Problem Statement

Original problem or focus question

Restate the initial problem that launched the inquiry process, or rewrite the focus question or one of the clarifying question as a statement.

Stakeholders who are most affected by the problem

Identify who is most directly impacted by this problem? Alternately, who would benefit the most if this problem were resolved?

Type of problem

For example, is the problem based upon skills, attitudes, knowledge, resources, competition, defects, or something else.

Suspected cause(s) of the problem

Based on the data analysis and/or the root cause analysis, what does the team think is the most significant cause(s) contributing to this problem? What, if addressed, would make the greatest impact on resolving the problem? Include specific evidence.

Goal for improvement and long-term impact

Describe the target for impact. The goal should be measurable.

Impact to Stakeholders

Describe possible impacts to stakeholders if the problem is not addressed.

Proposal for addressing the problem

The proposal is a high-level strategy that represents promising practices drawn from research, local knowledge, and local expertise. Note sources, if possible, when presenting this information. This proposal will become the basis for subsequent action planning.

Final problem statement

Tie the above statements into 3–5 coherent sentences that could be easily understood by a wide range of stakeholders.

Original problem or focus question

· The claims processing call center representatives are not accurately capturing claim information and taking too long on the calls

Stakeholders who are most affected by the problem

· External customers

· Call Center Operations

· Call Center Representatives

Claims Processors (Back-office)

Impact to Stakeholders

· Loss of customers and revenue

· Customer dissatisfaction

· Lower performance evaluations for representatives

· High operations cost

Delays in claims due to rework

Type of problem

Skills, Process and Technology

Suspected cause(s) of the problem

· Call center representatives do not receive adequate training

· The current technology requires manual entry of information and does not drive claims representatives to ask appropriate questions

Standard operating procedures are not automated into process.

Goal for improvement and long-term impact

· Increase quality for claims calls from 95% to 99%

· Reduce Average handling time by 30%

Reduce call center operating cost by 10%

Proposal for addressing the problem

· Automate standard operating procedures into the online claims filing process

Reduce manual data entry for claim filing process

Final problem statement

Many call center representatives are not achieving quality and call time standards; thereby contributing to the overall low quality rating of 95% for the call center and Average Handling Time for Claims Filing Calls of 650 seconds. Through data and process evaluation, it was determined that the process required 90% manual data entry of claims information. In addition, the online tools available to the call center representatives are not updated frequently with procedural changes and do not contain all required information necessary for representatives to perform their job. The low quality over the past 6 months has resulted in a 2% decrease in customers and $550,000 loss in annual revenue. The high average handling time has increased operating cost by $250,000 monthly.

Original problem or focusing question

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Stakeholders who are most affected by the problem

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Impact to Stakeholders

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Type of problem

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Suspected cause(s) of the problem

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Goal for improvement and long-term impact

Proposal for addressing the problem

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Final problem statement

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Original problem or focusing question

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