Saturday, January 30, 2010

Lean Six Sigma for Law Enforcement

Editor's Note:  The guest is a servicemember.
On March 4, 2010, Conversations with American Heroes at the Watering Hole will feature a conversation Sergeant William Wilkerson, Jacksonville Sheriff’s Office on Lean Six Sigma for Law Enforcement.

Program Date: March 4, 2010
Program Time: 1700 Hours Pacific
Topic: Lean Six Sigma for Law Enforcement
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About the Guest
William "Billy" Wilkerson is a Police Sergeant with the Jacksonville Sheriff's Office and 20 Year veteran with the Florida Air National Guard. He is currently assigned to the Sheriff's Office Continuous Improvement Division along with serving as the Staff Inspections Unit supervisor. The Jacksonville Sheriff's Office has been using Lean Six Sigma to streamline its processes since 2004, with much success. Billy is a certified “Kaizen” facilitator through the Jacksonville Lean Consortium, and the US Air Force, and has received Lean Six Sigma Green Belt and Black Belt training with the Jacksonville Electric Authority. Billy has also been assisting with the Florida Air National Guard's rollout of their CPI Program (Continuous Process Improvement).

According to the Six Sigma Website, “The fundamental objective of the Six Sigma methodology is the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the application of Six Sigma improvement projects. This is accomplished through the use of two Six Sigma sub-methodologies: DMAIC and DMADV. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is an improvement system for existing processes falling below specification and looking for incremental improvement. The Six Sigma DMADV process (define, measure, analyze, design, verify) is an improvement system used to develop new processes or products at Six Sigma quality levels. It can also be employed if a current process requires more than just incremental improvement. Both Six Sigma processes are executed by Six Sigma Green Belts and Six Sigma Black Belts, and are overseen by Six Sigma Master Black Belts.”

About the Host
Lieutenant Raymond E. Foster was a sworn member of the Los Angeles Police Department for 24 years. He retired in 2003 at the rank of Lieutenant. He holds a bachelor’s from the Union Institute and University in Criminal Justice Management and a Master’s Degree in Public Financial Management from California State University, Fullerton; and, has completed his doctoral course work. Raymond E. Foster has been a part-time lecturer at California State University, Fullerton and Fresno; and is currently a Criminal Justice Department chair, faculty advisor and lecturer with the Union Institute and University. He has experience teaching upper division courses in Law Enforcement, public policy, Public Safety Technology and leadership. Raymond is an experienced author who has published numerous articles in a wide range of venues including magazines such as Government Technology, Mobile Government, Airborne Law Enforcement Magazine, and Police One. He has appeared on the History Channel and radio programs in the United States and Europe as subject matter expert in technological applications in Law Enforcement.

Listen, call, join us at the Watering Hole:
Program Contact Information
Lieutenant Raymond E. Foster, LAPD (ret.), MPA

TRICARE Leader Explains Plans for the Future

January 30, 2010 - To balance increasingly complex responsibilities at home and overseas the Military Health System has adopted the Quadruple Aim model of care, Rear Adm. Christine Hunter, deputy director of the TRICARE Management Activity, told a standing-room only crowd of military medical leaders Thursday. The Quadruple Aim, she explained, supports readiness, population health, a positive patient experience and responsible management of health care costs.

During the 2010 Military Health System (MHS) conference, key speakers described the scope and complexity of military medical operations and the TRICARE program. The MHS is becoming increasingly complex, Hunter said, and must create a learning culture to develop the next generation of leaders ready to adapt to unforeseen circumstances. MHS leaders, she said, are adopting a learning culture to share knowledge.

The MHS is responsible for the care of 9.6 million people. In a single week, 1.6 million outpatients are seen, 2.48 million prescriptions are filled and 3.5 million claims are paid. Hunter congratulated all of the providers who’ve supported the ongoing relief efforts in Haiti while they handled TRICARE’s regular workload.

“Active, reserve, civilian and network partners came together immediately in an inspiring demonstration of teamwork,” Hunter said of the effort.

Hunter discussed the Quadruple Aim, which she began implementing in July 2009 soon after her arrival at TMA, explaining how it is designed to help achieve near-term goals and guide long-range planning.

“The MHS has been successful in achieving three parts of the Quadruple Aim – readiness, population health and cost management,” Hunter said.

Ending her speech, Hunter impressed upon the more than 3,000 MHS professionals in attendance the importance of their jobs, and urged them to continue the great work they do. She closed by emphasizing how attendees can help achieve MHS goals by promoting individual and family readiness, a healthy population, positive patient experiences and responsible management of health care costs.

