Medical Group focuses on efficiency and reorganization

  • Published
  • By Lee Anne Hensley
  • 75th Air Base Wing Public Affairs
HILL AIR FORCE BASE, Utah (AFNS) --  It seems common for an employee to utter the phrase, "Things would run so much more efficiently if ..." at least once in his or her career, yet it seems rare for a business to dedicate time and money into making such improvements. 

Officials in the 75th Medical Group here have broken that trend and dedicated an extraordinary amount of effort and resources into making their group more efficient in the past year.

The efforts were made after the group underwent a Rapid Improvement Event and looked at how their organization scheme could be managed most efficiently.

Lt. Col. Christopher Dun, 75th Medical Support Squadron commander, was tasked to find the resources to make its dreams into reality. 

"We have a five-year master plan that the health facilities office helped us to develop into a multimillion dollar project, in which no funding was available," he said. "When I arrived here in July as the commander, Col. Matthew Chini (75th Medical Group commander) asked me to look at our fiscal position and, if we had the money, we were to move out on aspects of this plan with an end-state to provide better quality care and more space for the provision of healthcare in our primary care clinics."

The numerous items targeted in the plan required a tremendous reorganization effort.

Bioenvironmental Engineering, or BEE, Flight buzz

"We respond to chemical, biological, and nuclear incidents, as well as perform health risk assessments and sample the environment to determine the hazards, and then make personal protective equipment recommendations to the incident commander," said Master Sgt. Michael McGurl, bioenvironmental engineering and readiness emergency response coordinator. 

"We rewrote our medical contingency response plan in the beginning of the year to reflect the requirements of what a medical clinic can provide rather than what a hospital can provide," he said.

The BEE Flight leaders took their training plans a few steps further by forging training relationships with other groups to create a more responsive emergency team.

"We started building our relationship with (civil engineer) readiness," Sergeant McGurl said. "We were mandated to do this before, but we wanted to come together as a team with emergency management, bioenvironmental engineering, the fire department and (explosive ordnance disposal), to become an effective emergency response force for the wing."

Sergeant McGurl and his flight began internal training exercises with CE readiness personnel and the fire department, which facilitated their working relationships and recognized them for awards.

Members of BEE, CE readiness and the fire department continued training on their wartime and peacetime emergency response skills throughout the past few months. In addition, the entire 75th MDG staff has enhanced their emergency response capability and devoted a tremendous amount of effort to ensuring they are prepared to respond to any catastrophic event. 

"We've done a lot of training with the disaster teams and chiefs, to make sure that we are ready to go, and we've beefed up our training and exercise schedule and coordinated with the wing for 2009," Sergeant McGurl said.

Pharmacy gets nipped and tucked

"When I first got here as a pharmacist, I really could not recognize our workflow," said Maj. Rodney Jorstad, Pharmacy Flight commander. "First thing we did was a value-stream analysis, where we looked at overall workflow and efficiency in the pharmacy."

That analysis showed that the pharmacy was taking 35 physical steps to fill one prescription because the layout of the pharmacy required the team to travel more than necessary. The pharmacy staff decided to remodel their space to a more efficient layout and make room for new, standardized automation.

"We've seen at least a 50 percent decrease in those steps," Major Jorstad reports. "The pharmacy employees commented on how much more energy they have at the end of the day versus before and that allowed us time to track and work on other things."

Among those "other things" were their error rates. Their newfound time and energy allowed them to reduce their error rates by 54 percent. One simple change made in the pharmacy greatly reduced time and errors and cost the staff nothing to incorporate: moving the pharmacist from the end of the prescription filling process to the beginning. 

"When we looked at the workflow and the function of the pharmacist, we recognized that it was a clinic piece and there was nothing that mandated that the pharmacist should be at the end of the process," Major Jorstad said. "We moved the pharmacist from the end of the processing line to the front, where the pharmacist checks the order before the order is filled. This reduces the amount of rework down the line."

The pharmacy staff also saved time and money by moving the logistics team, which accepts the pharmacy shipments, from downstairs into the pharmacy. 

