Using Lean Six Sigma Methodology to Improve a Mass Immunizations Process at the United States Naval Academy.

Lean Six Sigma (LSS) is a process improvement methodology developed in the manufacturing industry to increase process efficiency while maintaining product quality. The efficacy of LSS application to the health care setting has not been adequately studied. This article presents a quality improvement project at the U.S. Naval Academy that uses LSS to improve the mass immunizations process for Midshipmen during in-processing. The process was standardized to give all vaccinations at one station instead of giving a different vaccination at each station. After project implementation, the average immunizations lead time decreased by 79% and staffing decreased by 10%. The process was shown to be in control with a capability index of 1.18 and performance index of 1.10, resulting in a defect rate of 0.04%. This project demonstrates that the LSS methodology can be applied successfully to the health care setting to make sustainable process improvements if used correctly and completely.

Co-infection with gonorrhoea and chlamydia: how much is there and what does it mean?

A cross-sectional study of new clients with either gonorrhoea or chlamydia attending King's College Hospital in 1998. One thousand two hundred and thirty-nine women and 1141 men had gonorrhoea, chlamydia or both. Overall, 24.2% (124/512) of heterosexual men and 38.5% (136/353) of women with gonorrhoea also had chlamydia (P<0.001). Of heterosexual males 18.8% (124/660) and 13% (136/1022) of females with chlamydia also had gonorrhoea (P=0.002). Ethnicity had no effect on the proportion of co-infection after controlling for age and gender. Clients with dual infection were younger than those with either infection alone (P=0.0001). Over half of women and a quarter of men aged 15 to 19 years were dually infected so testing for both gonorrhoea and chlamydia may be appropriate in this age group in settings outside genitourinary clinics. The high proportion of cases of gonorrhoea that also have chlamydia justifies the policy of epidemiological treatment for chlamydia.