testing of the tool by the 2​nd​ week of October, I had to strategize on how to

ensure that timelines and milestones are met. Since we have regular report outs to the senior

leadership team, I can use these meetings to hold everyone accountable for each action item so

that we would be able to complete the development on time. Having regular meetings was one of

the key factors that contributed to the timeliness of the development of the tool. During the

meetings, we were able to discuss and address the issues we identify in real time. Also, during

the meetings, the software engineers report out the progress and percent completion of the

development of the tool. Fortunately, we were able to complete the development of the tool on

time which is the last week of September 2019. The next step is to ensure that the tool developed

had no issues or bugs. To test the accuracy of the tool based on the business logic, we have

conducted user acceptance testing. UAT entails that a select group of agents will test out the tool

themselves and they have to check whether each functionality of the tool is working as expected.
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If an issue is identified, revision on the code would be required. Since I anticipated that pulling

out agents from their actual work might be an issue due to the call volume that is coming in, I

have worked closely with the workforce management team in order for them to identify what

part of the day has the lowest call volume and we can pull them out without compromising

operations. During the UAT, another issue I have anticipated was agents incorrectly filling out

the UAT tracker. During the 1​st​ day of UAT, I reviewed the UAT result of one of the agents to

check if they have done it correctly. I replicated the scenarios the agent has completed and as

e​xpected, there are scenarios being tagged as failed but in reality, the scenario should be a

pass. To address this, I have partnered up with the supervisor of the subject matter experts in

order for us to hold a demo and teach them how to fill the tracker. Since this happened during

UAT,I have come to a realization about the importance of communication and collaboration that

there is a likelihood that this will happen during production​ roll out. Knowing this, with the help

of the automation team, we have created a document that lays out the features of the tool and

how to use it. Although Lean Six Sigma is a methodology that significantly reduces defects and

variation. On my cycle 2, we focused on ensuring that we have completed the user acceptance

testing cases with 0 defects or errors, the principles of lean six sigma is still applicable with our

objective. We started by defining the scope and problem by targeting to have 0 defects for all test

cases included in the user acceptance testing form. After that, we continually monitored and

measured the defects as the participants tested the tool for one week. In addition to measuring the

percent of errors, we also took into consideration the quality of our measure. We compared the

results per participant and it seems that there’s misalignment with our measures. Some items

were passing for some participants while for others, there were errors. We realized that we need
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to address this issue before proceeding on testing more cases. We conducted a demo session and

we trained the participants on how to properly answer the test cases. Now that we have aligned

the participants on the method of testing the cases, we monitored and measured the performance

each day. After identifying the issues, we had real time communication with our developers to

fix the identified bugs for us to improve the tool. Lastly, we created and placed controls in the

process wherein if an issue is identified, what will be the control that needs to be placed. If an

issue is identified, automatically, the agent has to revert to doing the process manually for us to

not compromise the call by giving incorrect information. We also created a ticketing system

wherein agents would log the issues identified and issues are targeted to be fixed within 2 days.

During this process, I have realized that even a problem as simple as this, the principles of Lean

Six Sigma is applicable as long as there are any defects that can be found. Organizations

shouldn’t limit themselves from using the Lean Six Sigma framework and principles just because

a problem might be small. At the end of the day, multiple small issues lead to a bigger problem

Premise

During the UAT, I took this opportunity to see for myself how comfortable are the agents using

the tool since I want to check whether there is an opportunity in changing some of the user

interface. Also, I want to ensure that once the tool is deployed in production, there will be no

resistance from operations. During my side by side monitoring, I have seen positive reactions

from the participants and I was getting feedback that this will make their work faster. Feedback

was also given on what to improve on the tool. Unfortunately, I have not received any additional

recommendations as the response I got was what we have right now would already be of great
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help to them. Prior to this action research, I always had a negative connotation towards meetings

and I tended to work in silos. I had the mentality of if you want to get things right, you have to

do it yourself. However, during this action research, I came to the realization on the importance

of communication and collaboration. Working with different departments on this project made

