Public Health Nurses Improve Efficiency and Quality of Performance Management

The QI team began this initiative by mapping the current data tracking process from the time when the public health nurse obtained referrals from local hospitals to the time when a home visit occurred. Upon examining the process flow diagram, it was evident that the largest contributor to the inefficiency of the process was the fact that almost all tracking was done via paper until the program supervisor had the chance to update the electronic database in the LCPH server. Using paper led to (1) hand copying of referrals, (2) the same data having to be entered twice, (3) referrals stacking up on desks, which increased the likelihood of assignments being missed, and (4) a requirement of administration staff to file. In addition, a fishbone diagram was created that identified some of the logistical problems with the database itself; the structure did not allow for efficient or useful reporting, and the LCPH server allowed only one staff member to be in there at a time. The team determined that to streamline the process and capture more robust and relevant program data, a database that can be linked to an electronic form should be developed. This was accomplished using Microsoft Access. A barrier was identified in that the data need to be stored on the LCPH server, which nurses do not have access to in the field (hospitals and clients' homes). To get around this barrier, a copy of the database was locally stored on the nurses’ laptops, and a training component was incorporated, so nurses could independently upload new referrals/client information from the hospital into the database on the LCPH server. This new electronic form not only allowed for new/more client information to be tracked, but it also enabled the supervisor to assign clients to staff without stacking paper referrals on their desks. The immediate impacts of this QI initiative have been felt by the staff in the Newborn/Prenatal Home Visiting Program in that it is much less time consuming and easier to track data on clients. The community should also see benefits because program planning and surveillance will improve.

The team measured the time staff spent on referral tracking and data entry through the LCPH electronic time system before and after implementation. However, the greatest impact of the QI initiative can be described qualitatively because the usability of the performance management system has improved immensely.