{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:32:04Z","timestamp":1773880324328,"version":"3.50.1"},"posted":{"date-parts":[[2025,11,21]]},"group-title":"Epidemiology","reference-count":33,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>With declining infrastructure funding for large-scale epidemiologic cohort studies, continuous process improvement is essential to sustain research quality and impact. The authors recently undertook a Lean Six Sigma (LSS) training initiative with operational staff of the Nurses\u2019 Health Studies, among the longest-running and most productive cohort studies, to modernize operations and build internal capacity for process improvement. Twenty staff members across operational domains completed a structured LSS curriculum and three improvement projects: (1) reducing median turnaround time for medical record retrieval by 90%, (2) decreasing the proportion undeliverable questionnaires by 31%, and (3) cutting biweekly freezer maintenance time by 43 person-minutes per cycle, yielding an estimated 6.5 person-weeks annually. Staff reported substantial increases in understanding and confidence in applying process improvement methods. Fourteen trainees completed all requirements for LSS green-belt certification. Though some participants questioned the need to learn a specialized framework, most valued the collaborative, data-driven approach. This experience demonstrates that LSS can be successfully adapted to non-clinical trial epidemiologic research, improving efficiency and data quality. The results support broader adoption of structured continuous improvement efforts to enhance the sustainability of epidemiologic research platforms.<\/jats:p>","DOI":"10.1101\/2025.11.20.25340660","type":"posted-content","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T15:55:14Z","timestamp":1763999714000},"source":"Crossref","is-referenced-by-count":0,"title":["Building process improvement capacity in epidemiologic research operations: The Nurses\u2019 Health Studies experience"],"prefix":"10.64898","author":[{"given":"Leanna","family":"Bassett","sequence":"first","affiliation":[{"name":"Research Operations, Brigham and Women\u2019s Hospital, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedika Vilas","family":"Patankar","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cizz-l N.","family":"Lockhart","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt B.","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janine","family":"Neville-Golden","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya L.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Romero","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline R.","family":"Starr","sequence":"additional","affiliation":[{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts, United 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