Continuous Process Improvement project competition yields treasure of submissions, innovative winners for NMFP

Naval Medical Forces Pacific announced its annual Continuous Process Improvement project competition winners during an NMFP Commander’s synchronization meeting at the headquarters in Naval Base San Diego, July 7.
 
The annual NMFP CPI project competition was held to showcase and share the work performed within Navy Medicine Readiness and Training Commands, Units, Detachments, and supported operational commands and units.
 
Winners were announced in five categories: Define-Measure-Analyze-Design-Verify, Define-Measure-Analyze-Improve-Control, Rapid Improvement Event, Four Disciplines of Execution, and Other Process Improvement Initiatives.
 
“It’s important to have this event annually because it’s a way to share innovative new processes with other commands,” said Cmdr. Tim Whiting, director, Improvement Sciences, NMFP. “Many of the commands experience similar pains in a multitude of processes and when a command decides to address their pain using process improvement methodologies, we are able to enter those new improvements into a central repository for other commands to see and possibly replicate.”
In total, there were 39 entries from 16 organizations, resulting in the following winners:
 

1. Category: Define-Measure-Analyze-Design-Verify  (DMADV)
   1. Winner: NMRTC Okinawa  – Lt. Cmdr. Paul Lewis
   2. Project Title: Under Taking Excess Scripts
   3. Problem: There were no data-driven processes at NMRTC Okinawa to inform those responsible for prescribing postoperative opiate pain medications after general surgery procedures. Most providers decide how much pain medication to prescribe based upon their personal opinions or how they were trained.
   4. Actions and Results:  The new process provided surgeon and provider data on excess opiate reclamation and adjusted prescription practices based on self-evaluations.  The newly designed process resulted in 31 percent overall practice group reduction of opiate prescribing—exceeding the goal of a 20 percent reduction. The reduction prevents unnecessary distribution of opiates to the community and the risks of misuse and diversion such potential excess would present.

 

2. Category: Define-Measure-Analyze-Improve-Control (DMAIC)
   1. Winner: III Marine Expeditionary Force – Lt. Cmdr. Benjamin Drew
   2. Project Title:  Improve Medical Provider Credentialing Process
   3. Problem: Between July 2019 and September 2019, the average time between a medical physician arriving in Okinawa, Japan, and being ready to practice clinical medicine was 26 days. Several clinicians required as much as 55 days after reporting aboard to complete the credentialing process.
   4. Actions and Results:  The III MEF identified the bottlenecks that resulted in delays, defects and rework.  They created a revised go-by checklist, provided application support during permanent-change-of-station move, and assigned surrogates in the approval process.  Providers are now credentialed before reporting to III MEF, on average seven days before arriving on island.

 

3. Category: Rapid Improvement Event (RIE)
   1. Winner: Navy Medicine Readiness and Training Unit Everett - Dr. Ryan McDonald
   2. Project Title: Drive-Through Pharmacy: Mitigating COVID-19 Exposure
   3. Problem: In response to COVID-19 and the elevated health protection condition that restricted base access, script volume was significantly reduced. As the base returned to a less restrictive health protection condition and the number of scripts filled increased, the pharmacy needed to find a safe way to protect patients from COVID-19 exposure.
   4. Actions and Results:  The team analyzed waiting room space, social distancing guidelines, script volume, and customer surveys resulting in the development of a drive-through pharmacy. The efforts safely increased script volume by 165 percent, decreased risk of COVID-19 exposure, and used new technology to improve quality and patient safety.

 

4. Category: Four Disciplines of Execution (4DX)
   1. Winner: NMRTC Yokosuka – Cmdr. Mary Piliwale
   2. Project Title: Flattening the Curve on Rush/Peak Hour
   3. Problem:  The Immunization Clinic’s average wait time is 8 minutes.  However, 30 percent of patients wait longer than 30 minutes during rush/peak hours.  Still a low average wait time, but significant percentage of patients waiting longer than 15 minutes indicates that there are significant congestions throughout the workday.
   4. Actions and Results:  The team improved prescreening and appointment system utilization. Large group events were organized through collaboration with stakeholders.  The improved wait times were sustained for more than four months, leading to increased appointment availabilities and decreased clinic congestion.

 

5. Category: Other Process Improvement (OPI)
   1. Winner: NMRTC Camp Pendleton – Lt. Ashley Pataky
   2. Project Title: Cost Savings Using Quick-Response Codes
   3. Problem: In 2020, the pharmacy spent $7,100 on paper and ink toner to print 67,655 medication information leaflets to be given to patients—a necessary cost to comply with Federal law requiring medication information for new prescriptions.  However, paper and ink toner were backordered due to the COVID-19 pandemic.
   4. Actions & Results:  To mitigate use and cost of paper and toner, the team proposed to include QR codes on medication vial labels, which when scanned with a mobile device, would display medication information previously printed on leaflets. The process improvement was well-received by patients, and the QR code implementation resulted in $2,471 paper and toner costs saved for the remaining fiscal year—and projected $11,000 annually as paper and toner use continues to trend down with patient familiarity.

 
Many of the projects were focused on reducing inefficiencies, which in turn indirectly reduced costs.
“The annual competition provides a platform to identify the best of the projects from the past year and not only recognize the teams but share those projects for others to benefit,” said Justin Bacio, deputy director, Improvement Sciences, NMFP. "Additionally, many of the projects were led by junior enlisted staff--bolstering their leadership skills and arming them with a proven problem-solving methodology to tackle problems at all levels." 
The CPI program compliments the Chief of Naval Operations January 11 call to action for the Navy to Get Real and Get Better – the initiative to broadly apply the leadership behavior of Navy’s highest performing, strongly self-assessing and self-correcting, units and organizations.
 
One of the tenants of GRGB is to empower people to find and fix problems – and innovate – at their level, from the deckplate to senior leaders.
 
“In my opinion, CPI promotes innovation,” said Whiting. “Measuring indirect cost is difficult to quantify. However, the processes used in addressing these inefficiencies often require innovation because it is rare that these teams are provided a budget in any form. To achieve some of the results that these teams experience requires some outside-the-box thinking. So I think innovation is the focal point from this perspective.”
 
Each winning project team was recognized by the NMFP Commander. In addition, a team Letter of Appreciation, signed by the NMFP Commander, was sent to winning commands. These commanders will present the team LOA at an appropriate venue at their discretion.