Lean at Qualirede: how to optimize deliveries
More and more companies are seeking to optimize their results, and one way to achieve this goal is through the lean methodology. Inspired by the automotive industry, the approach aims to improve results by making the best use of human potential. By applying it, it is possible to eliminate waste continuously, solving problems systematically. In addition, the methodology requires managers to rethink the way they lead, manage and develop people.
Always seeking to improve its deliveries, Qualirede adopted lean exactly one year ago. And to celebrate this partnership with Lean Institute Brasil (LIB), we are going to tell you a little about the challenges and lessons learned with lean in our segment.
Lean at Qualirede
Qualirede is a health plan management company that has been in the market for 10 years. With four values in mind - people first, excellence that makes us go further, innovation in everything we do, and making things happen -, the company has been continuously seeking to improve its processes and deliveries, and lean has been the means through which this whole transformation has been taking place.
LIB's initial proposal was to run one cycle of the A3 Project - which is part of lean - in six months, but since the Qualirede team is eager for innovation, it asked for a pilot project of only three months. Likewise, our consultant at LIB, Augusto Fonseca, challenged us and brought a proposal for us to be even bolder: he gave us the possibility of combining lean and agile. So we used A3 thinking, with agile execution.
Starting with Utilization Management
The first area to receive the methodology was Utilization Management. It was chosen because it is the company's core business, so a significant result could be achieved for Qualirede right from the start. Starting with this area in particular was very important, since it simultaneously covered several other departments that are fully involved with Utilization Management itself, such as: IT, Parameterization, Medical Claims, the Costs and Specialties Unit, HR and the Provider Relationship Network.
“It was a bold test that made it possible to quickly leverage the lean journey in the company, especially since this is a service provided in Santa Catarina, São Paulo and Bahia, and all three locations took part in the project with representatives,” says Qualirede's Strategic Management Unit manager, Simone Angélica.
The big challenge, after the A3 was signed in August 2019, was organizing the execution of the actions in an agile way. The team learned to define which actions they could commit to carrying out in 0 to 3 months, 3 to 6 months and 6 to 9 months. None of the actions had a completion date, but rather a commitment to be done within the planned time frame. To ensure the pace, the kanban system was used, showing what needed to be done, what was being done and what had been finished. All of this was managed through the 15-minute daily, with visual management.
Day to day
In this way, the ritual of weekly meetings, called tactical meetings, was carried out, lasting 30 to 45 minutes, to analyze the week's pace and make any necessary alignments. The first A3 had eight support people, one for each kanban, in addition to the support of the area manager, the A3 owner and the SMU team coordinating lean.
The concept of a chain of help was used very emphatically: every 24 hours, an action that was “stuck” moved up a level, going from the action owner to the kanban support person, the A3 owner, the lean coordinator and finally, at the last level, the project sponsor at Qualirede. Of the more than 300 actions in the first A3, only one reached Qualirede's CEO, Paula Bianca, the project sponsor.
A very important and fundamental concept in the first A3, which the team took away as a lesson for all the others, is “Done.” When a countermeasure is completed - and in the case of the Utilization Management A3 there were more than 60, which unfolded into more than 300 actions - the countermeasure needs a check to find out whether it is really done. This “Done” is defined together with the project team and ensures that the initial countermeasure has really been delivered.
The A3 Express
The A3 Express is a collaboratively built problem-solving tool that aims to teach the lean mindset for solving problems and pursuing continuous improvement in a given area. The tool works through the 4C analysis logic (context, cause, countermeasure and control), which clearly identifies a problem, analyzes its root causes, lists countermeasures to solve it and carries them out in an agile way, tracking them with control indicators.
The A3 Express was presented by Qualirede's SMU manager, Simone Angélica, and by SMU specialist Lucas Senra at the Lean Institute Brasil Showcase last month. In addition to LIB's president, Flávio Augusto Picchi, more than 90 participants from various companies, such as Rede Globo, Itaú, Angeloni and BRF, connected to the showcase, sharing ideas and questions about Qualirede's methodology.
Step by step with the areas
When applying the A3 Express, the SMU team initially divides its approach with the areas into two periods. In the first period, the pain points of an area are surveyed and categorized in an exercise known as the bucket. This exercise is derived from the MoSCoW method, which helps categorize the pain points. The first period ends with one pain point to be analyzed. In the second period, the A3 Express methodology is carried out through the 4C steps, ending with the definition of the rituals: daily meetings, the weekly tactical meeting and the indicators.
Autonomy and experience with home office
Another challenge was implementing lean in Qualirede's finance department, since it was in this department that the SMU team acted most autonomously. “We had several challenges throughout the process, such as maintaining pace and engagement, but the project is moving full steam ahead, on its way to consolidating the journey in this area as well. Augusto's mentoring from LIB has been essential for us to keep the "axe sharp," which allows us to keep going strong in our work,” says Simone.
