Changingthewaywelead…AgileOperations:

Jennifer Richardson, Senior Vice President OperationsBlue Cross & Blue Shield of Nebraska

Wherewewere…Thehealthinsuranceindustry…Whetwewere…

DataWarehouse

v.1

Corelink

TheAffordableCareAct

KeepYourPlan

CHI

Sustainability

20092010

20112012

20132014

20152016

AgileIntroduced

LeanIntroduced

CentralCity

Migration

ITStableTeams

AgileOperations Enterprise

CommandCenter

AgileGovernance

PrioritizedBacklog

Wherewewere…ClaimOperations…wewere…

• ClaimsSystemmigration:Firstgroupsmigratedin2009:completelyalteredworkflow

• “Staffedup”Operationstoensureaseamlesstransitionforourmigratingmembers

• Bymid-2010,operationsstaffwasatall-timehigh,wefaceddownsizingpost-migration

• Dueto2monthgraceperiod,½ourstaffmetproductivitygoalsonlyeveryothermonth

• Entitlementculture

• ACApromptedcontinualchanges

• Archaicleadershippractices

• Productivitydrivenwork

• LetterstoCEOfromauditors:productivitygoals“unfair”,we“owe”themajobuntilretirement

Leadership:• Hiredforsubjectmatterexpertise• CommandandControl• InconsistentLeadership• Highlyempathetic/maternal• Createdentitlementculture• Processcontrolledaction

Work:• Significantwasteinprocess

• Bottlenecks• Slowdeliveryspeed

• Qualitychallenges/rework• Processheavy

• Reliantonovertime

Thechallenge…

lackofcriticalthinking

timespentfire-fighting

cultureofentitlement

burnout+spreadtoo

thin

decisionshappenin

silos

over-production,

duplicateworkbetweenareas

over-reliantonprocess

bottlenecks“that’snotmyjob.”

maternalistic

compliancefocused

lowtolerance

formistakes

reactive

lowteammorale

leadersasproblem

solvers/heroes

specializedroles

administratorsacceptanceofstatusquo

reactivecapacityplanning

• Typical4weekLeanKaizen– Firstthreeweekswithco-leads– Lastweekwithcrossfunctionalteamof5-7

• Eachleaderrequiredtolead2peryear• Implementbyendof4th week• Teamreportoutatendofweek4

Oursolution…IntroduceLeanModel…were…

• ServantLeadership– Factorymodel- weallcontributetothewhole– Focusonprovidingsupportandleadershiptofrontlineemployees

• Facilitation– Learntospeakup– Drivehealthyconflict

• Shadow– Adopt- Modify

LeadershipTraining

LeanProgramLeadershipGrowth…

constantevaluationandsharingofresources

questionoldpolicies

focusoncontinual

improvement

managersowningtheprocess

empoweredaction

reducedcomplacency

intunewith“layerbelowthesurface”

bettercommunicatio

n

LeanProgramWorkResults…

0

50

100

150

200

250

300

350

400

450

500

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

#ofEmployees

0

500

1000

1500

2000

2500

3000

3500

2010 2011 2012 2013 2014 2015 2016 2017 2018

ClaimsperEmployee

Leanbroughtsignificantimprovements,buttherewasstillachallengingpathahead…

LeadershipTeamChallenges:– Managerassignedwork– PendandWait– ProductivityFocused

TimeSpent:

WorkChallenges:• Largebacklogofwork

• Constantlychangingpriorities• Silos,handoffs,lackofcollaboration

• Qualityandreworkissues• Heavyprocess

Thenextchallenge…

workmanagementandfire-fighting

processimprovement

PeopleDevelopment

falseprogress:start+never

finishtimespentfire-fighting

burnout+spreadtoo

thin

decisionshappenin

silos

emailasprimary

communication

over-production,

duplicateworkbetweenareas

unproductiveconflict

pendandwait

peopledevelopmentnotprioritized

lackofresults

thegrapevine

lackofabilitytorespondtomarket

conditions

politicsandturfwars

TheSolution…

• WorkforceTeam:• Evaluatesallworkloadsandassignswork• Resolvesimpediments• Accountabletotheteamforresults

• WorkforceLeaders:• Workmanagement• Firefighting• ResourceCapacityReview

Completedindailystandups

workmanagement

peopledevelopment

Fire-fighting

processimprovement

ResourceManagers:• PeopleDevelopment• ProcessImprovement

Separateworktoensureappropriatefocusonpriorities

Delivery Manager

Business Advisor

Workforce Manager

Resource ManagersStand-Up

ManagersTeamLeads

SMEsfromotherareas

Workforce Management Team Leadership Triangle in Operations

FUNCTIONAL LEAD FACILITATION

EXECUTE

STRATEGY

PRIORITIZE

• Improveturn-aroundtimeforourCustomers• Prioritizebacklogs&queues• Removeimpedimentsfromauditingteams• Increaseexposuretootherlinesofbusiness• Increasedflexibilitybyresources• Strategizethetechnicalandbusinesschanges• Improvecommunicationacrossteams• Eliminateredundancyandduplicateworkefforts• Createmorevisibilityandtransparencyinordertobemore

proactivethanreactive

ResponsibilitiesoftheWorkForceTeam

• Improveturn-aroundtimeforourCustomers• Beaccountableatdailystandupsforanyagedclaims

• Cometothestandupandexplainanyclaimover30daysandwhatimpedimentsstandinthewayofprocessing

• Bringanyimpedimentstoprocessingtodailystandup

NOTE:Notallstaffattendsstandups.Leadsrepresenttheteamsgenerally.Anyauditorswithclaimsover30days(orhighdollars)cometothestandup.