"When logistics received our order shipments, logistics scanned in all the shipments downstairs and they brought them upstairs to the pharmacy to be shelved," Major Jorstad said. "It took an hour to an hour and a half to do that. Now we have logistics bring the shipments up to the pharmacy immediately after they receive them and they scan them in while people put them on the shelves. That process has saved that hour, and we can have orders in by 10 (a.m.)."

Another initiative the pharmacy staff implemented was to update its automation, the system that counts and fills the prescription bottles, by switching to the Air Force standard machine called the PharmASSIST.

"Switching to this new system has saved the pharmacy approximately $75,000 per year that we were paying for maintenance and leasing costs on the old system," Major Jorstad said. "The new system also cuts down on the manual counting of the medication and these machines are much faster. Our system is 100 percent bar-coded, and that greatly reduces error rates."

Major Jorstad and his team are not keeping these improvements a secret. 

"We are working on putting out a standardized workflow and logistics to AFMC to apply Air Force-wide. We are giving other Air Force bases our proven methods with proven efficiencies to help them with their workflow."

Physical Therapy gets room to grow, stretch

Injuries are a reality of war and therapists in the 75th MDG Physical Therapy clinic saw a significant increase in their demand since the peak of the war on terrorism.

"I've been (in the Physical Therapy clinic) three and a half years," said Lt. Col. Therese Bohusch of the 75th MDG physical therapy clinic.  "When I arrived, we were seeing active duty, dependents and retirees, and within a year that changed to seeing active duty only due to rise in demand."

Around the same time, officials with the Tricare Management Activity recognized the potential to recapture the dependent and retiree care on base by applying for contract dollars to hire additional manpower. A space-expansion project to accommodate the new staff and anticipated patients is scheduled to begin shortly.

"The expansion will last throughout most of 2009, which will limit our services since we will be down to about 50 percent of our space for the construction," Colonel Bohusch said. "During that time, we expect to refer more people to our Tricare network physical therapists. Ultimately, at the end of our expansion project, we hope to get everyone back into our clinic."

The physical therapy staff also will expand with the project. In addition to their current staff of two physical therapists, three technicians, all of whom are active duty, and one administrative support employee, the clinic will contract one more physical therapist and three physical therapist assistants.

"Eventually we would like to extend our services to active duty dependents and retirees," Colonel Bohusch said.

Airmen Clinic, Flight Medicine to improve flow

Imagine that you have to operate out of six offices instead of just one, and each office is organized slightly different than the others. This would add more time and frustration to an average workday. Then add to that fact that the offices were not arranged in a convenient manner for you to move from one to the next. 

These were just a few challenges the staff at the Airmen Clinic and Flight Medicine were dealing with and decided to do something about.

To accommodate the necessary changes for efficiency and standardized work areas, the Optometry Clinic, which shares the annex with the Airmen Clinic and Flight Medicine, will be moved to another area of the medical clinic in the near future. This will allow the Airmen Clinic and Flight Medicine to expand a bit and Public Health will be placed in the annex, since Public Health delivers deployment medicine, force health management and community health.

"Colonel Chini's vision all along has been for that annex area to be a one-stop shop for the Airmen, where 90 percent of what they need in the Med Group gets taken care of in this annex," Colonel lBohusch said.

The annex area will be renovated to allow the Airmen Clinic and Flight Medicine staffs to optimize their space by accommodating more examination rooms and an additional procedure room. The goal is to utilize the layout more efficiently and, like the pharmacy, eliminate the excess running-around for the staff.

"Our biggest complaint from our clients is wait time, which is directly related to space issues," said Master Sgt. Michael Quoma, non-commissioned officer in charge of the Airmen Clinic. "Once we have centrally located, easy-to-find doctors and have our nurses closer to the providers, this will eliminate the time and energy spent on them trying to find one another."

Part of the space expansion goal is to standardize each examination to be as similar as possible, allowing the providers to work more efficiently. If everything is located in the same place in each room and every piece of equipment operates the same, it will eliminate time wasted on searching and adapting to different equipment.

