Running head: MISSING APPOINTMENTS PROCESS IMPROVEMENT PROJECT 1

Missed Appointments

Trevor D. Kearns

Southwestern College Professional Studies

CLO 410

April 15, 2011

Mrs. Tollie Hartmann

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Abstract

The 85th Engineering Squadron is a unit whose members are consistently either deployed

or on temporary duty. Due to the high ops tempo of being on the road, the unit is plagued with

an extremely high rate of missed or broken appointments in physical fitness testing, promotion

testing, dental, and medical appointments. Missed or broken appointments waste the health

professional’s time and reduces the opportunity for others who need medical assistance. Each

missed medical appointment cost millions of dollars each year in fact, “Nearly 5,000 missed

medical appointments per month costs Army Medicine in Europe about $5 million per year.

Engaging beneficiaries and unit leaders can help reduce the number of missed appointments by

half, health officials say” (Tegtmeier. P). More importantly, missed appointment effects the

unit’s reputation as it displays a lack of discipline on its members. This project will examine the

problem of missed appointments at the 85th Engineering Installation Squadron and will

recommend corrective actions which may be applied through other functional areas within the

squadron.

]
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Missed Appointment Process Improvement Project

The 85th Engineering Installation Squadron has approximately 177 personnel assigned;

these numbers include 143 military and 34 civilians. The mission of the 85th is to provide solid

communications around the world, anytime, anywhere. The mission is harsh on its people as

they spend most of their on the road, either on temporary duty or deployed. The issue is two

fold, it costs a lot of money and our members don’t seem to care, in fact according to an article

from Seymour Johnson Air Force Base’s commentary “Many Airmen today think missing an

appointment is not a big deal. In reality for anyone, military or civilian, at an appointment with a

military office; it is a big deal. It affects the budget that operates a wing. For example, today it

cost $250 dollars for each missed dental appointment. This is broken down by having to pay the

doctors' salaries, support staff and facility operation fees. If between a two-hour period 10 people

miss a dental appointment, it cost the military $2,500. If you continue the math, missing an

appointment can end up costing thousands of dollars a day. You can see missing one simple

appointment can turn out to be very costly” (Wilson.G). Recently, the unit has had a gradual

increase in all kinds of missed appointment and the Wing commander is asking my commander

why the increase? My commander, Lt. Col, Hammack chaired a meeting with leadership to

discuss the issue and appointed me to investigate the reasons. I accepted the task and gather a

small team to help me investigate. I first had a brainstorming session with my team and broke

out each functional area of the missed appointments into these areas: Dental, medical, promotion

testing, and physical fitness. My team hit the ground running and started to see a trend in why

unit personnel were missing appointments. It appeared initially that all personnel were not being

held accountable for missing appointments and the appointed program coordinators were not

being held accountable for their failed actions.

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Reduce or Eliminate Missed Appointments

The commander was indeed highly concerned why our people were missing so many

appointments and asked me to find the problems and reconvene with the results in 30 days. I

screened squadron personnel and hand picked a team of four individuals to be part of a tiger

team to investigate. The team members were from different backgrounds, such as, TSgt

Drummond from quality control, MSgt Snell from program management, and SSgt Norris who

have recently returned from a long deployment and TSgt Birch who recently returned from a

TDY. Each team member was highly qualified and respected in the squadron. The commander

said, “The team you select will work directly for you for the duration of the investigation”. We

used my conference room as a base and had our first meeting March1, 2011. I opened the

meeting up with the objective “why does the squadron have so many missed appointments?”, the

team immediately had opinions why, I requested them to focus on the objective and we are here

to find out the facts and provide recommendations to the commander within 30 days. We

opened with a brainstorming session which concluded with the following areas; unit physical

fitness, promotion testing coordinators not performing to standards, personnel not being held

accountable, and lack of supervisor oversight in scheduling appointment. This established our

map for further investigating. I wanted statistics as to how many appointments have been missed

in each area; MSgt Snell was tasked with investigating these numbers to develop a trend within

each functional area.

