I recently got my Lean Six Sigma Yellow Belt certification from the Technical University of Munich (TUM) through an online course offered by TUM on the edX platform. I admire how the certificate itself and the process of obtaining it was highly efficient, exemplifying the ideas of Lean and Six Sigma, reducing waste and reducing variation in quality improvement.
Lean and Six Sigma are two separate, but related philosophies in the quality improvement and management realm across a variety of different industries. I was first introduced to the concept in the healthcare industry and in the field of public health.
Wanting to further my knowledge and be able to better apply the data and fact driven quality improvement Lean and Six Sigma tools to improve my performance and range of services offered as a consultant, I decided to get certified in Lean and Six Sigma.
I found that an online series of three courses offered by TUM through the edX platform was the most efficient and cost effective way to gain this certification. Online courses allowed me to work my continuing education around my work schedule. Also the cost was low enough to not waste or strain the resources of a fresh, innovative, new consulting agency for providing professional growth and development for its consultants.
I also thought it would be interesting to take online courses from a German university, TUM, with professors from backgrounds in industries, such as manufacturing, that I am not experienced in as I learned of Lean and Six Sigma from a public health and healthcare background, thus providing a different perspective.
Today Lean and Six Sigma are often combined, and I wanted to be able to provide the combined effect that has been shown to reduce costs, improve customer, client or other stakeholder satisfaction with quality control and continuous quality improvement in processes, services, or products in the projects I work on.
Though they are often combined, Lean and Six Sigma are two separate, but related philosophies. It can be useful to differentiate between the two.
Lean focuses on reducing waste while Six Sigma focus on reducing variation, such as variation in a process, product, or service that is out of specification. Variations are often considered to be errors or mistakes, depending on how far out of specification the variation is and how the variation affects the process, service, or product.
My Lean Six Sigma Yellow Belt certification from TUM efficiently lists out and differentiates which topics covered in the series of certification courses I took fall under each umbrella: Lean or Six Sigma. Most professional continuing education certificates do not include such detail, which causes wastes in time or an increased risk of error in understanding what topics were included in the course(s) that the certification was obtained through. The listing out of the topics on my Yellow Belt certificate allows me to easily, efficiently, and with a reduced chance of errors in listing the topic under the wrong umbrella, list them out in the table below if you are curious to learn which umbrella each topic falls under.
Differences between Topics in Lean vs Six Sigma at the Yellow Belt Level
It has taken a longer than expected amount of time to post about getting Lean Six Sigma certified consultant becoming certified at the Yellow Belt level because I have been busy getting Jill + Ian’s bicycle rental service started — a service that Rillian provided research and development for and is now being added as a service provided by of our affiliated businesses, Jill + Ian–and applying Lean Six Sigma principles to the service from the start to improve access to bicycles through a quality focused and innovative bicycle rental service.
However, due to the application of Lean and Six Sigma principles in my photography business, Jillian Regan Photography, LLC, I was able to quickly and efficiently add photos to complement this blog post.
Getting my Lean Six Sigma Yellow belt certification from TUM through the edX platform was an efficient way to improve my performance as a consultant and be able to better offer data driven quality improvement technical assistance and support and consulting to other organizations.
The certificate itself is created to reduce waste and variation by efficiently listing out the topics covered under Six Sigma and Lean and details not normally included on a professional continuing education certificate itself for easy and efficient access and comprehension.
A screenshot of the author’s Twitter profile as shown on a computer screen, taken on 3/27/2018.
Twitter is a social media platform with 330 million active monthly users as of 2017 for sharing posts of up to 280 characters–as of November 2017; prior to November, the character limit was 140 characters–that can also include images, links to articles, and short video clips.
Twitter is useful for health departments because it is low cost. Unlike running an ad in a newspaper or on the radio–there is no cost to share a post (called “Tweeting”), reply or share other users’ posts (called “Retweeting”), or like or otherwise engage with Tweets. The only costs are staff time and resources dedicated to creating the content to post, posting the content, engaging with the Twitter audience, and to post paid advertisements on Twitter.
Health departments can use Twitter as part of their overall communications strategy, participating in or hosting Twitter chats, to research barriers to accessing programs or services or to meet Public Health Accreditation Board (PHAB) standards and measures.
As part of the overall communications strategy
Some health departments (approximately 217 as of 2012)(1) use Twitter as part of their communications strategy. They communicate information with the community, the media, and other partner organizations and stakeholders about public health issues, health education topics, current public health related events like health fairs or an ongoing community health assessment, and other related topics.