me see the value that each department provides. Working with the operations team, "they

supported me so that execution of our action plans were implemented on time and they were

quick to adapt their schedule in order for us to design, build and test the tool. With the

automation team, I had the impression that they also tended to work in silos. However, I was

surprised by the level of support and involvement they have given. During the time the tool is

being built, they provided constant communication on the status of development. They were also

involved with the creation of the standard documents on the usage of the tool. Lastly, during

meetings, there are positive sentiments each day as bugs or issues are being addressed and the

automation team expressed that they are looking forward to engaging more automation initiatives

with us. The positive group dynamic can be attributed by the constant communication and

accountability of each other. Each project member has a critical role and failure of each one will

affect the whole project negatively and this resulted in us supporting each other in addressing

roadblocks even if the task or issue is outside our own accountability. Failure of one will lead to

the delay or failure of the whole project. Aside from addressing the issue of the average handle

time, one of the benefits of this action research is it allowed us to create a more collaborative

work environment and it empowers participants to provide value outside of their actual work.

My last observation and realization was if project members are empowered and they see the

purpose, value and impact of what they are doing, they tend to perform better and even go the
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extra mile in order to achieve a common goal. This was seen when some of the developers and

subject matter experts are offering they work overtime just to complete some of the scheduled

milestones.
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VIII. Extrapolation to a broader context and articulation of usable knowledge

The objective of this action research is to address the long average handle time of the agents during call

taking. Lean Six Sigma is a data driven problem solving approach that follows the DMAIC framework as

a problem solving approach. Using the Lean Six Sigma methodology aim and address the root causes of

the problem for us to prevent the issue from coming back for the same root cause.
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Table 13: List of Activities per Phase in the Six Sigma Methodology

Phase Activity

Define During this phase, we defined the problem, scope, project members, and the timelines. Since

our issue is failure to meet the average handle time, we have baselined the data and have

identified that as ​of the end of May 2019, average handle time is running at 1130

seconds vs. the target client target of 900 seconds. From here, we have also

identified the project champion, sponsor and key members of the project. The team

is cross functional and has a representative from different key departments. This will

allow us to have different perspective on how we see and interpret the issue. Below

are the activities completed for this phase

● Calculated the financial impact of us failing to meet the AHT charter and creation of

the business case

● Creation of the project charter

● Presentation of the business case and project charter to the project sponsor
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Measure For our measure phase, our objective is to measure the gravity of the problem and

understand our current state. To start off our measure phase, we first looked into what are

the most frequent types of call we receive. We extracted the historical call volume of the

enterprise for 2018 for us to capture the overall volume disregarding any potential

seasonality. The top 3 calls identified were related to reviewing the benefit or eligibility,

looking for a doctor or provider, and lastly, about their insurance claims. The top 3 calls

contribute around 50% of all the call volume. Addressing the top 3 calls gives us the

highest impact based on our action items. In addition to this, The top 3 calls is the most

complex compared to the other call types. Unfortunately, the database which houses our

AHT does not have segmentation based on the call type. We conducted processing

mapping activities in order for us to understand what are some value adding and non-value

adding activities also known as process waste in the process. Process maps can be located

on page 37-39. After agreeing on the process map and identifying the non-value adding

tasks which are called process waste, we have summarized our findings in a table located

in page 39 to 40. We also looked into AHT per agent tenure segmented into their quality

performance and NPS. Calls that resulted into a detractor are generally longer compared to

promoters and passives. While for quality, regardless on the quality performance, AHT

remained the same. Below are the activities completed for analyze phase

● Baselining of overall AHT and based on different segments

● Measuring of call volume and different call types

● Documenting the current process through process mapping

·​ ​Process waste identification

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Analyze Now that we have measured the current state and identified which area or call types to

focus on. We now move to the analyze phase wherein our goal is to identify and test our

root causes. To start this off, we started with qualitative analysis and we gathered as much

feedback as possible from different members of the project team. Summary of feedback

can be seen on page 41 to 42. Now that we have the root causes, we need to identify which

