Photo By Douglas Stutz | Advances in operational medicine for Navy Medicine and Defense Health Agency was on...... read more read more
Advances in operational medicine for Navy Medicine and Defense Health Agency was on full display with the annual Continuous Process Improvement Fair held at Naval Hospital Bremerton, March 10-13, 2025.
The project presentation was based upon such criteria as innovative/creativity and overall impact on quality of care, patient safety and operational readiness.
“By continuously evaluating and refining our processes, we can reduce inefficiencies allowing more time for patient care and more time to utilize/improve the knowledge, skills, and abilities that make us a ready medical force,” said Lt. Cmdr. Ashley Gripe, Navy Medicine Readiness Training Unit Everett Physical Therapy Department head and Process Improvement Sciences lead. “By always looking at ways to improve, we are better able to provide the safe and quality healthcare that our service members need to ensure a medially ready force.”
The ‘Continuous Process Improvement’ concept is based upon the DHA Ready Reliable Care principle, which is focused on reducing unwarranted variation across the system, eliminating waste, and lowering costs.
“We recognize that Continuous Process Improvement is critical to what we do in Navy Medicine and in the fleet. By constantly analyzing and refining processes, we can adapt to changing demands, increase our patient satisfaction, and optimize our resource utilization,” Gripe said.
“This CPI Fair gives us an opportunity to highlight initiatives around the command,” continued Gripe. “Staff can demonstrate the improvements they are making to advance patient quality and safety. It helps to encourage a culture of High Reliability and Continuous Process Improvement that we strive for every day.
CPI initiatives included such ideas as implementing clinical improvements; developing strategic clinical partnerships; and improving and refining administrative and support processes.
“The submissions this year included projects from throughout the command including submissions from our branch clinics. They show the innovation and creativity that our staff utilizes every day to improve the care of our beneficiaries. The submissions demonstrated an impact on safety, quality, and readiness with controls to make sure they are able to sustain the benefits over time,” explained Gripe. “Some of the best ideas come from our civilian staff and corpsmen working day in and day out on the deck plates.”
Each of the 15 submissions presented a process to be improved, measurement on the improved process, analysis which tested any change(s) implemented, and more.
Navy Medicine Readiness Training Unit Everett Pharmacy presented their submission of ‘Pharmacy Designated Service Hours,’ how increased patient wait times can occur when pharmacy staff helping patients are pulled to perform other necessary tasks. Their goal indicated to create designated service hours to increase efficiency and reduce patient wait time by allowing pharmacy tasks to be done prior to assisting patients. Project lead was Lt. Julianne Hui, with team members Hospital Corpsman 2nd Class Brian Matthews, Hospital Corpsmen 3rd Class Isabelle Doyle and Micheala Martinez, Dr. Audra McCoy, Dr. Kathy Scott, Sonny Wilson, and Latoya Hall.
NMRTU Everett Laboratory submitted their ‘Lab Order Reference Guide’ presentation, with project lead HM2 Alessandra Vera explaining to the judging panel led by Capt. Kala Lepore, Naval Hospital Bremerton director and Navy Medicine Readiness Training Command Bremerton commanding officer, that ship providers homeported at Naval Station Everett were encountering challenges when they tried to place lab orders. Vera and her team members of HM2 Moncho Cabahug, HM2 Caleb MartinezSewell and Ms. Jezieca Cachero devised their project around distributing a lab order reference guide – with regular updates – to all providers on the waterfront to ensure a seamless and efficient ordering process for lab work.
After Hospitalman Olivia Blader Polzin of NHB’s Patient Administration noticed that there was unknown supply inventory with several departments which caused delays and missed items, she took it upon herself to develop an Excel spreadsheet to keep accurate records to minimize deficiencies, streamline ordering of actual needed supplies and increase productivity between the departments.
NHB’s Information Management Department had a vexing problem which they rectified as presented in ‘Asset Refresh,’ led by project leads Lt. j.g. David Tegtmeyer and Electronics Technician 1st Class Adam Phelps, ably assisted by all IMD staff members. They had approximately 800 pieces of equipment which had to be timely updated to meet the stringent requirements. Each item took nearly four hours to upgrade as required.
NHB’s Radiology Department presented their project, entitled “MOU for CT Training.’ The department has had CT imaging challenges due to manning challenges, caused by transfer and retirement. The department has proposed establishing a memorandum of understanding with local civilian hospital, St. Michael Medical Center, to authorize NHB radiologic technologists to obtain added training for CT, as well as other modalities such as MRI, ultrasound and mammography.
Lt. Essie Gutierrez represented the Directorate of Health Services Specialty Care Clinic presentation, ‘Utilization of Electronic Colonoscopy Teaching Video,’ which called for streamlining the delivery process of patient education instructions for colonoscopy teaching.
The Neurology Clinic, with project leads Lt. Cmdr. Margaret Mitzkewich and Lt. Justin Roelofs and team members Hospital Corpsman 1st Class William Brown and HM2 Kyle Champion, determined that they were retrieving approximately 16 vials per week of Botulinum from the inpatient pharmacy. Not a difficult task, but time consuming. Due to the constant need for refrigeration and inability to pick up in bulk, there was the continuous need to only pick up one order at a time. Until a properly suited refrigerator was identified and relocated in the clinic.