When using Twitter as part of a communications strategy often in conjunction with using other forms of social media, it is important to keep in mind adapting the message for the format (240 characters with option to add photos and video clips) and audience using Twitter, which is slightly different than other social media platforms.
Also the time of day when the target audience will be active on Twitter is important to consider since that time of day may not coincide with the hours the person managing the health department’s Twitter account will be at work and posting on the Twitter account.
One way to handle this is by scheduling posts using an online social media manager like Hootsuite or Buffer. Whichever social media management system is used, it should include a way to schedule posts for each type of social media account, including Twitter, and not just one post with the exact same wording pushed to all social media accounts. While social media like Facebook and Instagram can handle long posts, Twitter posts are limited to 240 characters, so these posts need to be short and sweet and leave room for a couple hashtags.
Also, while the posts may be scheduled to be posted at optimal times for when the health department’s target audience is on Twitter, it is still important to have someone engaging with the audience on the platform by liking, responding to comments, and retweeting posts during that time, which may be outside of normal working hours. Some social media management agencies who have some staff with a background in both social media management and public health or a public health focused consulting agency might be able to assist a health department with managing their social media presence including Twitter.
A screenshot of a Tweet announcing a community health assessment (CHA) meeting, screenshot taken in 3/2018.
Hosting or participating in Twitter chats — scheduled conversations on a certain topic or event– is another way of using Twitter to communicate and engage with an audience on the platform.
For example a recent study found that there was moderate engagement and a measure called return on engagement between the organizers of the Twitter Chat and the chat participants for a Twitter chat #LiveFitNOLA on health and wellness topics in New Orleans, Louisiana.(2) The Twitter chat is organized and hosted by the Tulane Prevention Research Center (@TulanePRC), a university-based research and education center, and the City of New Orleans Health Department’s Fit NOLA Initiative (@FitNOLA). The authors noted that the level of engagement as two communication between the host organization or organizations depends on a variety of factors including the audience, context, scope, scale, and goal of the Twitter chat. It also depends on what other organized hashtag-based communications the organization or host already has on Twitter.(2)
To Research Barriers to Participating in Programs or Services
Twitter can also be used for researching barriers to participating in programs or services by searching specific hashtags in a local area. For example a recent study examined the barriers to CPR training in Pennsylvania using four years of Twitter data. The barriers were found to be time, duration, and location of the training.(3) A similar method might be able to be used by a health department or a research organization or consulting agency in partnership with the health department to find barriers to attending or participating in the health department’s services and programs.
A screenshot of Franklin County Health Department’s Twitter feed, taken in 3/2018.
To meet Public Health Accreditation Board (PHAB) Standards and Measures
Depending on how the health department uses Twitter, its Twitter strategy and usage could be used as examples to meet other measures in other domains such as Domain 4 (engage with the community to identify and address health problems). Some health departments have even used Twitter in their community health assessment (CHA) and/or community health improvement (CHIP) process — tweeting links to an online survey as part of the CHA or letting people know about and inviting them to their CHA or CHIP meetings.
A screenshot of a Tweet including a link to a CHA survey, screenshot taken in 3/2018.
Sharing information on Twitter can also make it easy for the health department’s partner organizations and other stakeholders who may be involved in the CHA / CHIP or are partners for other health department programs to share their message by simply clicking the button below the post to like and another to “retweet” it.
A screenshot of tweets about the hashtag #communityhealthassessment, screenshot taken in March 2018.
Tracking engagement & results
As more health departments use or are thinking of starting to use Twitter, it is important to measure and track metrics related to Twitter usage. Tracking metrics and results is a way that the health department can know if the resources they have put into using Twitter are getting the desired results.
Also, tracking metrics for engagement is important, not just of how many tweets they post or retweet a month, but how many followers they have and how engaged those followers are with the content the post, such as the number of likes, replies, and retweets the Tweets get. Tracking the results, as well as measuring if there’s any difference over time or for tracking a specific health promotion campaign can also provide valuable insights into how the health department can improve their Twitter usage to communicate with their target audience.
Having a dedicated staff role of public information officer
Having a dedicated staff role of public information officer (PIO), either as a separate position or as part of a role of another staff position at the health department is one way to manage social media, including Twitter, usage. Having a PIO role has been found to be associated with a health department having a larger number of Twitter followers who are local, or in other words are part of the local community that the health department is trying to reach.(1)
Having a PIO role is also one of the requirements for PHAB accreditation (PHAB measure 3.3). Although, as noted in the cited study, determining the locality of Twitter users is not very precise, due to many individuals using Twitter not including location information on their Twitter profile pages, whereas most Twitter accounts for businesses and organizations do include location information in their profiles.
