Friday, January 24, 2020

Lean Six Sigma: Louisiana Department of Health's quality improvement quest


By KEVIN LITTEN | LDH Communications Specialist

For the Louisiana Department of Health’s Mendy Richard, a passion for quality began at the State Police Crime Lab in 2010, where there was a massive backlog of DNA tests that waited as long as 260 days for analysis.

Richard was given a challenge: eliminate the 1,700-case backlog with no additional staffing and no outsourcing. She and her team did it in a matter of months, using a conveyor belt-type process using strict standards for the pace of all activities. The project cut the turnaround time to 14 days.

While the project was a lot of work, Richard said, it was made easier using a process first perfected in the manufacturing sector called Lean Six Sigma. This process aims to eliminate waste while accepting no defects.

Mendy Richard, the deputy assistant secretary of the Office of Public Health,
holds a box of green and yellow karate belts. The belts are awarded to
trainees who successfully complete different levels of training in the Lean Six
Sigma quality improvement program.
Now Richard, the deputy assistant secretary of the Office of Public Health’s Center for Community Preparedness and Health Protection, is deploying Lean Six Sigma across the Louisiana Department of Health with advanced training for team members. The training empowers its participants to lead their own teams, finding solutions to problems in their bureaus. The 14 advanced Lean Six Sigma graduates are now using their skills to reorganize processes, eliminate rework and rethink how Department of Health team members do their jobs.

Continuous quality improvement

The “Six Sigma” system was first developed at Motorola to ensure quality of products, and “Lean” was developed at Toyota to reduce waste. After the State Crime Lab experience, Richard realized that the Lean Six Sigma methodology, which had been combined into a single improvement program, could apply to government as well.

Richard landed at the Louisiana Department of Health after completing improvement projects across state government, and began using the same methodology for new challenges that had some pretty serious consequences: The Office of Public Health was at risk of rejecting many of the specimens it was receiving from across the state because of tightened federal standards around temperatures in specimen storage and transport.

Federal authorities were holding Public Health officials accountable for keeping specimens within their prescribed storage temperatures, with some ranges between 2 and 6 degrees Celsius. If the temperature went higher or lower during transport to the lab, the specimens weren’t valid.

With those specimens being driven across the state in courier vehicles, Richard quickly realized that she needed to use Lean Six Sigma and let the data drive the improvements. In the midst of the search for the perfect procedure, she and the team launched a search for the ideal ice chest. In the end, Richard discovered that the most reliable and affordable ice chest to travel across the state — sometimes in blindingly hot temperatures — plugs into a cigarette lighter.

The discovery allowed Richard and her team to reduce rejections from 15% to less than 3% within a few months.

Richard is certified as a Master Black Belt in Lean Six Sigma, which allows her to successfully execute projects and oversee a quality improvement training program that can be used throughout the Department.

The push for continuous quality improvement is coming from the highest levels — particularly Department of Health Secretary Dr. Rebekah Gee and Deputy Secretary Mark Thomas. Gee said she has long wanted to create a culture of continuous quality improvement, but said it can’t really be done without leadership being fully on board.

Mendy Richard works with a human resource team to identify process steps
to understand where bottlenecks occur and where the greatest delay happens.
“What’s different about continuous quality improvement is that it’s strategic action versus strategic planning,” Gee said. “People are used to planning and coming up with our objectives and key goals, but what a lot of organizations don’t do is act.” 

MendyThe Department wanted to implement a more formal process that would improve efficiency and streamline processes: “Lean Six Sigma is a methodology that has been used in both the public and private sectors very successfully,” Thomas said.

Department leaders selected 14 Department of Health team members to begin what’s known as Green Belt training, a course that teaches how to define a problem and how to collect data and measure progress as possible solutions are worked out. The course also schools trainees in how to analyze various parts of the problem and to design a solution in response.

Following training, each Green Belt team member took on their own project and put together a team that helped analyze and implement solutions.

