For the past year, the 436th Medical Group here has applied a continual improvement process many people often associate with maintenance personnel and programs.

LEAN, Six Sigma and Continual Process Improvement are all programs the Air Force has introduced into the maintenance career fields over the years.

Now, the aptly named Smart Ops 21 program has encompassed all three of these ideals, and they no longer apply strictly to the wrench turners on an installation.

The process is simple: do more with less money and less people while producing a better product.

The clinic applied Smart Ops 21 methods to the process of abnormal clinical results. These are the results patients receive from doctors in the city of Dover for services such as cardiology and orthopedic surgery.

The problem was that results from downtown doctors took as long as two weeks to reach the patient's primary care provider. This issue not only slowed down the care a patient received but also wasted valuable time and money.

One of the longest slowdowns was at the beginning of the process.

Every day results arrived to the clinic and were distributed to one of seven offices around the group. This process took one day. The next day, one person in each of those seven offices would match the results to a patient, then match that patient to a sponsor and finally match the sponsor to a primary care manager.

"It took one person in family practice an average of six hours a day to perform this task," said Maj. Michael Higgins 436th MDG medical staff chief.

Once the job of identifying the results was complete, they were sent to a different room and faxed to Tricare to ensure the doctor downtown was paid.

"By this point, we were around three or four days into the process," Major Higgins said.

After Tricare had acknowledged receipt of the results, they were sent back to the office, identified and put into a mailbox. The mailbox was then checked by a nurse who would deliver the results to the primary care provider.

"All in all, the process took as long as two weeks by the time a primary care manager contacted a patient to discuss their medical care, which is not a good set up for the patient," he said.

The clinic recognized the problem and organized a work group to solve it.

First, the work group pointed out that a day was wasted just getting results to offices so they could be identified.

"Most downtown doctors do not put the sponsor's social security number on the results," Major Higgins said. "This slows us down because our computers organize patients by the sponsor's number."

However, the insurance companies' computers don't work the way government systems do.

"We decided that as soon as we got the results, we faxed them straight to (Tricare), whose computer could sort and identify the patient to the primary care manager in one day," he said.

Next, the group looked into the amount of people who handled the files before they were finally placed on a primary care provider's desk. Since the files were sent directly to the insurance company, it eliminated three different offices handling the files before they were faxed. Now, all the group needed to do was isolate the slowdowns after the insurance phase.

Now the providers receive the files, are able to contact the patient, sign and date the report and send it to the medical records section for filing in three days instead of two weeks.

"This turn around gets patients the help they need faster," Major Higgins said. "They get healed faster and back to duty quicker. This turnaround can also support earlier, less inexpensive treatment. All these factors make judging the amount of money the Air Force saves hard to calculate Major Higgins said. By eliminating the time spent identifying patients, they expect to save approximately 200 man hours a month.

"You can compare what happens in the medical group to sorties in one of the flying squadrons," said Maj. Higgins. "Only our sorties are equivalent to patient encounter, or how many people we can get in, get seen and leave in a day."

By applying Smart Ops 21, the clinic can now "fly more sorties" at a higher effective rate.

"I am no longer working six hours a day identifying results," said Sherri Sodder, 436th MDG family practice. "Now, I work two to four hours on them and as we get further along, I have no doubt my time spent (on results) will drop considerably more than what it is now."

According to Major Higgins, the important thing is keeping people healthy and if something is wrong getting it fixed quickly. He said they turned to Smart Ops 21 not just to save the Air Force money, but to improve the services the Medical Group offers patients.