Health departments can use Twitter as part of their overall communications strategy to engage with their audience, participating in or hosting Twitter chats, to research barriers to accessing programs or services or to meet Public Health Accreditation Board (PHAB) standards and measures.
Tracking metrics, including engagement, and results of Twitter usage is essential to know if the resources being put into using Twitter to engage with the health department’s audience and communicate information are effective in doing so. Working with a social media agency that has staff with a public health background in addition to social media management skills or a public health focused consulting agency is one way to help create content, manage posts, and/or measure metrics and results from Twitter usage by the health department. Having a PIO role either as a separate position or as part of a role of another staff position has been found to be associated with a health department having a larger number of Twitter followers who are local.(1)
Do you know of a health department who’s active on Twitter? How do they use Twitter, do they post content, or participate in Twitter chats, or use Twitter for researching barriers or do they use it in another way? Share in the comments below!
Jillian Regan, MPH is a consultant at Rillian. She enjoys helping organizations find new ways or evaluate improve existing community health improvement efforts, so that the organization can better serve its community members, clients, customers, patients, or other stakeholders. Connect with her by email at Jillian.Regan@RillianConsulting.com or Twitter (@JillianReganMPH) or LinkedIn.
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Harris, JK, Choucair, B, Maier, RC, Jolani, N, and Bernhardt, JM. Are Public Health Organizations Tweeting to the Choir? Understanding Local Health Department Twitter Followership. J Med Internet Res. 2014; 16(2): e31. doi: 10.2196/jmir.2972
Rabarison, KM, Croston, MA, Englar, NK, Bish, CL, Flynn, SM, and Johnson, CC. Measuring Audience Engagement for Public Health Twitter Chats: Insights From #LiveFitNOLA. JMIR Public Health Surveill. 2017; 3(2):e34. doi:10.2196/publichealth.7181
McGovern, SK, Blewer, AL, Murray, A, Leary, M, Abella, BS, and Merchant, RM. Characterizing barriers to CPR training attainment using Twitter. Resuscitation. 2018; pii: S0300-9572 (18) 30118-7. doi: 10.1016/j.resuscitation.2018.03.010
Public Health Accreditation Board (PHAB) Accreditation is a set of nationally recognized standards in the U.S. that are intended to improve the quality and performance of all public health departments, whether they are Tribal, state, local, or territorial health departments.
As of this past August 2017, over half (51%) of state health departments are PHAB accredited, while another quarter (25%) of them are in the process of getting PHAB accredited. Less than a quarter (24%) of state health departments in the U.S. are not PHAB accredited nor in the process of getting PHAB accredited (Figure 1).
The percentage of state health departments that are PHAB accredited, in the process of getting PHAB accredited, or are neither PHAB accredited nor in the process of getting PHAB accredited as of August 2017. Data Source: Public Health Accreditation Board (PHAB). Accredited Health Departments as of June 2017. Graph: Rillian.
At the local level, only 21% of local health departments (LHD’s) are engaged in PHAB accreditation as of 2016. This percentage has increased greatly since 2013 when it was only 6% of LHD’s that were formally engaged in PHAB accreditation (Figure 2).
The percentage of local health departments (LHDs) that are formally engaged in PHAB accreditation between 2013 to 2016. Data Source: National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Graph: Rillian.
Only 4% of LHD’s are PHAB accredited as of 2016 with another 5% having just completed the application for PHAB accreditation, and 3% having registered in e-PHAB, the electronic system PHAB uses for document submission for PHAB accreditation application (Figure 3). Another 17% of LHD’s have plans to apply for PHAB accreditation in the future, but have not yet taken the first step of registering in ePHAB. Some LHD’s (31%) have not yet decided if they are going to apply for PHAB accreditation, while 20% of LHD’s have decided not to apply as of 2016 (Figure 3).
Local health departments (LHDs) level of engagement with PHAB accreditation as of 2016. Data Source: National Association of County and City Health Officials (NACCHO). 2016 National Profile of Local Health Departments. Graph: Rillian.
It should be noted that states vary in the structure of their public health department systems, so in some states, once the state health department is PHAB accredited, the accreditation may also apply to the LHD’s in states in which the local health department is essentially just an outpost of the state health department.
At the state health department level, most states (51%) are either PHAB accredited or in the process of becoming PHAB accredited (25%) while at the local level less than a quarter (21%) of local health departments are formally engaged in PHAB accreditation.