“You personally can help us achieve the Quadruple Aim,” Hunter said “by ensuring that patients with an acute minor condition contact their primary care manager or visit an urgent care center rather than the emergency room, transfer brand name prescriptions from retail pharmacy to home delivery and that patients get the right information the next time they interact with us.”

Seminar Tackles Drug-trafficking Issues

By Jason Tudor
Special to American Forces Press Service

Jan. 29, 2010 - Countering narcotics trafficking took center stage during an eight-day seminar at the George C. Marshall European Center for Security Studies here, as military and civilian security executives met to discuss the challenge. The seminar attracted 91 participants from 61 countries and focused on the complex security challenges posed by contemporary international narcotics trafficking, and its links with terrorist networks and organized-crime elements. The seminar participants examined how narcotics profits are used to fund terrorist activities, to corrupt officials, and to challenge and erode the authority of states.

"In today's globalized environment, counter-narcotics programs create intricate interdependencies within the international community which must be managed on numerous levels," said Jay Le Beau, seminar director. "As a result, there will also be discussion on various regional approaches that have been implemented to combat this problem."

Among the 91 participants were 21 Africans from Burkina Faso, Burundi, Cameroon, Cape Verde, Gabon, Gambia, Ghana, Guinea-Bissau, Kenya, Lesotho, Nigeria, Rwanda, São Tomé and Príncipe, Senegal, Swaziland, the Togolese Republic, and Uganda.

The seminar included almost a dozen speakers from a cross section of military and civilian disciplines, including Army Gen. William E. "Kip" Ward, commander of U.S. Africa Command. Also, Ambassador J. Anthony Holmes, Africom's deputy to the commander for civil-military activities, served as the graduation keynote speaker.

Holmes, whose background includes more than 15 years of experience in Africa and policy issues on Africa as a State Department employee, emphasized partnership and working together to address drug-trafficking issues.

"The problem itself is regional. It is inherently multilateral," he said. "There's no such thing as a transit country. There's no such thing as a producing country. Virtually all countries are producing, transit and consuming countries."

(Jason Tudor works in the George C. Marshall European Center for Security Studies public affairs office.)

DHCC Call for Papers

Call for Presentations for Deployment Healthcare Track, Force Health Protection Conference, Aug. 2010. The Deployment Health Clinical Center (DHCC) is seeking abstracts from speakers for the Deployment Healthcare Track (DHCT) at the 13th Annual Force Health Protection Conference, "Military Preventive Medicine and Public Health" Core Conference: August 10-13, 2010, and for Preconference Workshops August 7-9, 2010, at the Phoenix Convention Center Phoenix, Ariz.

Submissions of abstracts involving cross-disciplinary collaborations are highly encouraged. Please click on the link below to find out how to submit your abstracts. Deadline for submission is fast approaching.

Identifying Environmental Health Threats in Theater

By Rob Anastasio
FHP&R Staff Writer

January 30, 2010 - Environmental health exposures pose a major threat to service members in theater. While specific threats such as particulate matter, burning trash pits, pollution, and toxic industrial chemicals seem to be a normal part of in-theater living, the long-term health risks that have transpired have caught the attention of the military, Congressional, and medical communities.

At the 2010 MHS Conference, Dr. Craig Postlewaite, DVM, MPH, acting director of Force Health Protection and Readiness Programs, explained that much of the data gathered from OEF/OIF exposure records are still inconclusive.

With all of the research that has been conducted, professionals have derived a number of lessons learned. “Health care providers should be knowledgeable of occupational and environmental health (OEH) threats and updated on location-specific changes during deployment,” said Postlewaite.

Base camp health assessments should also be completed when the base camp is established. Postlewaite said this is an important lesson that has been discovered, as it includes acute health risks and possible latent/chronic health risks as well, archiving all OEH data in the U.S. Army Public Health Command – Provisional (USAPHC), and being strong advocates for risk mitigation by line commanders.

Other lessons learned show that health care providers must document possible and confirmed exposures in service members’ medical records, investigating, reporting, and documenting all OEH and chemical, biological, radiological, and nuclear (CBRN) exposures, advising commanders on locations of all burn pits, requesting timely reach-back for environmental health support to monitor conditions and identify those at risk, and ensuring that there are environmental health personnel in theater.

“It’s quite a challenge,” said Postlewaite. “Airborne particulate matter exposure alone is dangerous. The blowing sand/dust, coupled with some industrial pollutants is just one of the many exposures that folks are prone to in CENTCOM.” This can lead to water and food contamination, as well as soil contamination.

