Med Group adopts new way of doing business Published Sept. 18, 2015 By Jenny Gordon Robins Public Affairs ROBINS AIR FORCE BASE, Ga. -- The 78th Medical Group has implemented a style of communication and accountability that has proven successful across the 402nd Aircraft Maintenance Group's production lines. Known as tier briefings, the communication tool is beginning to gain traction throughout the 78th MDG - particularly in the 78th Medical Operations Squadron's family medicine, pediatrics and women's health, mental health and physical therapy areas. Instead of keeping track of aircraft programmed depot maintenance performance (flow days and aircraft on station), medical squadrons keep track of and measure their own metrics in order to ensure patient care is the clinic's top priority. Driven by several events earlier this year, including a lean event to further identify and plan continuous process improvements, after observing tier briefings outlining production issues in the 561st Aircraft Maintenance Squadron, it was decided this was a process that medical squadrons could use to track their own processes. "It was the perfect solution," said Lt. Col. Jennifer Trinkle, 78th MDOS commander. "On speed and quality, that goes right back to Art of the Possible with people, processes and resources. We really embraced CPI in the 78th MDG." "Tier briefs help because everyone knows what is happening. It sets the beginning of the day," she said. "I have a better idea now of the workload and what is going on in the squadrons, and I can help mitigate constraints on a daily basis." In the squadron's Physical Therapy flight, although a small office with a handful of technicians and a physical therapist, daily tier briefs discuss administrative details, patient appointments and productivity concerns, giving everyone face time to address current issues. "It's a chance for us to talk about patients who may be having issues who we need to keep eyes on and to share information," said Maj. Lee Warlick, flight commander. "It's a time for everyone to speak." After standing up tier briefings, within 30 days there were results. For example, with a limited staff, one identified constraint was not having someone available to check in patients. Now patients check in with pediatrics downstairs before heading upstairs for physical therapy. Tier briefings have allowed the flight to keep track and better handle patient cases that miss appointments, which led to an aggressive no-show policy. Squadron commanders are now notified when one of their active duty members does not show up for an appointment. As a result, patient cancellation rates dropped from 6 percent to 2 percent. Dependent appointments are also tracked with a reminder system that places calls to patients to remind them of upcoming appointments. This system further reduced no-show rates. With patient safety a key factor, tier briefings have also kept track of patient scheduling, allowing staff to fill appointment times far enough in advance based on patient needs. In another example, in mental health, tier briefings have further helped staff follow high-risk patients, making sure they receive the best care possible while at Robins. The process is slowly spreading. In the dental clinic, while still in the early stages, morning huddles are conducted the old-fashioned way where issues of the day are discussed, according to Lt. Col. Rene Saenz, 78th DS commander. However, since visiting aircraft production briefings, their huddles are now based on patient safety, quality and accountability. A GEMBA white board will transition efforts, and a team coordinator (dental assistant) helps keep teams on time and more productive. After visits to various squadrons which have adopted tier meetings to meet their own needs, Trinkle meets weekly at the group level to further communicate issues and problems that need to be solved. Visual tier boards also allow anyone at any time to see what's going on in another flight. "It's a good communication tool and keeps you headed in the right direction," she said.