"The Standard Work is an AFSO21 initiative, (which) was a follow-up to two different AFSO21 events, that allows the patient to know what to expect and know the process flow," said Lt. Col. Arthur Durkin, 75th MDG chief nurse executive. "So we created a standard operating procedure to ensure the format doesn't vary from technician to technician."

Another goal of the Standard Work initiative is to standardize electronic medical records to allow the doctors to search for data.

"One of the things we have initiated is to designate a technician to ask the patient (a health question) and enter it into a database of medical records," Colonel Durkin said. "Eventually, when our electronic medical records system gets savvy enough, we will be able to drill down into that information and better identify what our population actually does."

More space, more efficiency and less wasted time will equal happier clients for the two clinics.

"It will be a boon to our patients to have more space and happier, more productive employees," Sergeant Quoma said. "It will improve care overall."

Disease Management team focuses on prevention

"Since we are a Continuous Deployment Model base, which calls for one in five providers to be deployed at any time, we need to posture our staff to deal with the continuous deployments we face," Colonel Durkin said. "When that CDM was established, we set up clinics that had a doctor, secondary provider, a physician's assistant and support staff so anytime one of them was deployed, they would have a backup staff. Part of that was breaking up these managers and we made the conscious decision to take them out of the clinics and centralize them so that we could have a centralized disease management for the whole facility."

The Disease Management team targets patients diagnosed with asthma, hypertension, diabetes or cervical dysplasia, and they work in conjunction with the primary care providers to offer specialized care for the patient and they also enroll the patients in classes to educate them on how to better care for themselves. The goal is to mitigate or prevent further diseases and complications that typically afflict patients with these diseases. In the business aspect, these diseases can be time consuming for the provider to treat and cause the patient to return to the medical facility more frequently for disease-related complications.

"Our disease managers have been heralded by the Air Force and other services who have asked us to attend conferences," Colonel Durkin said.

Among them is Capt. Tracy Rue, the nurse manager in the Family Medicine clinic, who will be attending the American Academy of Ambulatory Care Nursing conference in March to share Disease Management's model and its successes.

"We are one of the first family practice facilities in the Air Force to have this program," Captain Rue said. "Disease Management gives the patients a place to go, a point of contact for specific care needs, and their number of visits to the clinic decreases."

The Disease Management model fit perfectly into the overall goal of the medical clinic.

"We have a primary care facility that is focused exclusively on prevention; prevent first, heal second," Colonel Durkin said.

Getting the message to the community

The 75th MDG staff has a wealth of knowledge that can empower its community, and they are not keeping the messages to themselves.

One obvious way medical group leaders broadcast the message was to place plasma-screen televisions in populated areas, such as the waiting areas in the medical clinic and in the base exchange food court, which display health tips and messages on successive slides.

Medical group officials also send representatives to make public appearances at military spouse club events and other family events. They set up an information booth at such events to educate the parents about immunizations, nutrition and breastfeeding awareness. They also are working together with the Health and Wellness Center staff to tackle tobacco cessation, stress and anger management, nutrition, fitness and lifestyle education.

Capt. Marcus Luce, a clinic medical doctor, initiated the Reach Out and Read program, which has donated more than 3,000 books to children, and teaches parents how they can read to their children more effectively. Dr. Luce demonstrates this technique to the parent and child in his clinic, which establishes a positive first impression on the child to make him more comfortable with the pediatrician.

Improving the future

The 75th MDG leaders have only tackled the top portion of their list of desired improvements. Colonel Dun reports the group's future goals include improving women's health, referral management and standard work. They also are dedicating a team to ensure that the group is operating on a daily basis in compliance with all regulatory organizations, such as Occupational Safety and Health Administration, Accreditation Association for Ambulatory Health Care and the Unit Compliance Inspection/IG team, and dedicating an administration team for the clinic.

"We are constantly engaging in work-flow analysis and seeking opportunities to improve our processes and think outside the box," Colonel Dun said.  "We currently have an on-going effort to stand up a personnel administration flight that will handle anything administrative to this building. Be it (officer performance reports) or (enlisted performance reports), PowerPoint presentations, committee minutes, memorandums, this core team will actively manage these products."

Although the medical group is small in number, it doesn't stop them from taking on goals twice their capacity, he said.

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