Burn pit smoke exposures have been the hot topic of Congress and the medical world in the past few years. In 2008, a health risk assessment was conducted at Joint Base Balad (JBB) to study the health effects of burn-pit smoke. While some 400 Veterans and dozens of Service members claim they have chronic health effects due to burn pit smoke exposure, the result of the study (which was validated by the Defense Health Board) stated that there were no elevation in long-term health effects to those that were exposed.

“The metric that this study failed to look at was combined exposures,” said Postlewaite. “If someone was exposed who also smokes tobacco, or has an underlying health problem, or has a genetic predisposition…that is what we didn’t consider.”

However, steps are being taken to mitigate any possible adverse health effects from the smoke exposure. Over the past two years, four industrial trash incinerators have been installed at JBB, and some of the biggest burn pits have been shut down.

Additional studies are being conducted by a number of agencies to explore the dose-response relationship, health outcomes at other burn pits, the persistence of diagnoses and symptoms, and expanded case findings for case control studies. Coming this spring is a report from the Armed Forces Health Surveillance Center (AFHSC) with a new burn pit monitoring plan which is up for review by the DHB. The Institute of Medicine is also conducting a health outcome study on veterans with a special emphasis on burn pit smoke exposure.

While these reactive measures will help clear the air about burn pit smoke exposures, researchers are trying proactive methods as well. “We’re working on an individual deployment longitudinal exposure record system,” said Postlewaite.

Basically, this system is specific to a service member, who will use a self-identifier to insert information to their electronic health record. This information will be distributed to a number of databases that will search deployment locations, possible exposures, and bounce against the Defense Occupational and Environmental Health Readiness System (DOEHRS) data repository. This will give the service member additional information on any OEH exposures that they may have been exposed to.

Changes in TBI Assessments Will Lead to Faster Treatment

By Sarah Heynen

January 30, 2010 - Pending changes to the in-theater mild traumatic brain injury (TBI) clinical practice guidelines (CPGs) are expected to be released in the coming weeks, drastically changing the system from a symptom-based approach to an incident-based approach.

Air Force Col. Michael Jaffee, national director of the Defense and Veterans Brain Injury Center (DVBIC) presented on the topic of TBI clinical practice guidelines and guidance at the 2010 MHS Conference Jan. 27. “There is a lot of movement in this field, especially in this past year,” he said.

The first guidelines used to assess mild TBIs among service members in theater were established in 2007 and required the injured person to come forward with symptoms. New guidelines will require that anyone involved in certain incidents – including all personnel involved in a severe vehicle accident, all personnel within 50 meters of a blast, anyone that sustains a direct blow to the head or loss of consciousness, and command directed referrals – must be screened.

This new approach will allow for earlier intervention, ensuring that the injured service member gets treated sooner. Additionally, line leaders will be the first to assess the individuals before sending on to medical assessment.

Additionally, the new guidelines will change how recurring concussions (also known as mild TBI) are treated in theater.

“There is an emerging body of evidence that we’ve seen from some NFL [National Football League] studies that indicate cumulative affects of recurring concussions over time,” Jaffee said. “The NCAA [National Collegiate Athletic Association] studies suggested increased risk with three or more, but more evidence is needed to better inform and modify our practice.”

Following a similar practice by the Marine Corps, the revised guideline will require that anyone with three mild TBIs within 12 months will go through a standard, thorough assessment. The first concussion evaluation and treatment will follow the CPG practices in place. The second concussion will have the injured service member on a seven-day mandatory rest. The third will provide a much more comprehensive neurological assessment including both a comprehensive neurological examination and occupational therapy.

What determines a mild TBI?

“A traumatic brain injury is a force applied to the head that results in an alteration or loss of consciousness,” Jaffee said. He further explained that classifying the severity of a TBI as mild, moderate or severe is based on the history of what happened at the time of the injury or how long someone had an alteration of consciousness or loss, or how long someone has post-traumatic amnesia.

“It’s not a judgment of how impaired you are, it is actually a system that was designed talking about the characteristics of the injury that happened acutely,” said Jaffee. “And there is also some imaging that correlates.”

DVBIC is a network of Department of Defense and Veterans Affairs centers with the mission is to serve active duty military, their beneficiaries, and veterans with traumatic brain injuries through state-of-the-art clinical care, innovative clinical research initiatives and educational programs. DVBIC is designated as the primary operational TBI component of Defense Centers of Excellence. To learn more about TBIs, visit

Ellen Embrey Closes 2010 MHS Conference Stressing the Commitment to Care

By David Loebsack

January 30, 2010 - Ellen P. Embrey, performing the duties of the assistant secretary of defense for health affairs, closed the 2010 MHS Conference with remarks reflecting more than 30 years of federal service. Above all, she stressed that the most important priority for the entire Military Health System is to provide the utmost quality care to soldiers, sailors, airmen and Marines throughout the system.