Problems and solutions

Clara Hudson, a quality assurance program monitor in the Department’s Office of Aging and Adult Services, took on a project that looked at why the Department was missing goals for approving Medicaid applications for people entering nursing homes across the state. The end goal was to ensure that people who apply for Medicaid to cover long-term care get a timely decision.

Hudson said her team was able to identify the problem fairly quickly: Application decisions depend on paperwork being scanned into the Department’s system, and scanning takes time — sometimes a couple of hours per application. But rather than hire more staff to mitigate that problem, Hudson said the team wanted to think more creatively, so it came up with a pilot program to bypass the need to hire more people.

“We created a partnership with some Medicaid analysts and a small group of nursing facilities that allowed the facilities to tell the analyst which application needed to be worked,” Hudson said. The analyst would become the single point of contact for the nursing home, and if the facility needed a decision on a patient more quickly, it could call the analyst directly and have that application located and scanned.

A key step in the process was identified as taking too long: 91% of the time, that step wasn’t being completed in five days or less. After the team completed the pilot program, that step only missed the five-day goal 5% of the time.

Christina Bolton, the quality management and improvement director at Pinecrest Supports and Services Center in Pineville, helped lead a project to improve talent recruitment and retention at the Department of Health. The Department had noted high turnover among nursing and direct care employees, and leaders knew that it was “very important to hire and maintain the right employees to improve quality and continuity of care.”

Bolton’s team created a tool that rated the quality of applications and then examined how the posting was written when there were a greater number of high-quality applications. The team found that because of nuances in the way that job postings were being presented online, some of the job titles were “vague and non-descript,” and other postings were not clear enough about required certifications.

Natalie Istre, a program manager in the Bureau of Nutrition Services at the
Louisiana Department of Health, goes over a plan for a pilot program that
was designed to improve quality in the Women, Infants & Children program.
The team decided to sculpt a new way for departmental leaders to advertise job postings by using a “working job title.” For example, if the Civil Service required a technical job title such as “Sanitarian I,” a manager could add something more descriptive in the title in parentheses, like “health inspector.”

They also improved the quality of job postings around certifications, linking potential applicants to ways they could receive a required certification.


“We wrote the job posting to appear more user-friendly to applicants: We show the required job qualifications and then let them know what steps to follow in order to become qualified if they are not already qualified,” Bolton said. ”We also worked with the Louisiana Civil Service Commission on improving how we are identifying the most effective job recruitment strategies.”

The strategy has been working, and by the end of the year, Bolton said her team projects its can scale up the pilot program to the point where it can train human resources staff to do what the team is doing with job postings. The results are projected to shave hours of time off the application-filtering duty of a hiring manager.

A transformative process

Both Bolton and Hudson said Lean Six Sigma training has transformed how they see things in everyday life as well as in their regular day-to-day work. Bolton said she’s even been doing housework differently according to principles learned in Lean Six Sigma.

“You begin to readily identify and avoid rework mishaps by properly sequencing steps,” Bolton said.
Richard said that while Lean Six Sigma stresses goals that can be applied throughout the Department — accept no defects is a common mantra, for example — the Department also sees the program as an important retention tool for retaining employees.

“Dr. Gee and Mark Thomas have whole-heartedly supported building this culture of quality,” Richard said. “It takes courageous leaders to invest in, engage in and promote this approach. Quite simply, having top-down support is the difference between mediocre and excellence in effective, sustainable improvements.”

Friday, January 17, 2020

The ‘State of the State’ of healthcare in Louisiana


By DR. ALEXANDER BILLIOUX | Assistant Secretary, LDH Office of Public Health

Recently, I had the opportunity to speak before the Rotary Club of Baton Rouge on the state of healthcare in Louisiana, looking back on our accomplishments while keeping our eyes on the future. I’d like to share some of those achievements here with you.


The success of Medicaid expansion in Louisiana is something to be proud of. It is truly making a difference in the lives of some of our most vulnerable residents. We are proud of Governor John Bel Edwards and the progress this administration has made when it comes to Medicaid expansion and improving access to healthcare.


