Valdez Michelle M, Liwanag Maureen, Mount Charles, Rodriguez Rechell, Avalos-Reyes Elisea, Smith Andrew, Collette David, Starsiak Michael, Green Richard
Graduate Medical Education Department, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA.
Information Management Department, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA.
Mil Med. 2018 Sep 1;183(9-10):e405-e410. doi: 10.1093/milmed/usy010.
Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project.
Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures.
The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p < 0.0001.
This RIE project utilized LSS methodology and tools to improve signature compliance and increase customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all authored work requests, and a 97% "completely or mostly satisfied" customer rating of the process.
出版物和/或演示文稿的指令审批流程效率低下，对国防部研究生医学教育（GME）住院医师培训项目满足毕业后医学教育认证委员会（ACGME）学术活动要求的能力产生负面影响。对圣地亚哥海军医疗中心（NMCSD）的著作审批流程进行的初步审查发现，该流程存在严重低效、流程差异以及客户满意度较低的问题。为了促进和鼓励NMCSD的学术活动，并满足ACGME的要求，执行指导委员会（ESC）组建了一个跨专业团队，领导一个精益六西格玛（LSS）快速改进活动（RIE）项目。
确定了两个主要结果指标：（1）包含所有所需签名的著作提交数量；（2）客户对著作流程的满意度。主要指标的基线数据通过一个跟踪出版物和演示文稿的临床研究数据库收集。次要指标的基线数据通过对GME教职员工和住院医师的客户满意度调查收集。项目团队分析了调查前的数据，并使用了LSS工具和方法，包括“现地现物”（实地）考察、因果图、质量关键树、客户声音、“浪费”图以及活动前后的价值流图。团队选择了一个电子提交系统作为最有可能对RIE项目结果指标产生积极影响的干预措施。
符合所有所需签名的著作数量从52%提高到了100%。被评为“完全或大部分满意”的客户满意度从24%提高到了97%。对于签名合规性和客户满意度这两个结果，均实现了统计学显著性（p < 0.0001）。
这个RIE项目利用LSS方法和工具提高了签名合规性，并提高了客户对著作审批流程的满意度，实现了100%的签名合规、所有著作请求的全面纵向存储库，以及该流程97%的“完全或大部分满意”客户评级。