ResponsibilitiesoftheStaff

• Coachinganddevelopingteammembers• Budgets• EmployeeProgressionProgram• ProcessImprovements• Hiring,rewardprogramsanddisciplinaryactions

ResponsibilitiesoftheResourceManagers

The Agile Practices we use in OperationsServant Leadership

Visual RadiatorsStand-Ups

RetrospectivesDemos

Collaboration SpacesJust Enough, Just in Time

Define “Done”

CLARITY * FOCUS * EXECUTION * CULTURAL TRANSFORMATION

Claims Workforce Management

OperationsStandup…

LeadershipTeam TacticaltoStrategicLeadership:• Visionary

• BigPicture/dotconnector

• Strategicplanning

• Valuefocus

• Effectiveinitiativeowner

• Continuousimprovement

• Effectivefacilitator

• Influentialchangeleader

• Coachandmentor

• Servantleadership

AgileOrganizationalStructureVPClaims

DirectorClaims

Manager

DirectorClaims

Manager Manager

DirectorClaims

Manager Manager

Before:

After:

Howarewemeasuringsuccess?

Collaboration + 42% ▲Trust + 37% ▲Respect + 27% ▲Customer Focus + 27% ▲Innovation + 25% ▲Team Management + 23% ▲Optimism + 22% ▲

Culture

Workable Claims/FTE + 20% ▲Transactional Measures + 10% ▲Aging Claims Reduced

Productivity

COLLABORATION:WeworkasaTeamtofindthebestsolution.Wespeakupwhenweknowsomethingiswrong.Succeedingasateamisasimportantassucceedingindividually.

RESPECT:Thereisanatmosphereofmutualrespectandgenuinepositiveregard.Contemptandhostilityarenottolerated.WeempowerothermembersoftheTeamtocontribute.

CUSTOMERFOCUS:AsaTeam,weputourselvesinourCustomer’sshoes.Wemakesounddecisionstomeettheirneeds.Wedonotignoreproblemsoutsideourareasofresponsibility.

TEAMMANAGEMENT:HelpTeamMembersgrowanddeveloptheircareerplan.ManagershelpimprovetheoverallprocessesoftheTeam.

INNOVATION:OnthisTeamwespeakupaboutourideasandlookforopportunitiestoperformourjobbetter.Wedonotholdontooutdated,inefficientwaysofdoingthings.

OPTIMISM:TheTeamhasaninspiringsharedvision.Theyareenthusiastic,forwardlookingandappreciativeofeachother.Therearelowlevelsofcynicism,pessimism,helplessness,hopelessnessordwellinginthepast.

• Veryhard,butveryrewarding.Adapttothepaceofchange

• Gotogether.Wemadethesechangeswithourexistingleadershipteam

• Inspectandadapt• Alwaysadheretocoreprinciples• Empowerthemanagementteam.Teachthemtoengageinstrategicleadership

LessonsLearnedandChallenges

• Greatatexecution– needtobalancewithsuccessfulachievementofmeaningfulresults

• Playtowin

Upcomingchallenges…

• https://youtu.be/nhe0KSGoUgc

Questions?Jennifer.Richardson@nebraskablue.com

+ Discontinueameetingthatnolongerprovidesvalue.

+ Lookataprocess&suggestimprovements.

+ Sendasurvey;usefeedbacktoimprove.

+ Whenyoumakeamistake,talkaboutit.

+ Adjustpriorities.

+ Experiment.Trysomethingnew.

Adaptability Adaptability…

+ Suggestasolutioninsteadofcomplaining.

+ Askifyoucantaketheleadonsomething.

+ Speakupwhensomethingdoesn’tmakesense.

+ Peopleclosesttotheworkmakedecisions.

+ Engagetheteaminabrainstormingsession.

+ Ask:“Whatdoyourecommend?”

+ Tellsomeonewhatyouwant,not howtodoit.

Empowerment…

+ Communicatethe“why”behindadecision.

+ Q&Asessionswithleadership.

+ Havemeetingsinopenspaces.

+ Keepdoorsopen.

+ Admitwhenyoudon’thavetheanswer.

+ Clarifyyourpriorities.

+ Visualizethings.

+ Celebratewhenyoureachateammilestone.

Transparency…

Ifyouwanttogoquickly,goalone.Ifyouwanttogofar,gotogether.

Africanproverb

Theflowerthatbloomsinadversityistherarestandmostbeautifulofall.-WaltDisney

CharlesDarwin

“It is not the strongest of the species that survives, nor the

most intelligent. It is the one that is most adaptable to change.”

“It is not the strongest of the species that survives, nor the most intelligent. It is the one

that is most adaptable to change.”