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Nellis hospital undergoes flow improvement initiative

by 2nd Lt. Laura Balch
99th Air Base Wing Public Affairs

2/15/2011 - NELLIS AIR FORCE BASE, Nev. (AFNS) -- Officials from the Air Force Medical Operations Agency began guiding lead members of the Mike O'Callaghan Federal Hospital here on a flow improvement initiative Feb. 7.

The fundamental purpose of this initiative is to improve the hospital's efficiency and its ability to complete the mission.

"Our goal in implementing this initiative is to improve our patients' experiences in our hospital," said Col. Penelope Gorsuch, the Inpatient Operations Squadron commander and project lead for the Nellis Air Force Base hospital improvement initiative.

To begin this optimization process, officials from the AFMOA, with the assistance of 99th Air Base Wing Air Force Smart Operations of the 21st Century staff members, conducted a high-level value stream analysis.

"The data collected from this value stream analysis will reveal the troublesome areas in our hospital upon which we must focus and improve," Colonel Gorsuch said. "We've been observing every aspect of our patients' stay, from when they're admitted to when we provide treatment to when they're discharged, in order to obtain the most telling data."

The hospital's staff members will study the conclusions drawn from this analysis, and subsequently will alter their day-to-day operations in order to serve their patients better.

It will take a few years for the hospital to optimize fully the newly developing hospital flow procedures, but this is a process that continually builds on itself, officials said. Every day the staff members will learn from the previous days' and weeks' successes and failures and will make adjustments to continue their overall positive progression.

The Nellis AFB hospital is the first base hospital to undergo this flow improvement initiative.

"Nellis (AFB) was chosen to be the first because the Air Force Surgeon General selected the Mike O'Callaghan Federal Hospital as the newest facility to be promoted to a medical center," said Dr. Stephen Jennings, a retired Air Force colonel and the AFMOA senior surgical consultant. "With this promotion, the base hospital will experience an increase in its number of staff members and patients, in the types of specialties that it can offer and in its demand to fulfill its day-to-day operations."

These growing numbers and responsibilities will dictate the hospital's need to continue to focus on the "five Cs" -- care: be effective, efficient and safe; capacity: improve access in order to help as many patients as possible; capability: offer the correct service or specialty; cost: offer services at a good value; and currency: keep staff members qualified and ready to deploy, explained Beth Kohsin, the AFMOA director of transformation.

"The improvement process will assist our ability to maximize the 'five C's' and to provide our patients with the best overall experience possible," Ms. Kohsin added.

"Ultimately, thanks to this innovative improvement initiative, our hospital will serve as a template for other medical centers to model themselves after," Colonel Gorsuch said.

This is not the first time the Mike O'Callaghan Federal Hospital has undergone an improvement initiative. A few years ago, surgical processes were improved, and in November 2010, the focus was on emergency room improvement. The ER staff members continue to monitor their initiative's effects. Thus far, there have been marked enhancements.

The initial analysis of the ER had revealed that, among other things, the layout of the ER beds was problematic, nurses and technicians were walking up to eight miles during their 12-hour shifts, and the evenly distributed staff working throughout the day did not match the rise and fall of the incoming patient population.

By repositioning certain types of patients, rearranging portions of the ER and rescheduling shifts, ER officials said they have optimized their capabilities and have seen many positive changes.

"Over the past year, we saw more than 40,000 patients; we are the second busiest ER in the Air Force," said Maj. Clarence Dunagan, the Medical Squadron Emergency Services flight commander. "Because of the recent ER improvement initiative, in the last two weeks we have shattered a number of hospital records. For example, in one 24-hour period, we served 162 people, which beat the old record by more than 20 people."

The Mike O'Callaghan Federal Hospital is one of three hospitals in the Air Force that serves Veterans Affairs and Defense Department members, to include active duty, dependants and retirees.

But despite its large and continually growing patient population, the base hospital's leadership and staff said they are committed to constant improvement.

"The hospital flow improvement initiative, like the previous surgical and ER improvement efforts, but on larger scale, is one more way we are bettering this facility; we are participating in this process enthusiastically so we can achieve the greatest positive impact possible for our staff and our patients," Colonel Gorsuch said.

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