The Ophthalmology Department presented their ‘Ocular Triage and Challenges of Standardization’ submission, noting they had determined there was a lack of accurate ophthalmic triaging at the initial point of care, resulting in deferred patient referral and delays in care. Their goal was to standardize the triage process with initial [patient] presentation at primary and urgent care clinics, reduce time delays for urgent and emergent ophthalmology cases and reduce potential patient harm through delays in reporting for care. Project lead was Lt. Cmdr. Lan Nguyen assisted by team member HM2 Quinniece Mosley.
‘Project Pulmonary Expansion’ was presented by the Pulmonary Clinic with project lead HM1 Joseph Towery explaining that the clinic is not generating [enough] encounters relevant to patient populations and referrals. In order to improve access to care for all respiratory therapy patients within the service area and lower the task load of primary care, the clinic restructured referral management template to provide NHB as the top source for appointments by bringing back patients previously sent for care into the surrounding network and Madigan Army Medical Center.
Improving time management was key the ‘RFID Implementation in the Clinic Setting’ presentation by Family Medicine, led by project lead Lt. j.g. Maryn Holtslander and team members Lt. Hana Reichert and Hospitalman Gillian Searfoss. Their premise indicated a delay when transferring intake [information] from paper to the DoD’s electronic health record, MHS GENESIS, instead of directly documenting during the initial intake process. Eliminating the need for paper charting provides a number of time-saving advantages, especially giving the provider added triage time with the patient.
The Family Medicine presentation ‘On the Lookout’ used HEDIS (Healthcare Effectiveness Data and Information Set) to help identify patients due – or overdue – for preventive medicine measures such as colorectal screenings and mammograms, as well as address other delinquent measures including immunizations. The goal, established by project lead Terri Jandron, registered nurse, with team members registered nurses Ramir Salcedo, Farrah Palad and Devry Cmelo, Lt. Mikala Tracy, Lt. Christopher Gunderson, Lt. Olivia Cook, and Reichert, Lt. j.g. Wanda Burdick, Lt. j.g. Halle Hassett, and Holtslander, was to ensure providers and support staff are aware of screening needs and added orders placed while patients are present for scheduled appointments which can increase the number of patients completing their preventive health needs.
‘Teams Communication’ was the submission from Primary Care, with project lead Dr. Brandi Hommel and Reichert, aided by Family Medicine staff as team members. Their problem statement indicated challenges in communication amongst staff members was spreading in the clinic, specifically relating appointment delays between administrative receptionists and clinic support staff. They implemented the process of using Teams chat for all; nursing and support staff to help improve easier – and timely – communication.
NHB’s Informatics Steering Committee, charged with planning and implementing strategic informational technology initiatives, determined that the command did not have appointed peer experts for clinical areas, a Defense Health Agency requirement for all military treatment facilities. Their ‘Peer Expert Program,’ was led by project lead Reichert and team members Kelly Gann, Chris Rona, Kristina Sainz, Gunderson and Cmdr. J. M. Patton. A standardized program format was developed and peer experts within two clinical areas were put in place on a trial basis to determine knowledge and confidence with MHS GENESIS.
‘Utilizing Auto-Text’ from Family Medicine’s Primary Care Clinic, led by project lead HM3 Adam Redman and Holtslander, with team members Reichert and HN Anfernee Coleman, realized that their clinic relied upon in-between encounters with MHS GENESIS to communicate information regarding patient requests and staff member needs. There were times some information would be omitted, and written messages were a time-consuming process. The project goal was to streamline routine tasks through automation by implementing a standardized approach for all users.
The Family Medicine Clinic presented the ‘Purple Paper Project,’ stating that obstetrics referrals from their clinic to OB/GYN could be delayed due to a non-standardized process for ordering, verifying test results and timely entering appropriate referrals for network care.
Their goal is to create a standardized format for patients enrolled in the clinic, as well as those who present in NHB’s Urgent Care Clinic and request a pregnancy test. Project lead was Hassett, with team members Tracy, Reichert, Cook, Gunderson, Holtslander, Burdick, Salcedo, Palad and Cmelo.
Gripe attests that the benefits of encouraging such innovation and creativity in military medicine are manifold.
“Both our beneficiaries and our staff benefit from us sharing our process improvement ideas. The benefit however is not limited just to here. After the CPI Fair we will enter these projects into the Strategic Performance Improvement Data Repository which makes these improvement ideas available to all Department of Defense and the Defense Health Agency entities. The improvements that we make here has the potential to impact staff and patients across the world,” stated Gripe.
| Date Taken: | 03.17.2025 |
| Date Posted: | 03.17.2025 11:18 |
| Story ID: | 493015 |
| Location: | BREMERTON , WASHINGTON, US |
| Web Views: | 202 |
| Downloads: | 1 |
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