Another challenge was moving in-person activities to virtual ones, due to the pandemic caused by the novel coronavirus. At first the change seemed somewhat more complicated, especially with regard to the workshops for building the A3 Express and the dailies of the projects under way. However, everyone soon learned to handle the dynamics of virtual meetings, and this even served as a boost to accelerate the spread of the lean journey in the company. “We started holding A3 Express workshops more frequently, advancing into areas of the company that we might have taken longer to reach if it were not for home office. It has been a great experience,” the manager emphasizes.
People involved talk about the lean experience at Qualirede
“Lean conceived a great project and put into practice what we talk about so much: the experience of working together, joining forces across the whole team to solve small and large problems. In addition, the methodology has streamlined processes, making everyone devote time to what they really should be devoting it to! Thank you all: the SMU team and the lean team that have been transforming our processes!” - Paula Bianca Coelho, CEO of Qualirede.
“I got to know lean at Ânima, before coming to Qualirede, so when our CEO accepted the idea of running a pilot, I was extremely excited, because I know the philosophy and the power it brings to an organization. But nothing compares to the way people received the project at Qualirede; it was simply fantastic, that is the only way to describe it. Qualirede lets us experiment all the time, and people are highly committed and take great pleasure in participating, which means the projects achieve results far superior to those found in other organizations at the same point in their lean journey. In this 1 year, we started with the beautiful pilot in Utilization Management. Then it was the IT team's turn, and then building the A3 with the SMU team. In the finance department we had a big challenge, because we were without the consultant. Now, in 2020, we created the “A3 Express”, which has already been piloted in 7 areas, with several prospects in other super-important projects for Qualirede. Today, I can only say how passionate I am about this company, this project, and especially each of the people taking part in the lean project in Utilization Management, where it all began. To them, my deepest thanks for taking on the challenge so beautifully!” - Simone Angélica, manager of Qualirede's Strategic Management Unit.
"Taking part in Qualirede's lean journey has been a privilege. With every initiative we take on the journey, we can see how committed the company is to lean. This commitment is explicit in people's engagement, as they readily take the lead in the change process, tackling day-to-day problems and diligently applying lean concepts. I can only be grateful for the opportunity to be part of this story!" - Lucas Senra, SMU specialist at Qualirede.
“About a year ago I joined the company to work with lean in health services - what it would be like, I had no idea! But today I feel it is something much bigger, a philosophy that draws us in more every day, with every challenge, with every different team we work with, people we teach and who teach us, experiences, unexpected situations that we keep adjusting and making flow. But always seeking learning, consensus, feedback and transparency to surface and solve problems” - Fernanda Martignago, SMU specialist at Qualirede.
“The people who live a process every day are the best prepared to bring effective solutions. As a leader, I have been following all the efforts to achieve better results, strong alignment, more effective continuous improvement and greater process efficiency. Many believe they need a radical transformation to reach higher levels of performance. However, I realized that the leader must do more than support the hard work of creating a culture of excellence; that is, participation from the very beginning and engagement are essential. The good news is that there are specific actions and lasting behaviors for an effective transformation. In Utilization Management we created a strategic management unit, where we trained a team and focused on continuous improvement, which was born from the partnership with the other areas and from the pain points listed by the team in the meetings to implement the lean method. We had little experience with the method, and the consulting played a fundamental role, teaching us from the start and above all helping change our mindset. The implementation in Utilization Management brought about a change in thinking: we began to “think lean,” with a critical eye in reviewing processes and improved performance in controlling and monitoring work packages. Each team does its own mapping and analysis, and the consultant is able to move among all the teams, giving training jointly, so that they help one another. It was this team mechanism that brought a greater sense of belonging to those involved, whether administrative staff, technical staff, other areas and, above all, the leaders.
As for the benefits, I can mention that:
- Work was standardized;
- Waste was pinpointed in the Utilization Management process, that is, processes that took hours or days were reduced and/or eliminated;
- It brought more responsibility and engagement to people;
- We saw improvement in process management.
Bringing about culture change in pursuit of improvement is without a doubt an excellent path for everyone involved” - Giselli Raupp, Health Utilization Management manager at Qualirede.
“We are completing one year of lean implementation at Qualirede. Initially, we had the challenge of running the pilot in just three months and within budget. Together we discovered that lean could be the way to enhance patient care, the reason for Qualirede's existence and its purpose. Then we moved to the IT area, where we stayed for four months. In this way, we began to spread lean strategically, unfolding A3 thinking in a unique and customized way, which became the A3 Express. I am immensely happy to have practical results in such a short time and to be able to tell this story with pride. Congratulations to all of us, especially the SMU and Qualirede's CEO, Paula Bianca, who has always supported the project” - Augusto Fonseca, project manager at Lean Institute Brasil.
Want to know a little more about the A3 Express? Then download the framework by clicking here!
