Improving WIC Open Access Appointment System

Summary

Impact Statement:

In order to improve client satisfaction and increase the efficiency of WIC visits, this medium size local health department used QI to improve their Open Access appointment system. They were able to reduce the time for a complete WIC visit by 25% and increase participant satisfaction to 96%.

Summary:

The Cabarrus Health Alliance (CHA) applied for and received a grant from the North Carolina Accreditation Learning Collaborative to engage North Carolina State University (NCSU) staff to conduct a Lean Kaizen event for our Women, Infants and Children (WIC) Program focusing on improving the Open Access Appointment process, which had recently been implemented. As a result of changing the appointment system, participant satisfaction had declined as well as the total caseload being served. The aim statement for this project was to make major improvements in access and efficiency for participants while at the same time improving staff satisfaction to attain the following goals by March 31, 2011:
• Increase participant satisfaction to 96% or higher
• Keep appointment availability to 0 days
• 90% of staff strongly agree that they would recommend our WIC Department as a great place to work
• Increase staff satisfaction to 85% or higher
• Four WIC staff will be formally trained in Kaizen quality improvement (QI) process.
In January 2011, we conducted a Lean Kaizen event with the help of Annah Poteat-Godwin from NCSU. After performing an assessment of the current process using Value Stream Mapping, the Lean Kaizen team divided to work on two different areas: one to add a receptionist in the WIC waiting room to improve “traffic” flow, and one to modify the Open Access scheduling to allow some pre-booked appointments. Utilizing Plan-Do-Study-Act (PDSA) worksheets, we placed a clerical staff person in the waiting room as a receptionist for part of a day and developed and instituted criteria for participants that needed to pre-book appointments. Cycle time for the complete WIC visit decreased 25%, and participant satisfaction improved from 89% to 96%. However, staff satisfaction decreased from 69% to 60%. The benefits to the staff included training in QI and feeling empowered to make changes.

Organization that conducted the QI initiative:

Cabarrus Health Alliance

Citation:

Stanley, C. Public Health Quality Improvement Exchange. Improving WIC Open Access Appointment System. Thu, 12/27/2012 - 16:01. Available at http://www.phqix.org/content/improving-wic-open-access-appointment-system. Accessed April 19, 2024.

Background and Aim

Planning and Execution Details

QI Implementation:

The CHA WIC Program converted to an Open Access Appointment System in February 2010. Although it succeeded in reducing the no-show rate and decreased the delay in getting an appointment, there was a decrease in participant satisfaction and a decrease in WIC caseload. The NC Quality Improvement Mini-Collaborative allowed us to conduct a Lean Kaizen event in January 2011 to make improvements in the WIC scheduling process. After some initial training on Lean Kaizen method by our coach (Annah Poteat-Godwin from NCSU), a team comprised of our sponsor/champion Cappie Stanley, WIC stakeholders (Flor de Liz Bustos, Kathleen Tucker, Regina Kurtz, and Susan Anderson), and cross-functional representatives (Betty Braxton, Human Resources; Bobbie Rowe, Clinic; Cindy Walker, Clinic; Julie Hurt, WIC Regional Consultant; and Tammie Harkey, Finance) participated in a Gemba Walk in which we all visited the WIC work area and observed the present appointment scheduling process. The team then proceeded to create a Value Stream Map to illustrate the current process the WIC participant followed from making an appointment through the actual WIC visit. From the analysis of the Value Stream Map and the Gemba Walk, the team decided to work on two different areas: one to add a receptionist in the WIC waiting room to improve “traffic” flow, and one to modify the open access scheduling to allow some pre-booked appointments. We implemented two PDSAs: one placing a clerical staff person in the waiting room as a receptionist for part of a day, and the other developing criteria and implementing them for participants that needed to pre-book appointments. With the receptionist in the waiting room, the average cycle time for the complete WIC visit decreased 25% and the wait steps were reduced from 5 to 1. When we piloted the modified Open Access scheduling, there were open appointments every day, so there was little need to modify. The changes that allowed some pre-booking appointments added flexibility, which was translated into improved participant satisfaction.

Focus activities

Maternal and Child Health Services:

WIC

Administration:

Customer Service/satisfaction

Organizational effectiveness

QI Methods:

Kaizen

Model for Improvement

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Other QI tools:

Gemba Walk

Initiative Dates:

10/1/10 to 3/1/11

Initiative Duration:

Less than 6 months

Methods of evaluation:

The QI initiative was measured by WIC participant satisfaction surveys and staff satisfaction surveys as well as cycle times for participant visits.

Other Information:

NC Division of Public Health: Because Julie Hurt, NC Regional WIC Consultant, participated in this QI initiative and realized the potential benefits for other WIC programs, she instigated a presentation by NCSU on Lean and QI to her colleagues at NCSU. Seeing the value in spreading the word about the benefits of QI and the positive experience that CHA had, a session on the QI process was added to the NC WIC Conference, enabling other local WIC Programs to institute QI.

Supplemental Materials:

Storyboard

PowerPoint Presentations

Supplemental Files:

Attachment	Size
Lean Kaizen Event introduction.ppt	990.5 KB
WIC Kaizen Event Completed 3-28-11.pptx	1.33 MB

Results

Measurable QI Outcomes:

With the receptionist in the waiting room, the average cycle time for the complete WIC visit decreased 25%, and the wait steps were reduced from 5 to 1. When we piloted the modified Open Access scheduling, there were open appointments every day, so there was little need to modify. Participant satisfaction improved from 89% to 96%. However, staff satisfaction decreased from 69% to 60%, with only 16% strongly agreeing that they would recommend the WIC Department as a great place to work.

Other QI Outcomes:

The staff involved in this QI initiative received valuable training and experience in the Lean Kaizen methodology and also learned how to use different QI tools, such as the Gemba Walk and Value Stream Processing. It reinforced the importance of obtaining measurable data as well as input from the all levels of staff.

Lessons Learned, Observations and Insights:

NC Division of Public Health: Because Julie Hurt, NC Regional WIC Consultant, participated in this QI initiative and realized the potential benefits for other WIC programs, she instigated a presentation by NCSU on Lean and QI to her colleagues at NCSU. Seeing the value in spreading the word about the benefits of QI and the positive experience that CHA had, a session on the QI process was added to the NC WIC Conference, enabling other local WIC Programs to institute QI.

Future Plans:

CHA is adapting some of the changes. The receptionist position has been relocated to the issuing area and is combined with the vitals position to increase staff efficiency and decrease participant waiting time. The Open Access scheduling continues to be modified, allowing more flexibility for the participants. Walk-ins for new participants are allowed, classes no longer have to be scheduled, and the criteria for pre-booking have been expanded. Establish Future Plans This was just the beginning of looking at the WIC scheduling and appointment process. As CHA prepared to move into a new building with a new floor plan, processes continued to be analyzed, and changes were made to improve the flow for participants and staff. Because of the decrease in staff satisfaction, increased efforts will be made to determine the root causes and to implement improvements to improve staff satisfaction.

Improving WIC Open Access Appointment System

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

QI Spotlight

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Improving WIC Open Access Appointment System

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

QI Spotlight