The reality is Medicaid expansion in Louisiana has been a great success. Bringing federal tax dollars home to Louisiana has allowed the state to solve a budget deficit, keep the TOPS scholarship program in place, and support roads and other infrastructure.

In addition to expansion, and under the leadership of Governor Edwards and outgoing Secretary Dr. Rebekah Gee, the Department of Health has seen many other improvements to our healthcare landscape.


Because of the work of the Department of Health, FQHCs and other providers and community partners, in July we announced that fewer people have been diagnosed with an HIV infection in the past year than in any of the previous 10 years. In 2018, there were under a thousand — 989 people newly diagnosed with HIV — for the first time in a decade.

The CDC’s national STD rankings show Louisiana’s prevention efforts are paying off. Louisiana’s case rates of primary and secondary syphilis, congenital syphilis and gonorrhea improved from 2017 to 2018:

  • Primary and secondary syphilis: #7, down from #3
  • Congenital syphilis: #3, down from #1
  • Gonorrhea: #5, down from #3
Improvements such as these take time, and show that increased screening, education and prevention efforts are making a difference.



We are leading the nation on a new model to expand access to hepatitis C treatment. Our agreement with Asegua Therapeutics provides unlimited access of Asegua’s authorized generic of Epclusa to Louisiana Medicaid recipients and Louisiana Department of Corrections inmates while capping the state’s annual expenditures. We want this life-saving treatment to reach everyone in the state over the next five years.

Since medications became available on July 15, more than 2,400 people have been treated so far. Our ambitious public health strategy to screen and treat as many people as possible prioritizes educating the public, encourages screenings to determine one's status, links individuals living with hepatitis C into care and extends the cure to as many Louisianans as possible. We’ve also launched a partnership with Wal-Mart to offer free screening in 10 stores across the state.

Through this work, we are aiming to be the first state in the nation to eliminate the deadliest infectious disease in the country.


Medicaid re-entry program

Our work for hepatitis C represents our strong partnership with the Department of Corrections, which is rare nationally. Another great partnership are proud of is our Medicaid re-entry program for prisoners, which ensures people who have served their time will have Medicaid when they are released. This means they will have access to mental health services, medications and primary care. We have had more than 10,000 applications for this program.

KickStart pilot

In Monroe, we are running a pilot program called KickStart that connects Medicaid recipients to job training, helping them reach financial independence through work. We are hearing early success stories: A son who was already enrolled in a training program began studying alongside his mom when KickStart became available. The mom who always put her child's needs before her own has now completed training as a forklift driver.


Sixteen Louisiana Department of Health employees have earned their Lean Six Sigma Green Belts.
Continuous quality improvement

Beyond these programs, the Department of Health is also very focused on always striving to be more efficient and do more with the state and federal dollars we are entrusted with. Our goal is to ensure we are effective and eliminating waste. So, under the Secretary’s leadership, we started training our employees on a program called Lean Six Sigma, which empowers employees to fix problems. Nearly 50 leaders across the agency have completed the initial yellow belt training and another 16 have trained on the next-level green belt segment that allows them to oversee their own projects.

These employees have become the bridge between different offices who have identified problems, reduced excess steps in our processes and provided better services. We are already seeing the benefits of their initial projects, and more importantly a culture of continuous quality improvement is taking hold and spreading across the Department.

Maternal mortality

This focus on outcomes and quality improvement also extends to our approach to improving health. One example is the Louisiana Perinatal Quality Collaborative, a collaborative that is focused on reducing the number of women who die or are seriously injured related to childbirth. No woman should die giving life.

Through training programs, staff support and the sharing of best practices, we've set an ambitious goal to reduce maternal morbidity by 20% by this Mother's Day. We have already seen some early wins: Since 2016, we’ve seen a 32% drop in the severe health consequences of bleeding in moms who are giving birth.