“Their care [must be] representative of their sacrifice,” said Embrey.

She specifically thanked each lecturer – whether senior military advisors, private sector leaders or academics at the forefront of their research – for helping the MHS achieve that goal.

“My takeaways from this week, can be boiled down to three things: relevance, recognition and renewal,” said Embrey.

The business of the MHS is extremely relevant to today’s decision makers, and no one needs reminding that each choice can mean life or death for every enlisted service member and officer in theater. If the MHS fails at promoting readiness, delivering high quality care, cultivating healthy lifestyles and operating at a sustainable cost, the consequences would be disastrous.

Just as important, Embrey said, is recognition both for a job that is met with success, and when a job ends in failure.

“We have a need for a properly and regularly recognized way of celebrating excellence in our midst,” she said. “We can [also] be our own toughest critics – and that’s actually a compliment.”

Embrey urged MHS leaders to stay committed and continually self improve, in order to keep the organization thriving. Although she credited the MHS with being extremely self-reflective, she asserted that continued transparency will be integral to its future. Ultimately, recognition must go both ways – recognizing military medicine’s greatest achievements and worst failures, and learning from both.

Finally, Embrey said renewal is key. Emerging from a week-long conference where some of the most brilliant medical minds in the country have gathered epitomizes that notion. She challenged everyone in the audience, not just the senior leaders, to make a difference as a result of their time together.

“Innovation [comes] from your personal experience and your commitment to achieving it at the local level with you patients. You can achieve that tomorrow,” said Embrey.

She ended with a reminder of the quadruple aim that had been stressed all week: readiness, quality, overall health, and cost effectiveness.

“[These are] going to become the fabric of how we do business, and we’re going to learn together how to get it right,” Embrey said.

Embrey retires from her position performing the duties of the assistant secretary of defense for health affairs on Jan. 29.

Two Wisconsin Air National Guard units among best in nation

By Tech. Sgt. Jon LaDue
Wisconsin Department of Military Affairs

January 30, 2010 - Air Force officials announced Tuesday that two Wisconsin Air National Guard units would be among top Air Force units to receive the 2009 United States Air Force unit awards. The Madison-based 115th Fighter Wing was one of only 31 units to earn the Air Force Outstanding Unit Award and the Camp Douglas-based Volk Field Combat Readiness Training Center was one of nine to receive the Air Force Organizational Excellence Awards.

"This is a tremendous accomplishment for the men and women of the Wisconsin Air National Guard," said Brig. Gen. Don Dunbar, adjutant general of Wisconsin. "These awards reflect the superb leadership at the 115th FW and the Volk CRTC, and the quality of our superb citizen- Airmen. It is a privilege for us to serve."

This is the sixth AFOUA for the fighter wing. Col. Joseph Brandemuehl, 115th FW commander, said the award is in line with the wing's motto of "Dedicated to Excellence."

"It's that motto that has built the culture of excellence we have today and that allows us to perform at such a high level," said Brandemuehl. "I think this award is validation that Wisconsin citizen Airmen are the best in the Air Force."

Col. Gary Ebben, Volk Field CRTC commander, credits a great staff, great work ethic and vast experience as the recipe for his unit's tremendous success.

Of only four CRTCs in the nation, Volk Field was the only one selected for the award in 2009. "All of the CRTCs provide a valuable service to our nation in supporting Guard, Active Duty, Reserve and interagency training and operational needs," said Ebben. "I can't speak to the specific tempo of the other CRTCs, but Volk Field has never been busier when all mission sets are considered."

A total of 40 units were recognized throughout the country.

The AFOUA was first authorized by the Department of the Air Force in 1954. It is awarded by the secretary of the Air Force to numbered units that have "distinguished themselves by exceptionally meritorious service or outstanding achievement that clearly sets the unit above and apart from similar units."

The AFOEA critiques nearly identical criteria but is awarded to units who are unique, unnumbered organizations that operate or perform missions like a numbered unit would.

Volk Field won the AFOUA in 2007 but National Guard Bureau determined the CRTC was more appropriately placed in the AFOEA category.

"This is a group of incredibly dedicated and committed individuals who collectively combine, forming an extremely effective team," said Ebben. "They do a tremendous job performing a very challenging mission."

Resources for Wounded Warriors Continue to Expand

By Marqeis Sparks

January 30, 2010 - Wounded warriors will be on the road to recovery more quickly and efficiently thanks to a growing list of programs offered by the Office of Wounded Warrior Care and Transition Policy (WWCTP).

