R OBINS AIR FORCE BASE, Ga. – The Air Force Reserve Command’s Surgeon General’s office has refined the case adjudication process and is burning down the backlog of cases currently under review.
A team of process improvement specialists, doctors and medical technicians armed with the command’s intent for the program came together to tackle the 2,000-case backlog that was plaguing AFRC in October of 2017.
“The initial look into this was an info-gathering phase that lasted several months and it culminated in a continuous process improvement event,” said Col. John Buterbaugh, AFR command surgeon here. “We did a value stream mapping of the process we use to process cases here and it revealed where each case was in the process and how long they were at each stage. This provided us the opportunity to start looking at remedies to take care of the backlog problem.
Buterbaugh said the backlog was thought by senior leadership to be one of the biggest drivers of low medical readiness leading to decreased morale which made it a top priority.
According to Maj. Travis Nelson, AFRC A9A operations research analyst here, the biggest challenges the team faced initially were manpower and process related. He was in the initial phase of observing and identifying how to locate the issue and refine the process so a backlog didn’t happen again.
“My value to an organization comes from being able to organize large amounts of data and distill it down to a point where decisions can be made,” said Nelson. “One of the first things I did was set up a means of getting the right data in a scheduled, recurring way. Then in order to understand what medical data I needed, I took time talking to the physicians, technicians and others to understand definitions of the data and how it was collected.”
Through his research he was able to use various tools and formulas in an electronic spreadsheet to organize more than 180,000 records with more than a million data points in a way that painted a clearer picture of what was going on, where the hang-ups were and how to leverage the work the SG team was already doing more efficiently.
“The two biggest challenges were manpower and process,” said Col. Sam Galvagno, SG acting division chief for medical operations. “For many years, the medical operations division was only staffed by one to two physicians. Coupled with recent technological advances that resulted in greater access to electronic medical records (and hence, greater visibility of potentially medically disqualifying conditions), keeping pace with the growing case log was unsustainable.”
Buterbaugh said in order to aide with the manpower issue, additional technicians and flight surgeons were contracted for various temporary term lengths to aide in reducing backlog and to get SG moving in a steady-state, case-processing rhythm.
“We already had authorizations and two contract flight surgeons working for us and we added three more to give us increased capacity to have flight surgeon adjudication of cases,” said Buterbaugh. “A lot of our backlog was at the med-tech level, so we have increased our med-tech staffing team by three full-time techs on six months orders to help process cases.”
The team was able to eliminate two review steps that the team felt was redundant. This sped things along and put a priority system in place.
The priority system was defined by the AFRC commander and aligns with the National Defense Strategy. Priority one and two cases are cleared through SG in less than 14 days with priority three cases taking no longer than 90. Additionally, cases are no longer first-in, first-out, but tackled by the case inception date.
With manpower increases in place and processes fixed there was only one thing left for the team to do — create a production model to track cases and monitor progress. This will allow team members to keep the cases flowing smoothly in the adjudication process so there won’t be another backlog.
“Now we have established benchmarks and can apply statistical techniques to make sure we are staying in range without risk of generating a new case backlog,” said Galvagno. “The process will also provide our staff with daily expectations and a decreased workload.”
The main benefit of the process overhaul is to the Airmen. No longer will they be placed on no-pay, no-points status for years at a time while they wait for case adjudication, said Buterbaugh. “No one benefits and the whole force suffers when our Airmen can’t participate because their medical readiness is in limbo,” he said.