'Lean' workshops helping clinic staff improve productivity Published July 15, 2013 By Robert Goetz Joint Base San Antonio-Randolph Public Affairs JOINT BASE SAN ANTONIO-RANDOLPH, Texas -- An initiative is under way to turn the Joint Base San Antonio-Randolph Medical Clinic into a "lean" facility. A series of "lean" workshops began in May, orienting 359th Medical Group active-duty members and civilians to ways they can improve processes to save resources and eliminate waste in the delivery of health care services. "Lean is a process of eliminating waste," Tech. Sgt. Rolando Guerrero, 359th Medical Operations Squadron Physical Therapy Flight chief, said. "The plan is to change the topic each month and focus on a new lean tool so employees can rapidly use it in their duty sections." The first workshop - titled "What is Lean?" - was delivered to 60 people over the initial four one-hour class periods, he said. Participants divided into two teams and simulated the process of treating patients from start to finish, attempting to treat as many as possible within five minutes in two different rounds. "The objective was to have people be able to recognize the eight types of waste in their current processes," Guerrero said. Guerrero, who set the stage for the workshops by implementing changes over a year's time at the physical therapy flight, said the lean concept was born in Toyota's automobile manufacturing process more than a half-century ago. Guerrero was qualified to lead process improvements as a result of Air Force Smart Operations for the 21st Century green belt training he received when he was assigned to Luke Air Force Base, Ariz. AFSO 21 is the Air Force's effort to maximize value and minimize waste in all its processes. When he was assigned to Randolph last year, he wanted to apply his knowledge throughout the clinic, so he started at his own flight. The physical therapy flight successfully addressed a number of issues, reducing its no-show rate, better organizing items in the storage room, keeping frequently used supplies in the therapy area and implementing changes to free technicians from administrative chores. Guerrero said there was "resistance at first" to the changes. "It was hard to do, but then people felt the advantage," he said. "Now we've done a whole 180. People are fixing things without me saying anything. We want to get the medical clinic on the same level." First Lt. Christine Mulshine, 359th Medical Support Squadron patient administration officer in charge, said one of the biggest benefits of implementing lean processes is immediate stress reduction in the workplace. "I know the last thing people associate with performance improvement initiatives is stress reduction, but utilizing lean principles in the workplace has a marked effect on reducing the constant firefighting that we can encounter when trying to accomplish our tasks," she said. Mulshine said less time is spent hunting down supplies or tracking a lost document, and expectations of performance and timelines are made explicit. The benefits are "very real, both tangible and intangible," she said. Trained as a Lean Six Sigma green belt in the civilian community, Mulshine is assisting Guerrero in the lean workshops. Six Sigma is a method to eliminate variations and standardize processes. Changes at the physical therapy flight resulted in improved morale among the staff and more satisfaction from patients, Guerrero said. Cost savings are yet another benefit of lean processes, Guerrero said. "You see that immediately," he said.