are the valid ones and conduct hypothesis testing. To do this, we applied the appropriate

statistical test in order for us to validate our assumptions. Results of the test can be found

on page 43. Below are the activities completed for this phase

● Brainstorming of potential root causes

● Validation of root causes through hypothesis testing

Improve During the analyze phase, we have identified our root causes which will be addressed

during the improve phase. Identification of action plans started through brainstorming

between the project team and the leadership team of the program. During the

brainstorming, we started to gather as many action plan ideas as possible based on the root

causes through diagnostic inquiry. Once we gathered the action items, confrontative

inquiry was done in order for me to provide my insights on the action plans that were

generated. Lastly, we have chosen the action plan based on the potential impact and

resources needed for implementation.

Action plans are discussed in detail on page 48 to 53.

Control ​The last phase of DMAIC entails that we monitor the improvement and ensure that we

sustain the improvement. As part of our action plan during the improve phase, we have
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created performance dashboards for AHT which the operations supervisors will be

monitoring in order for them to control the AHT of their team. We also have a daily

performance call which we discuss the AHT performance and different departments

provide insights regarding the movement of the metric. Performance management is in

place to control the average handle time,

​As we underwent the DMAIC process, aside from identifying the root causes and addressing

them, the participants of the project also developed an understanding on how to address

problems in the organization. Rather than addressing the symptoms of the problem and do fire

fighting, it taught everyone that for every issue there is an underlying root cause which needs to

be addressed. By following this philosophy, organizations will be saving on resources by

preventing issues from coming back for the same root cause as opposed to implementing action

plans without evaluating the root causes first. In addition to this, the program I’m supporting is

developing a culture of continuous improvement and is starting to question how we can improve

the processes better.

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VI. References

Benbow, D. W., & Kubiak, T. M. (2005). The Certified Six Sigma Black Belt Handbook. Asq

Press.

Coghlan, D. (2019). Doing Action Research in Your Own Organization. SAGE.

Hernandez, K. (1n.d., July). DoH to address BPO health issues. Retrieved 2017, from

https://www.manilatimes.net/2017/10/07/news/national/doh-address-bpo-health-issues/3551

06/355106/

George, M. (2003). Lean Six Sigma for Service, Chapter 1 - The ROI of Lean Six Sigma for

Services. McGraw Hill Professional.

UnitedHealth Group. (2019, May 16). Retrieved July 30, 2019, from Fortune website:

https://fortune.com/fortune500/2019/unitedhealth-group

Patton, F. (2005), “Does six sigma work in service industries?”, Quality Progress, Vol. 38 No.

pp. 55-60.

Womack, J.P. and Jones, D.T. (1996), Lean Thinking, Free Press, New York, NY.Torbert,

William. (2001). The Practice of Action Inquiry.

Fritze, C. (2016). The Toyota Production System - The Key Elements and the Role of Kaizen

within the System.

Petrescu, R. (2010). Organizational Change Process- Steps to a Successful Change. Annals of the

University of Craiova-Economic Sciences Series, 3.

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VIII. Appendices

Appendix A: AHT per NPS survey type tested using Kruskal Wallis Test

Condition: Reject the H0 if P<.05

H0: Median AHT for each group is equal

H1: Median AHT for each group is not equal

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Appendix B: AHT per quartile classification based on quality score tested using Kruskal

Wallis Test

Condition: Reject the H0 if P<.05

H0: Median AHT for each group is equal

H1: Median AHT for each group is not equal

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Appendix C: Audit based on call listening from quality department

Appendix D: One Sample T-test on sampling data during navigation of tool to look for
code/diagnostic related information.

N=300

Condition: Reject the H0 if P<.05

H0: Average process time is equal to 60 seconds

H1: Average process time is not equal to 60 seconds

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Appendix E: Exact Poisson Test to verify if rate or number of outbound calls is equal to 3

Condition: Reject the H0 if P<.05

H0: Average rate of outbound call is equal to 3

H1: Average rate of outbound call is not equal to 3