CIGNA's Quality System Evolution: Ready for the Next Step

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Len Javinett

When I left my continuous improvement job at United Technologies to join CIGNA nearly 10 years ago to run the Rapid Solutions Center, I couldn’t help but notice that the company did not have any kind of corporate-wide quality system. Quality, primarily in the form of audit/inspection teams, existed formally, by name, only in some parts of the organization. But business was good, and there was no "burning platform" to spur any change. However, that platform began burning brightly very soon after my arrival.

Service levels had dropped well below the competition due to a difficult computer systems changeover. This in turn had caused the loss of clients, sending the share price down. David Cordani, head of the Program office at the time (and today president and CEO of CIGNA Corp.), instructed Recruiting to find someone who could bring Six Sigma to CIGNA to help fix the service problems and to prevent something like this from happening again.

Under the leadership of a former Motorola Six Sigma executive, and with the help of an expert training resource, volunteers from different parts of the corporation gradually became trained as Black Belts or Green Belts and began successfully completing local DMAIC projects. Concurrently, a small number of already-trained Master Black Belts and Black Belts were hired to form a central team to help mentor the new students.

A couple years later, some Kaizen leaders were hired to begin a series of focused Lean events in selected parts of service operations. The combination of DMAIC projects and Kaizen events, coupled with employee’s increased appreciation for metrics and asking "why," brought results. CIGNA eventually rose above the competition in service survey results and was recognized by such organizations as J.D. Power and Associates, ASQ and WCBF.

By the end of 2009, CIGNA had trained 150 Black Belts (four weeks), 450 Green Belts (two weeks) and 2,100 Yellow Belts (two days). Some departments were becoming self-sufficient. The leader of the core Lean Six Sigma team left CIGNA to begin the journey again with another company, and the team itself, which had grown over time to a couple dozen experts, was reduced to one third its size as the company transitioned to a decentralized engagement model. That is, each major department was asked (not required) to select a person to be its Lean Six Sigma lead and become part of CIGNA's Lean Six Sigma council, chaired by the core team. Participating departments would now mentor their own students.

The Need to Raise CIGNA’s Performance Level

On the surface, things seemed fine. Over a period of seven years, hundreds of DMAIC projects had been completed along with dozens of Kaizen events. Hundreds of millions of dollars of costs had been saved or avoided by CIGNA or its clients. CIGNA's service levels were at the top of its peer group.

Sounds good? Yes, but ... CIGNA's peer group, the health insurance industry, ranks far below many other sectors, such as banking or aerospace. Claims processing at three sigma levels of quality are considered acceptable, rather than the five or six sigma levels seen and expected by bank clients examining their monthly statements. For CIGNA to achieve its goal of becoming the leading health service company, these standards would have to rise.

David Cordani, the CIGNA executive who brought Six Sigma to CIGNA (by the way, if you can say that phrase three times very quickly, we’ll give you a Black Belt) is now our CEO. He is adamant about our company mission, which is "to help the people we serve improve their health, well-being and sense of security." We no longer view ourselves as just an insurance company — we’re a health service company.

For example, we have on our payroll a substantial number of doctors and nurses, and we operate on-site clinics for clients. Our focus is on improving the quality of health-related services while driving down the costs associated with waste and inefficiencies. Customer focus is key. Every CIGNA employee must become a customer-focused zealot. Three sigma levels of quality can no longer be tolerated. Can we do it?

The Next Phase of CIGNA’s Journey

We looked at our current state of Lean Six Sigma and found something was missing. In fact, a lot was missing! There was still no overall total quality management system. More important, there was still not the kind of widespread employee engagement that some companies achieve, where you can see evidence of enthusiastic quality best practices in every nook and cranny of the corporation. And so the next phase of our journey is now getting underway.

The first step being taken is to use the Baldrige Quality Award framework to identify those aspects of performance excellence where we have gaps to fill. The good news is that we have many trained experts and many pockets of best practices which we can identify and leverage. For example, one smaller, independent unit of the company has already achieved ISO certification and has applied for a state award modeled after Baldrige. In another area, we have formed a world-class organization focused on improving the customer experience. In yet another area, we have a team using solid Design for Six Sigma techniques in the design of a new health care professional database. A plan is being developed, based on benchmarking other companies, for putting in place a structure and process to get all business units using all the best practices.

Another step being taken is a significant increase in CIGNA's learning and use of change leadership principles and tools. A number of change agents have gone through training, including CIGNA's Enterprise Lean Six Sigma team. We are integrating the change leadership tools with our Lean Six Sigma and project management tools and will make that integrated toolset part of our future training.

Last but not least is widespread employee engagement. With about 30,000 employees spread across the globe, CIGNA still has a lot of potential. The percent of employees who have already been trained or have been on a DMAIC project or in a Kaizen event is still relatively small. There are simple but effective and proven ways to ramp that up from the current 15 percent to 80 percent or more. These techniques include things such as visible metrics boards, local improvement teams, 5S workplace practices, etc. It is only when the entire workforce is enlightened, empowered and energized that the real results begin to happen.

And so, CIGNA is about to embark on the most exciting part of its quality journey. Stay tuned as we "kick it up a few notches!"