Naval Health Clinic Team Wins First Place at National Quality Symposium

A Six Sigma Green Belt in the Naval Branch Health Clinic (NBHC) Gulfport led a team that won a quality award for a process improvement project that raised the quality of care given to children.

The four-member team at NBHC Gulfport beat out 47 other applicants to win the quality award at the 2019 National Capital Region Quality Symposium.

The Navy has been a strong advocate for process improvement, along with other branches of the military. This project involved use of the Navy’s Healthcare Effectiveness Data Information Set (HEDIS), which is a tool used throughout the Navy that measures the effectiveness of healthcare.

The Green Belt who led the team at NBHC Gulfport, Hospital Corpsman 2nd Class Carolanne Hardy, told the Defense Visual Information Distribution Service (DVIDS),  “I am very proud of the team and what we were able to accomplish. The feeling is indescribable.”

Team Accomplishments

Completing the process was part of the Six Sigma Green Belt training for Hardy. She wanted to focus on a project that impacted healthcare and how the Naval clinic delivers services.

The project focused on wellness exams for children. Before the project, the Gulfport clinic achieved an average HEDIS score of 57%. After the project, that score skyrocketed to 90%.

Higher HEDIS scores mean better healthcare services are being offered at the clinic, which serves active-duty servicemembers at the Naval Construction Battalion Center Gulfport.

The team first analyzed the root causes for the low HEDIS scores, using tools like the Fishbone Diagram. Then, they identified ways to make improvements. One of the biggest involved combining wellness visits with acute care visits.

Dr. Elisabeth Haller, a pediatrician at NGHC Gulfport, told DVIDS that one change was to proactively contact parents and ask them to make wellness visits. Also, if a child was brought in due to illness, the doctor would also perform a wellness exam. Haller noted that many parents “have two or three children, so it is difficult for them to get in for a sick appointment and a well-child visit. We try to combine those in the instances when it is possible.”

This offers a real-world example of how small changes implemented after detailed analysis can lead to big impacts.

Hardy told DVIDS that the project team never even thought about awards and were focusing on improved healthcare for the children, adding that “being surrounded by ranks much higher than I am from all branches of services and being able to represent the clinic and the hospital was an honor.”

Six Sigma Tools Used

The health clinic offered a detailed look at some of the Six Sigma tools they used to achieve success. They included the following, each of which fit within the DMAIC roadmap (Define, Measure, Analyze, Improve, Control) used in Six Sigma.

Voice of the Customer – This involves collecting information from customers or end users. In other words, the people who use the finished product or service. Understanding their expectations, preferences, needs and requirements can help teams define what is needed and what is wasteful in a process. It is part of the Define phase.

SIPOC – A SIPOC diagram allows teams to look at every aspect of a process through the lens of customer requirements. SIPOC stands for suppliers, inputs, process, outputs and customers. Waste is quickly identified by separating what parts of a process help meets customer needs and which do not. It is part of the Measure phase.

Fishbone Diagram – This is one of the cause-effect diagrams used in Six Sigma. In this case, the clinic used the diagram to find “root causes” – the underlying reasons behind the issues that occur in a process. The diagram is used to list causes for issues, then sub-causes, then sub-causes of the sub-causes. This continues until the root of the problem is discovered. It is part of the Analyze phase.

Implementation Plan – Once solutions are found to process challenges through tools such as Kaizen events, an implementation plan plots out how improvements will be put into place. That includes the actions planned, the due dates for those actions and the people responsible for putting them into place. It’s part of the Improve phase.

Control Plan – A control plan sets limits on the variations expected within a process. Using a control chart, teams can identifying the difference between common-cause variation (random variations that can be left alone) and assignable-cause variation (variation caused by flaws in the process that need to be addressed). This is part of the Control phase.