As we approached this problem the team and the commander needed to know the severity

of the issue and to track down how many people have missed appointments and separate these

into each functional area. MSgt Snell worked with the 81st Medical Center on base and talked

with SSgt Wise, he found out that each month the medical center sends a missed appointment
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letter to the squadron coordinator for all medical and dental appointments. The commander has

never seen this letter. MSgt Snell asked for copies of these letters for the past three months and

SSgt Wise provided the lists. MSgt Snell proceeded to talk with the base promotions testing

Officer Ms. Brown and requested to obtain a list of personnel who have missed promotion

testing for the last three months and also found out each time a member misses promotion

testing, the first sergeant is notified via e-mail. After getting some data together, the numbers for

missed appointments in each functional area are as follows:

Missed Appointments Statistics

1 Jan - 31 March 2011
Cou % of Cumulative
Category nt Total Percent
Medical 48 52.7 52.7
Dental 23 25.3 25.3
Promotion Testing 4 4.4 4.4
Physical Fitness Testing 16 17.6 17.6
TOTALS 91 100 100

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As you can see, medical appointments are the highest, following dental, promotion

testing and physical fitness. These numbers will be our target discussion throughout the
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improvement process. Now, that we have the statistics, the team will attempt to isolate the

reasons why members are missing appointments.

Why Missed Appointments have Increased

Once the team had the true numbers of missed appointments over the last three

months, we held a meeting and had another brainstorming session in regards to potential reasons

why the unit has over 91 missed appointments in a three month period. MSgt Snell said that he

would like to interview Mrs. Stallsworth, the squadron’s promotion testing and physical fitness

coordinator. I told him that would be a great idea and to look into her processes for scheduling

and appointment notifications. SSgt Norris had an idea to see how the squadron’s in and out

processing checklist worked to make sure the correct people were doing their part when signing

off their checklist to deploy or go TDY. This was an awesome idea, as leadership really never

looks at these checklists when people go on the road. As the leader of this group or tiger team

facilitator, I reminded the team we are doing this to help the squadron and to ease the burden on

our people, medical staff, and the commander. The team at this point all jelled very well and

understood they were part of a team to look at the process and facts and determine only the

potential reasons why missed appointments were on the rise. After interviewing Mrs. Stallsworth

who is the promotion and physical fitness program coordinator and the first sergeant who

receives the late letters from base agencies, the team gathered the possible causes for missed

appointments and documented their work on the Cause and Effect Diagram below:
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Fitness Testing Promotion Leadership

Members are notifiedTesting Supervisors areOversight

Scheduling is only conducted via e-mail through unaware of any
between member and base agency and unit appointments and
coordinator coordinator while are left out of the
member is deployed… process
supervisor does not get
Program coordinator signs out notified.
processing checklist without re-
scheduling appointments Commander does
not receive monthly
data from unit
First sergeant does not coordinators
Out processing checklist out notify the commander or
of date supervisors of missed
appointment
Missed
No squadron policy
Appointments
Squadron coordinator governing missed
does not check with base appointments
agencies prior to signing
off checklist
No repercussions
for missing
appointments
Member fails to re-schedule
appointment before going
TDY or deploying

Squadron’s
coordinators not
performing to
standard

Medical Accountability

Solution Ideas to Fix Squadron Missed Appointment Problems

Generate Alternatives

My tiger team and I held a meeting to discuss the findings of the cause and effects

pertaining to the high rate of missed appointments. The team was still very much “on point”

with the task at hand. I re-addressed the objective for the reason why the team was put together,

“why the squadron has so many missed appointments” and requested the team to search for fix
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actions based off the cause and effect results. The team immediately implemented a

brainstorming session once again and TSgt Birch explained, at his last base his unit had a

squadron policy pertaining to missed appointments and they hardly ever missed appointments. I

asked him to see if he could obtain a copy for a potential recommendation to the commander.

SSgt Norris asked if it would be a good idea to check with other base agencies to see how they

dealt with missed appointments and how the functional area coordinators managed their

programs. I concurred with these excellent choices to provide the commander a wealth of

alternatives to fix the missed appointment problem at hand. The team at this point was looking

at ways to eliminate the problem, to provide solutions with constructive effort. The team is

highly motivated to eliminate this hindering problem in the squadron. At this point each member

has provided a broad input to the reasons for the high rate of missed appointments and has had

zero conflict. Up to this point it appears the squadron has failed mainly in administrative areas

and functional program coordinators are not following procedures to prevent missed

appointments. The discipline for administrative procedures in a high ops tempo unit is critical to

the success of the mission. As the facilitator for this team, I instructed them to generate options

based off of their findings both inside and outside the squadron for the commander; therefore, the

team developed an Affinity diagram to show the potential corrective actions to eliminate the

missed appointment problem, the diagram is below:

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Missed Appointment Suggested

Actions

Decrease Missed Appointments

Improve
Program
Coordinator Accountability
tasks
Check Scheduled
appointments for Develop Policy for
members prior to punitive actions for
signing out missed appointments
processing checklist
Notify leadership of Formal Counseling for
missed appointments those who miss
in a timely manner appointments

Hold program
Check with base
coordinators
agencies for medical
accountable for
appointments
failure to perform
according to checklist
duties