Eliminating waiting lists

We have also been successful in eliminating a waiting list for services for people with developmental disabilities — there were over 10,000 people on that waiting list, which has existed for 25 years. That list has been eliminated and now the needs of the people with developmental disabilities are being met.

We want to replicate this success for our older adult community and we are working to drastically reduce the waiting list for home and community-based health services for older adults.

Nursing home quality improvement

Many of our state’s older adults are also benefiting from improved quality in our nursing homes. A training program to reduce the incidence of pressure ulcers in Louisiana nursing facilities has resulted in some dramatic improvements. The state has moved from 50th in the United States in 2016 to 45th in the first quarter of 2018. We have more work to do but we are making progress.

Dr. Alexander Billioux speaks to the Rotary Club of Baton Rouge.
Call to action

We at the Department of Health are optimistic about the future, but we know that we did not get here without hard work, and this improvement will not continue without even more effort and focus on our ultimate goal: improving the health of ALL Louisianans everywhere.

We know that achieving this will take more than increasing access to healthcare — though that is critical — it will mean that we must also work to improve the efficiency and impact of the healthcare system our citizens are accessing. Ultimately, it means working to improve health upstream to reduce the amount of preventable healthcare our citizens need in the first place. We want to make bold moves, and I know Louisianans have the spirit to take up that challenge!

Tuesday, January 14, 2020

Can you dig it? New Orleans Blastoff kicks off 2020 Governor’s Games


Every year, sports enthusiasts across the state have the opportunity to showcase their athleticism in the Louisiana Governor’s Games. The 2020 Governor’s Games get underway this weekend with the New Orleans Blastoff, a girls’ volleyball competition Saturday, January 18 and Sunday, January 19.

The Blastoff features 4,000 participants from 266 teams competing in two venues: the Ernest N. Morial Convention Center, Halls C and D, 900 Convention Center Blvd. and The Health Club by Hilton at the Hilton New Orleans Riverside, 2 Poydras St. Admission is $10 for adults and $1 for ages 12 and younger. Saturday action begins at 8 a.m. for 12s, 16s, 17s and 18s, and at 2:30 p.m. for 10s, 13s, 14s and 15s.

If you can’t make it to the Blastoff, you’ll have another 35 chances to see Louisianans of all ages, skill levels and economic demographics participate in fitness competitions during the Governor’s Games. Over the next six months, competitions including basketball, volleyball, gymnastics, boxing, tennis, golf, track and field, girls’ softball, youth baseball and more will be held in cities all around Louisiana.

Uniquely Louisiana

The Louisiana Governor’s Games began in 1997, replacing the previous Louisiana State Games and expanding to offer more sports. They are coordinated by Durand “Rudy” Macklin, director of the Governor’s Council on Physical Fitness and Sports, former NBA player and one of four LSU men’s basketball players to have his jersey retired by the school.

In true Louisiana fashion, the Governor’s Games are one of a kind. Other states hold their state games in one location at one time every year. But, in Louisiana, the Governor’s Games are spread out all around the state over half the year.

Why has Louisiana chosen such a unique approach? When the games are held in a single location, as other states do, the economic impact stays in that single location. However, by scheduling different events around the state, like Louisiana does, the economic impact spreads to areas that can then benefit from the money athletes, coaches and fans will spend at local businesses like hotels, restaurants and service stations.

It’s also a way for people living in underserved areas to receive exposure to sports they may not otherwise have the opportunity to participate in, to develop an interest in a new sport or even just get inspired to get moving. That spark of inspiration may inspire a sedentary person to take up daily walking, or a spectator at a bodybuilding competition to start building muscle.

Fitness is a key step in lowering the obesity rates in our state. Louisiana consistently ranks among the top 10 states with the highest obesity rates for both adults and children, and nearly one of out of four adult Louisianans is considered obese. Physical activity doesn’t just affect obesity, though: it can cut down on the risk of heart disease, Type 2 diabetes and certain cancers, as well as other health benefits.

What’s next?

