NMCP's Top Cost-Reducing Clinics Recognized during 4DX Forum

PORTSMOUTH, Va. (NNS) -- Naval Medical Center Portsmouth (NMCP) celebrated the progress made in decreasing network health care costs and improving patient care through the implementation of the Four Disciplines of Execution (4DX) June 17.

The 4DX system enables organizations to achieve higher levels of performance by breaking up goals into small, realistically achievable tasks. Network costs have been reduced nine percent since the 4DX initiative began in January.

The Franklin Covey program was brought to the command by Rear Adm. Elaine C. Wagner, NMCP commander, and is the first in Navy Medicine to use it. During the 4DX forum, directorates participating in the initiative talked about the goals they made and awards were presented to the top performers.

Cmdr. Jeffery Johnson, director for Strategy, opened the forum by talking about how important the 4DX idea is for accomplishing their individual goals - that without visible landmarks, people will walk in circles, sometimes even crossing their own path without noticing it.

"Last year, the Navy Surgeon General, Vice Adm. Matthew Nathan, set the course for Navy Medicine by giving us guidance on three things to focus on as reference points, which are readiness, jointness and value," Johnson said. "The command decided to focus more on value and set decreasing network costs as our goal."

NMCP set the goal of decreasing costs paid to network health care providers by 20 percent, from $100 million to $80 million. The Orthopedic Clinic has already made a huge impact.

"We did some research with the business office and determined that an outside orthopedic specialty appointment, on average, is $521, where we can see the patient here for about $102," said Naomi Ramshur, Orthopedic Clinic manager. "So that $400 or so we are saving with the 1,048 patients that we saw just in five months, is almost $440,000 just by this one clinic."

The difference between 4DX and other cost-cutting measures is that 4DX allows clinic staff, at even the most junior level, to help decide what changes need to be made to help the command reach its goal.

"With 4DX, the direction comes from the bottom up; they come up the approach, the plan, the goal, how they are going to do it, the whole nine yards," Ramshur said. "The line level really takes ownership of it, and it becomes theirs and they are proud of it. They want to do it, rather than doing it because they are told to. I think that's the key to the success of it."

As the name implies, there are four disciplines, which begin with focusing on the most important objectives, also known as the wildly important goals, defining actions that enable teams to establish a standard for performance. This standard for performance is known as the lead measures. They must also have clear measurements for team and individual performance, or scoreboards, and team and individual accountability.

"For our command, we had every clinic create their own scoreboard," Johnson said. "Weekly, they review if they met their goals or not and then they set a goal for the next week. So every week you are creating that accountability.

"We plan to reach the overall goal of reducing network costs by increasing our kept appointments, decreasing deferrals to the network and decreasing auxiliary services, which are our support services, including the laboratory, radiology and pharmacy," Johnson added. "Thus far we have really been targeting the pharmacy."

During the forum, representatives from the five participating directorates displayed their scoreboards and talked about their goals and the progress they have made since the initiative began.

Ramshur said that when the program kicked off, she gave her staff $40 and told them to decorate a 15-foot bulletin board to use as their scoreboard.

"Every week, I update it with the new data and they see me walking up to the board with the new charts and will come up to look because it has become so competitive between the subspecialties as to who's going to outperform the other one during the week," Ramshur said. "The board stimulates questions, even from patients. When our patients are waiting to be seen, they can look at it, and it reiterates to them that we are taking all actions necessary to get them in as quickly as possible."

This initiative directly affects readiness by decreasing unbooked appointments, which allows patients to be seen earlier, decreasing the number of monthly unbooked appointments from 1,500 to just above 500.

"We see family members and retirees, but we also see a huge active-duty population here," said Ramshur. "We have two satellite clinics that are all active duty only, and we are doing 4DX at those two clinics also. Our original goal was to make a 10-percent decrease in unbooked appointments and we far exceeded that goal."

Following the scoreboard presentations, the top performing clinics within each directorate were recognized. Wagner awarded the Admiral's WIG Cup to the top directorate, the Directorate for Surgical Services.

"The command will continue the current goals it set, to decrease network costs," said Johnson about future of the initiative. "Some of the areas will come up with new areas to focus on, while others will continue with the goals they have already been working on."

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/local/NMCP/.