Communication Improve Internal

processes

IN-Out Squadron
Processing Education

Update outdated out- Teach all personnel

processing checklist proper out processing
process
Ensure all members
sign checklist and Ensure supervisors
turn them into 1st receives appointment
Sergeant notifications
Old equipment, due
to be replaced, not Educate program
operating at peak coordinator to inform
capacity leadership of all
appointments

Affinity chart retrieved from, http://sc.blackboard.com Decision making Templates

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Options to Consider to Eliminate Missed Appointments

Evaluate the Alternatives

The missed appointment problem in the squadron has been an issue which has been

overlooked for some time now, the tiger team has isolated where the root causes are with the

problem, it will be up to the commander to decide which area he would like to address first. All

the suggested corrective actions are administrative and no financial obligations will be associated

with any of the alternatives. The benefits with each alternative action will decrease or eliminate

the missed appointment dilemma. If all personnel make their scheduled appointments the

medical center and the individual’s health care will be preserved. The reputation for the squadron

will definitely improve and the squadron will eventually be removed from the wing commanders

naughty list for having the most missed appointments in the wing. Relatively to implement all

the alternatives can be accomplished quickly and no delays are expected. The only risks

associated with the alternatives are the program coordinators who may have their pride hurt

when they are told how to do their duties more effectively. Below in the tree diagram is the

proposed timeline for the process improvement plan. It starts when the tiger team started the

process and ends by conducting a follow-up at approximately 60 days, this will ensure the

process has indeed worked. If it has not worked further investigation may be required or other

alternatives may be implemented based on the commander’s recommendation. The commander

has directed the priorities based on the timeline table, the highest priority is the first to be

accomplished.
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Suggested Missed Appointment

Process Improvement Timeline

Tiger Team re-looks

Squadron
Tiger Team starts holding
at the process
Squadron trains all
Tiger Team Briefs people improvements and
personnel on new
Starts accountable briefs the
Commander out-processing
Investigation commander
on findings checklists

Mar 2011 Mar 25, 2011 April 4, 2011 April 14, 2011 April 18, 2011 May 1, 2011 June 15, 2011

Tiger Team Commander New checklist Program

finishes Writes/implem developed coordinator get
Investigation ents missed Implemented re-training on
appointment core duties
Policy

Accountability is Key to Discipline

The commander was shocked when he found out no policy was in place for correcting

those who fail to meet mandatory appointments. He made this his number one priority, he stated

“no wonder people keep missing appointments, they have zero repercussions”, he was very

adamant about getting the policy off the ground and knew this would hold the individuals

accountable for missed appointments. The tiger team showed him a copy of a policy form TSgt

Birch’s last base and he said he would re-write it for our unit immediately. He said, “From the

day I sign this policy all those who miss appointments will meet with me to explain themselves”.
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Conclusion

The squadron has been plagued with people who missed appointments and these

members were not being held accountable for their actions. Just one missed medical

appointment takes away from someone who may have truly needed care and subtracts the time a

doctor has with other potentially gravely ill patients. The reputation of the squadron in the wing

was bad as the squadron was rated with the highest missed appointment rating. The tiger team

unveiled several factors that directly contributed to people missing appointments, such as,

program coordinators not checking is a member has any appointments prior to TDY or

deployments, the medical centers monthly missed appointment list was not being routed to

leadership, supervisors unaware of members appointment schedules. The team developed

alternatives for the commander to implement and the commander concurred with all measures to

stop the missed appointments. The commander was very pleased with the team’s decisive action

and the presented timeline for implementations. The team will follow-up to ensure the process is

fixed after the 60 day point and re-address any lingering issues at that time via a brainstorming

session. The internal process for in and out processing for TDY and deployments was virtually

broken for all intense purposes. Now, the squadron has a plan to get off the wing commanders

naughty list, help the medical professionals better manage their time, and prevent members from

missing promotion testing, physical fitness testing and medical appointments.

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References

Tegtmeier. P. (2011). Missed Appointments cost Millions Annually. Retrieved March 25, 2011

from,

http://www.stuttgartcitizen.com/article.php?i=16001

Wilson. G. (2009). Failure to go. Retrieved March 25, 2011 from,

http://www.seymourjohnson.af.mil/news/story.asp?id=123175891

Decision Making Templates. Retrieved March 23, 2011 from,

http://sc.blackboard.com

Brassard & Ritter (2010) Memory Jogger 2

The following are the decision making tools utilized to conduct this project improvement project:

Affinity Diagram.

Fishbone Diagram

Pareto Chart.

Timeline Chart