Medical team goes Lean to save Published March 26, 2012 By 1st Lt. Ryan DeCamp 56th Fighter Wing Public Affairs LUKE AIR FORCE BASE, Ariz. -- Do you like long waits for medical appointments? I didn't think so. The 56th Medical Group doesn't like you waiting either, and they chose to do something about it. They decided to get "Lean." More than 40 students from a handful of Air Force bases attended the Lean For Healthcare course taught March 5 to 9 on Luke Air Force Base. The students included medical doctors, nurses and NCO-technicians from across military medical fields. "It's Lean because it has less waste in the process, and it uses fewer resources," said Keith Leitner, University of Tennessee Center for Executive Education faculty member, who helped teach the course and oversaw the training. "Lean is a philosophy that allows you to remove wasteful activities that occupy resources and diminish good, quality care." The course began with classroom time covering subjects like where the Air Force medical need is and analyzing case studies of emergency rooms across the U.S. Then the hands-on work began. Instructors split students into two teams. Students were instructed to build an emergency room from scratch, using tables to represent buildings. They used large index cards to symbolize rooms where patients would receive care and smaller multi-colored index cards representing tests or supplies such as X-rays, casts and crutches. Teams essentially played a medical war game. Virtual patients entered an emergency room, and based on what symptoms were on their cards, the medical staff chose what care to give them. The instructors timed each step of the process. "When they came in with the stopwatch and they were going to time every procedure, I was sitting back going, 'this is just a waste of time,'" said Maj. Jeanine Hatfield, 56th Medical Operations Squadron Medical Services Flight commander and pediatric nurse practitioner. "Then as they took those times and put them in a system; it showed us where the waste was and how to get rid of it. "My eyes were opened. This can work. It's not about doing more with less. It's about doing a better job of what we do." The teams competed to see who could treat 100 simulated patients while providing quality care, without mistakes. Instructors didn't allow talking either, which adds to the chaos. The lack of speech and constant clicks of stop watches made the room sound like an orchestra of scurrying feet and watch beeps. The teams played the game three times during the week. After each game, the teams looked at where they could save seconds by moving equipment needed for treatment to rooms and drawers closer to the patient. Each second marked on the patient's scorecard represented one minute that patient spent waiting around or moving to another room between seeing doctors or having tests done. They also reorganized rooms based on the order patients needed to visit each room, cutting time needed to move patients around. This allowed medical staff to spend more time providing treatment. When students finished their third round of the game, they had, on average, a 71-percent increase in the total patients using fewer staff members and rooms. They also cut 70 percent of the time patients weren't getting care, such as sitting in a waiting room. They saved half the amount of overtime usually worked. The game represented an emergency room scenario, but the students who don't work in an ER said the training still applied to them. "We do complain about the lack of resources and personnel," said Senior Master Sgt. Donald Perkins, 10th Surgical Operations Squadron superintendant at the U.S. Air Force Academy. "I hear that day in and day out. This Lean process showed us that we can be more efficient than if we had more people. My take-home was it's not about increasing manning all the time. It's about restructuring what you're doing on a day-to-day basis and tightening up processes." The instructors say that allows patients on base to more quickly see the doctor and for a longer time. Air Force leadership at the course reiterated that Lean is designed to improve healthcare, not to remove people from the system. "This is not a manpower drill to figure out where positions can be cut," said Beth Kohsin, Air Force Medical Operations Agency transformation director. "It's to provide more efficient and effective care overall. "We're not at capacity," she said. "The mentality is, 'we need more people, we need more space, we need more money,' so we can treat more patients. When we're in there watching the students perform, if you get rid of the waste Lean points to, you easily free up so many of the resources and can then focus back on the care you really need to provide. Patients get more, better care." The students said the course will give them more time to do what they joined the military to do in the first place -- treat patients and do it better.