Dates and locations for other competitions will be posted online at the Louisiana Governor’s Games website. Competitions scheduled so far include:
  • Gymnastics
    • Boys State Championships: March 13-15 at Acadia Gymnastics, Lafayette
    • Girls State Championships: Lower Level, March 20-22 at Louisiana Tech Intramural Center, Ruston and Upper Level, March 27-29 at Alario Center, Westwego
  • Elementary State Championship Fitness Meet: April 25 at Alexandria Senior High School, Alexandria
  • Youth Golf: June 6-7 at Le Triomphe Community Center, Broussard

If you’re interested in competing in the Louisiana State Games, registration is open now. Sign-up for adults is available through local recreation departments and sports leagues, or advertisements and public service announcements made through media partners. For children, sign-up is available through local schools and physical education teachers.

If you’re not interested in competing, consider attending and cheering on our amateur athletes as they share in the spirit of competition. See you at the Governor’s Games!

Friday, January 3, 2020

Vaping injuries and deaths cloud alleged safety of tobacco alternative


By DR. REBEKAH GEE | Secretary, Louisiana Department of Health

Louisiana in November 2019 gained the unfortunate distinction of joining the states that have recorded deaths tied to vaping devices and the lung injuries they cause.

There have been questions about the safety of vaping since the devices, including e-cigarettes, were introduced to the U.S. in 2006. Conventional wisdom among the industry and those who use vaping products is that vaping is a safer alternative to smoking because vaping products do not contain the dangerous, harmful tar found in cigarettes. However, the Louisiana Department of Health and the Centers for Disease Control and Prevention (CDC) believe that vaping is not safe.


The absence of tar in vaping products does not make vaping safe. Again, vaping is not safe, and Louisiana’s two deaths and more than 30 people severely sickened by vaping products serve to highlight that fact.

While we do not yet have long-term studies to understand how vaping devices affect long-term health, the vaping injuries we are seeing are very serious. Nationwide, 95% of those patients with lung injury, also known as EVALI, were hospitalized.

Stop vaping

Vaping-related lung injuries are having an impact on families in the state. That’s why the Department of Health is recommending people stop using all vaping products — especially those being sold on the street or that have had substances added after their manufacture. The CDC has found what it’s calling a “chemical of concern” that may be the source of the deaths and injuries: Vitamin E acetate. It’s often used as a thickening agent in vaping devices that deliver THC, the active ingredient in marijuana. The chemical is also found in some nicotine products.


People who continue to vape should seek medical attention if they experience symptoms of EVALI, including cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever and weight loss.

The Department of Health is asking healthcare providers to ask their patients who have used vaping devices within the past 90 days if they’ve had any of those symptoms. Providers who suspect their patients may have lung injury should report those cases to the Department.

Young people

One of our major concerns about the rise in vaping use is its popularity among young people.

Between 2011 and 2013, the CDC reported the use of vaping devices doubled among people ages 18 to 24 nationwide. In Louisiana, vaping among middle and high school students doubled since 2017 and tripled since 2015.

CDC data also shows how much vaping-related injuries have affected young people. About three-quarters of those with vaping-related lung injury were under the age of 35.


The troubling rise among youth using vaping devices and people who have never smoked before could be tied to the perception that vaping devices are safer than traditional tobacco products. That’s why it’s important not only to highlight the safety concerns, but also to remind the public that vaping devices are a nicotine delivery device, and that nicotine is one of the most addictive substances currently known.

The presence of nicotine may make vaping devices appear attractive as a less-harmful replacement to smoking, but the safety concerns around vaping should emphasize the importance of quitting nicotine use altogether. Smoking cessation aids are widely available to help users quit smoking and vaping, with nicotine patches, gum and lozenges all available over the counter.  Inhalers and nasal spray are also available with a doctor’s prescription.

E-cigarette users and smokers interested in quitting can find free, confidential help by calling 1-800-QUIT-NOW or visiting www.quitwithusla.org. Let’s Geaux Tobacco Free, Louisiana!