“We want to provide every possible option of recovery to all the branches of service. Our goal is to empower and encourage service members to return to duty,” said Pam McClelland, director of coordination operations, WWCTP, at the 2010 MHS Conference.

The Office of WWCTP was formed in November 2008 and aims to ensure that wounded warriors and veterans have employment and benefit opportunities as well as a smooth transition back into duty or civilian life.

Disability Evaluation System
The DoD and VA are collaborating to administer the Disability Evaluation System (DES), which provides one exam, one rating, and one assessment for wounded service members to determine their level of disability. The system, which is still in the pilot stages, will give wounded warrior programs increased transparency and faster processing. Officials hope to expand the DES to six new sites by the end of February.

Recovery Care Plan
As part of a new Recovery Care Plan (RCP), Recovery Care Coordinators, or RCCs, will be hired and trained by the DoD and wounded warrior programs to assist in service member transition. The RCCs will work to meet the non-medical needs of service members, and also partner with commanders to make sure the RCP is completed and implemented. Policy regarding the RCCs and RCP was signed in December of last year and should make these services available to Guard and Reserve service members later in 2010.

Transition Assistance Program
The Transition Assistance Program (TAP) connects transitioning service members with counselors, provides benefit briefings, and employment workshops. The WWCTP and other warrior programs are currently working to modernize the TAP. The Web site for TAP resources is

“Referring a warrior or a family member of a wounded warrior to a Web site may seem impersonal, but we offer a list of great resources that are only a click away. It really does help get the information out there,” said McClellan.

National Resource Directory
The National Resource Directory is an online resource for wounded warriors, their families, and those who support them. The DoD teamed with the Department of Labor, and the VA so that the National Resource Directory provides links to thousands of services and available resources at the national, state, and local levels to support recovery, rehabilitation, and community reintegration.

Renuart Discusses Haiti Support, Olympic Aid

By Jim Garamone
American Forces Press Service

Jan. 29, 2010 - The commander of U.S. Northern Command discussed Northcom's support for the earthquake relief effort in Haiti and the upcoming Winter Olympics in Canada during an interview this week.

Air Force Gen. Victor E. Renuart Jr. said Northcom offered personnel skilled in disaster remediation to U.S. Southern Command as soon as news of the Jan. 12 earthquake in Haiti reached the United States.

"Our components practice and train and are certified in the functions that are necessary for large-scale disaster response," he said during a Jan. 27 interview with the Pentagon Channel, noting that Northcom personnel are now assisting Southcom in Miami and in Haiti. "While they are trained to focus that in the homeland, it is very easy for them, because of the interagency nature of our team, to plug in anywhere."

Renuart also commands the binational North American Aerospace Defense Command, which, like Northcom, is based at Colorado Springs, Colo. The United States and Canada, he said, are cooperating in the effort to provide security for the Winter Olympics in Vancouver, British Columbia, next month.

"Our role is to be a great partner, friend and neighbor to Canada," he said. "The Canadians have the opportunity to demonstrate to the world what a great sporting environment they have in the west."

The Canadians do not want an overwhelming security presence, the general said. "We want it to be a sporting event that is secure, not a security event where there are athletes," he explained. NORAD will help with coordinating airspace use. "We want to make sure the airspace is safe, secure and controlled, so NORAD will have a role to monitor that space," Renuart said. "We'll have Canadian fighters north of the border and U.S. fighters south, and if needed, they can respond to an event that you are uncertain of."

Scrambling fighters gives commanders a set of eyes on a situation, and often is a prudent step, the general said.

Northcom will stand by to be of assistance to Canada Command in the event of a contingency. "We have been asked by the Canadian government to provide some key enablers to be available to them," he said. "We can deploy those if necessary."

But Renuart's missions go beyond disaster response and airspace. They also include air and space warning and maritime tracking.

Also, he said, Northcom has a homeland defense mission in operating the missile defense system, and it provides support to civilian law enforcement and other government agencies.

Northcom has had an interagency focus from the start, Renuart noted. Most of the general and flag officers at the headquarters, for example, are National Guard or reserve-component members.

"Our coalition is about 120 strong, and we count in that nations like Canada, Mexico and the Bahamas, but also the states," Renuart said.

Fifty-two different federal and state agencies work in the headquarters alongside the command's military members. This is important inside the United States, the general explained, because each organization has different authorities.

"None of us are in charge of any one event by ourselves, and we all have to work together to be successful," he said. "It really is a very complex environment."