From Process Improvement to Change Management – Lean Six Sigma at Naval Hospital Bremerton

Lean, keen, and green.

As Navy Medicine continues to evolve in providing operational and patient-centered care, the challenge for staff to meet demands requires them to understand, manage and positively influence change.

Towards that end, Naval Hospital Bremerton staff members took part in Navy Medicine’s Lean/Six Sigma (L/SS) green belt training, March 4-8, 2019, under the tutelage of retired Navy Capt. Charles Mount.

“Lean Six Sigma is all about solving problems that are important to the command,” said Mount, senior healthcare strategy advisor and L/SS master black belt.

According to Elaine J. Huggins, NHB L/SS master black belt and training organizer, the L/SS course is designed to prepare those enrolled to become a change-agent for process improvement at their Navy Medicine command.

“Because there is so much change going on in military medicine, leaving change to chance means poor outcomes and a burned out staff. Remember what Albert Einstein is purported as saying: ‘The definition of insanity is doing the same thing over and over and expecting a different outcome’ and ‘using the same logic to get out of the trouble that got you there in the first place,’” said Huggins, who has extensive background in L/SS training dating back to being assigned to Vandenberg Air Force Base in 2006.

Vice Adm. Forrest Faison, Navy surgeon general and chief, Bureau of Medicine and Surgery, stated in a recent blog that military medicine, including Navy Medicine, “is undergoing some of the most significant changes we have seen in decades.”

Military Treatment Facilities like NHB are transitioning management and administration of health service delivery to the Defense Health Agency to standardize care and gain efficiencies across the enterprise, along with a renewed emphasis on readiness by establishing Navy Medicine Readiness Training Commands to assure medical personnel continue to develop and maintain operationally relevant skills.

The transition should be seamless for patients. “For beneficiaries, the bottom line is the transition shouldn’t cause any significant changes. If you’re a patient, you’ll still continue to receive the same high quality medical care,” wrote Faison.

Huggins attests that patients, staff, and leadership all benefit from the use of L/SS because of improved quality performance, improved patient satisfaction, productivity improvements, accuracy improvement, error reduction, financial savings, and cost avoidance.

Applying L/SS can lead to a decrease in duplicity of effort, remove waste, eliminate variability, and manage, improve, and increase work flow.

“As an example, say for one clinic, the patient check-in process has 25 steps. The ‘lean’ part of L/SS tries to decrease those steps perhaps to 15, with each step designed to drive the patient to be completely checked in. The ‘six sigma’ part examines all those steps and wonders if there’s any redundancy, any step that might be done wrong, and how to ensure so there’s no misinterpretation,” explained Huggins, adding that L/SS is a problem-solving methodology designed to increase value delivered to the customer, which in Navy Medicine means the patient customer, staff customer, and leader customer. The methodology assumes that there will be no end to improvement. It is a continuous journey of constant improvement.

The L/SS methodology is built on the management philosophy that front-line workers are key drivers for actual improvement. It’s the front-line workers, says Huggins, who are the experts knowing what needs to be improved and how to improve it.

“In this method, middle management is there to support workers in improving the product, such as patient care and health care services, by giving time and space to work on the projects and serving as subject matter experts,” added Huggins.

The role of senior leadership is to remove the roadblocks – such as lack of funding, manpower shortage, and organizational approval – that can halt any improvement plan.

There have already been several Lean/Six Sigma projects completed at Naval Hospital Bremerton. These cover a wide range of processes such as Computed Tomography Cost Reduction Plan for Radiology Department, Charge Nurse Implementation, and Newborn Care Clinic Process Optimization.

From the Secretary of the Navy to Department of Defense and throughout Navy Medicine, L/SS is recognized as a valuable process improvement program able to increase readiness and mission support, assess and improve efficiency and effectiveness, and enhance patient-centered care and safety.

The driving force behind L/SS has been Mount, who served approximately 39 years on active duty, as a young hospital corpsman in the midst of the 1968 Tet Offensive during the Vietnam War to commanding officer of Navy Medicine training command(s) at San Diego and Portsmouth, Va.

“To be able to learn from him is like learning football from Vince Lombardi,” commented Huggins.

Mount’s green belt training had approximately 20 active duty and civilian staff members enrolled, representing varied departments, directorates and disciplines. Such diversity provided an additional asset to leverage well after the course is completed.

“Diversity in the ranks make for a richer mix of Lean Six Sigma. Everyone learns from each other. There’s a wide variety of perspective, from those who have served for a long time from those who are new. All that combined knowledge that is a mixture of age and experience, irrespective of rank or rate, directly helps their command become a learning organization that will actually keep learning from itself. By taking this course and becoming certified, it becomes part of their skill set,” Mount said.

That skill set centers on learning L/SS problem solving techniques and follow up by what Huggins refers to as ‘controlling the change.’

“Controlling the change’ means that Lean/Six Sigma is also a change management method. The whole theory of L/SS starts first with looking at the command mission, vision and key goals, and then aligning projects with those goals,’ said Huggins.

Staff were mentored how to improve any process or problem affecting their daily work and also teamed up for two L/SS projects before completing the class to become certified.

“This course provided a lot of opportunities to study processes and how to improve them, make them work better by cutting our hurdles not needed, and revising procedures in ways that I wouldn’t have thought of before. It’s really taking a step back to look at any issue from an entirely different perspective,” said Krista Mysko, NHB pharmacy technician.

DISCLAIMER: This article was originally published at the Defense Video Imagery Distribution System Hub ( The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.

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