The Warrior Medic Medical Treatment Facility represents a medical facility charged with delivering quality and safe patient care. The staff prides itself on being the command's premier medical facility. Recently, however, the MTF has fallen below target performance on one of the U.S. Army Medical Command's critical objectives -- Accessible High Quality Care, or access to care. What is happening within this MTF, and how can they improve the process and meet performance goals?

A newly trained team of Lean Six Sigma students were given the task to find out in a mock scenario offered by the Regional Health Command -- Central Lean Six Sigma team recently. Using what they learned in the two-week class, and their newly developed LSS skills, the class discovered a way to improve one of the simulated MTF's processes impacting on access to care.

This class was one of many Lean Six Sigma classes, including Yellow Belt, Green Belt and Black Belt, being offered to units across the command. These courses are paying dividends by improving performance in a myriad of process metrics in health and readiness, healthcare delivery, and taking care of Soldiers and their families, all three being lines of effort established by the MEDCOM commanding general, according to Glenn Taplin, RHC-C director of strategy and innovation.

The three types of belts -- yellow, green and black -- each represent a different level of certification within the LSS model, and all three shares a common theme that LSS is a data-driven process improvement methodology.

A LSS Yellow Belt has completed a one-day course that covers the basics of LSS, and includes a simulation, such as the one discussed above, as a learning re-enforcement tool for the concepts learned in class. Ideal candidates are staff members who will serve as a member of a LSS project team, or who serve in a process improvement role within the organization.

A LSS Green Belt is a graduate of a two-week class that targets first and mid-level leaders. The class provides training in the "Lean" process improvement tools and techniques, and the basics of "Six Sigma" methodologies, which focus on reducing the variation in the results/output of a particular process. It requires the completion of the two-week class, passing the end of course comprehensive written exam and completion of a process improvement project that demonstrates mastery of the skills and tools taught in the didactic phase of the course. All three elements must be successfully completed in order to obtain Department of the Army Green Belt certification.

A LSS Black Belt candidate is someone who has already successfully completed the Green Belt course prior to enrollment. The Black Belt course is also a two-week course, but it builds on the "Lean" skills learned in the Green Belt course, and adds in-depth, statistical analysis tools to enable the graduate to collect and analyze process data, identify root causes of sub-optimal performance, develop and pilot a changed process to negate those identified weaknesses, and present the command with proposed new process in order to achieve the desired results. This course targets mid-grade and senior leaders, and covers the full range of LSS skills. To receive certification, just as in the Green Belt course, the candidate must complete the didactic class, pass a comprehensive end of course written examination, and complete a project that demonstrates mastery of the analytical skills taught in the didactic phase of the program.

"As leaders," Taplin said, "we too often focus on the outcome of a given process, such as evaluation timeliness percentages, ER throughput or pharmacy wait times, without looking inside the process in question to see what one or two steps within the process are negatively affecting the desired outcome of the process ."

For two of the last three years, the RHC-C Lean Six Sigma team has been named the best in U.S. Army Medical Command, a status the team plans on continuing in the years to come.

The RHC-C team, consisting of Taplin, the RHC-C LSS deployment director, Damian Centeno, RHC-C's only certified Master Black Belt; Darrell Coleman, a certified Black Belt , and Susan White, a certified Black Belt and management analyst, critically reviewed and improved their own processes to better serve the needs of the region's unit commanders.

Centeno attributes their accomplishments to the "tremendous command support at all levels" in addition to a five -year plan laid out by Taplin.

"We looked at where we wanted to be and laid that out very strategically," said Centeno. "We took into consideration who we have, who's been trained and what we needed to do to get us where we wanted to be."

From there, the team looked at what policies were in place, what tracking was being done to identify who had been trained and who was in the field to help. They discovered there was no tracking mechanism in place and decided to standardize how they did this across the Region and at each military treatment facility.

The plan paid off and they are seeing an increase in the numbers of individuals trained as well as the number of projects.

Since the Lean Six Sigma program's implementation by the MEDCOM in late 2006, the Green and Black Belt training was largely centralized with a limited number of seats being available in classes taught at the Army Medical Department Center and School. This methodology meant that unit commanders might get an average of one or two belt-producing class seats a year, which did not adequately address RHC-C's needs as units began addressing the transition to High Reliability Organizations. One of the three stated pillars of HRO was "Robust Process Improvement", with LSS being the emphasized process improvement methodology for that initiative.

For RHC-C, the centralized LSS classes did not adequately support that goal, due to the low number of belt training opportunities. In Fiscal Year 16, RHC-C began exporting classes with the Strategy and Innovation staff conducting the actual training. During FY16, the region's completed projects provided a cost avoidance of $577,000. They conducted the LSS Executive Leaders course for 60 unit senior leaders at five locations, trained 44 black belts at two locations, and 366 yellow belts at six locations, as well as partnered with the Medical Department Center and School to provide a Green Belt course to 18 Baylor Master of Health Administration students. The team also developed and built a MEDCOM-wide belt certification tool to manage, request and track project certifications.

This fiscal year, there are 94 active/proposed projects expected to produce a return on investment/cost avoidance of $600,000, according to Centeno. They will visit eight locations, train 80 leaders in the Executive Leader course, 48 black belts, 180 green belts, 420 yellow belts as well conducting eight project identification workshops that will generate 192 projects, compared to the total of 15-20 belt candidates they were able to accommodate in a year when they were totally reliant on centralized MEDCOM --sponsored training at the AMEDDC&S. This changed approach enabled a drastic increase in the LSS-trained staff members and helped enable unit commanders in their HRO journey.

Additionally, the exported training has had budgetary benefits as well. For example, one medical center that hosted a Black Belt class in 2016 was able to get that training for 13 of their own staff members. If they had relied on the historical centralized classes at the AMEDDC&S, and had been able to get 13 seats in a centralized Black Belt course, the TDY costs for the travel and per diem TDY costs for those staff members would have been over $80,000, versus benefitting from the exported training and not having any TDY costs for those 13 staff members, according to Taplin.

The success of the program is not a secret, and more and more people are requesting training as unit leaders market the program. Not surprisingly, there are also requests from Installation Management Command, Forces Command and Training and Doctrine Command units to send people to RHC-C classes on the various installations within the command. While the priority of training remains RHC-C units and their staff, the LSS team does enroll staffers from other commands on a space available basis.

The RHC-C's primary and overarching intent is to create an internal, organic process improvement capability for unit commanders that are led by trained and certified LSS practitioners on their own staff.

During the region's transition from Southern Regional Medical Command to Regional Health Command -- Central, the region gained 22 new units, most without significant recent LSS activity, Taplin said. The LSS team contacted the commanders of new and existing units across the region to gauge their interest in hosting classes on their installations. The response, according to Taplin, was much better than expected, and resulted in an admittedly ambitious FY 2017 training plan.

Classes during the rest of FY 2017 are:
Raymond W. Bliss Army Health Center -- January (Green Belt)
Reynolds Army Community Hospital - February (Green Belt)
Evans Army Community Hospital -- March (Black Belt)
Bayne-Jones Army Community Hospital - April (Green Belt)
General Leonard Wood Army Community Hospital - May (Green Belt)
Irwin Army Community Hospital - June (Green Belt)
William Beaumont Army Medical Center - July and August (Green Belt -- July and Black Belt-August)

This training is available for Soldiers and DA Civilians in RHC-C units. Contractors are not eligible to attend this training. To obtain information regarding attendance at one of the classes listed above or to request training, contact Centeno at 210-295-2643, Coleman at 210-295-2200, or Taplin at 210-295-2477.