Performance excellence: using Lean Six Sigma tools to improve the US Army behavioral health surveillance process, boost team morale, and maximize value to customers and stakeholders.

Lean Six Sigma (LSS) is a process improvement, problem-solving methodology used in business and manufacturing to improve the speed, quality, and cost of products. LSS can also be used to improve knowledge-based products integral to public health surveillance. An LSS project by the Behavioral Social Health Outcomes Program of the Army Institute of Public Health reduced the number of labor hours spent producing the routine surveillance of suicidal behavior publication. At baseline, the total number of labor hours was 448; after project completion, total labor hours were 199. Based on customer feedback, publication production was reduced from quarterly to annually. Process improvements enhanced group morale and established best practices in the form of standard operating procedures and business rules to ensure solutions are sustained. LSS project participation also fostered a change in the conceptualization of tasks and projects. These results demonstrate that LSS can be used to inform the public health process and should be considered a viable method of improving knowledge-based products and processes.

Nurses as equals in the multidisciplinary team.

For many years nurses have had a high profile both nationally and internationally, but in the past most nurses played only a supporting role. Although the doctor is still recognized as the leader of the clinical team, nurses have become recognized as professionals in their own right, carrying responsibility for their own actions. The clinical and managerial judgement of nurses is respected and increasingly they are given the authority to make policy decisions within a team. However, nurses must take personal responsibility for developing their own leadership and boardroom skills to enable them to make an equal contribution. In this article I reflect on how Professor Michael Hull valued the role of nurses as equal members of the clinical team. In the Centre for Reproductive Medicine in Bristol he paved the way towards making nurses equal. He encouraged nurses to learn and use their knowledge and this in turn developed self-esteem and confidence, which not only made nurses equal but also made them feel equal.