4-6 Initiatives

Three counties in central Oregon, Crook, Deschutes, and Jefferson, were faced with rates of only 60%–70% of 2-year-old children having received all recommended vaccinations. The counties used QI methods; elected to implement an evidence-based process, AFIX (Assessment, Feedback, Incentives,...

The number of flu vaccines provided by Cerro Gordo County Department of Public Health (CGCDPH) has risen greatly, with many flu vaccination sites around the rural county. As the number of vaccines rose, the ability to enter the vaccines into the state immunization registry fell, and 57% of flu...

The Cerro Gordo County Department of Public Health (CGCDPH) used PDSA to improve its process for applying for grants and involving all staff in understanding the process.

Tazewell County Health Department (TCHD) followed a Kaizen QI process to decrease the time for completing the deposit and receipt process for fee revenue. The number of days from receipt to post decreased from 30 to 5, an 83% reduction. Additional improved outcomes resulted from the Kaizen process.

Deschutes County Health Services (DCHS) in Oregon improved its process to increase clinic show rates and caseload for clients of the WIC program. This improvement optimized staff time and ensures access to care and benefits for these needed services in the community.

Using a PDCA approach, the Philadelphia Department of Public Health (PDPH) achieved a more efficient process for onboarding new employees. The amount of paper used went from 136 pages to 16 pages, an 88% reduction. The mean monthly staff time dedicated to the onboarding process dropped from 653...

The Connecticut Department of Public Health (DPH) significantly reduced the number of steps needed to place student interns. By improving access to job descriptions and applications for preceptors and prospective interns, staff could more easily increase capacity to meet the community's health...

Lake Cumberland District Health Department (LCDHD) in Kentucky receives grant funding for several program activities, and staff realized that it was not unusual for different divisions to apply for the same grant. A QI committee used QI tools to address this issue. New policies and procedures have...

Butte County Public Health Department (BCPHD) in California used QI to expedite the annual medical review (AMR) process for eligibility into the California Children's Services (CCS) program. More children and their families now have improved access to these specialty health care services.

Kane County Health Department (KCHD) in Illinois increased staff knowledge of the Emergency Operations Plan (EOP), which improved timely response to emergencies and protection of county residents.

Deschutes County Health Services (DCHS) streamlined the referral process for its Nurse Family Support Services(NFSS) and Oregon MothersCare (OMC) programs. Staff satisfaction with the process has improved and program clients are now more efficiently being served.

Customer satisfaction is key to any health department, and ensuring new employees’ satisfaction is no exception to this tenet. Deschutes County Health Services (DCHS) achieved tremendous success in orienting and onboarding these important “internal” customers through a comprehensive process that is...

By using the Six Sigma DMAIC method, Lake County Health Department streamlined their billing process for the Dental Program. This change resulted in a significant decrease in lost revenue, from an average of $5,354 per quarter down to an average of $2,076. The quarterly losses decreased steadily...

Staff at Deschutes County Health Services (DCHS) recognized that they had so many different programs in operation that it was difficult for staff to make all the appropriate referrals for clients. They did a QI project, and their improvement hypothesis targeted three areas: knowledge, workflow, and...

Franklin County Health Department (FCHD), a small local health department (LHD) in Kentucky, needed to improve the completion and timeliness of restaurant inspections to meet regulatory requirements. By using the Kaizen process and involving leaders from the LHD, the QI project team identified root...

Columbus Public Health (CPH), a local health department in Ohio, was bogged down by a slow, costly process to administer vaccines to children at schools. By using PDSA and a Kaizen event approach, CPH increased the timeliness and efficiency to document the immunization services and decreased its...

This medium-size local health department improved and standardized the effectiveness of environmental health (EH) plan reviews for new restaurant establishments. The QI team used Kaizen and Lean Six Sigma methods and tools to successfully reduce the EH plan review approval time frame from 30 days...

Clackamas County Public Health Division has improved its onboarding processes to ensure that occupational health requirements are met within 30 days after hiring new employees and annually thereafter to ensure that risk is low and that employees and clients are safe and healthy.

In becoming ready for PHAB accreditation, the City of St. Louis Department of Health’s performance management team used quality planning to create, test, and install a performance management system. The process included a fishbone diagram of the barriers to a culture of quality, an affinity diagram...

The Minnesota Department of Health Birth Defects Monitoring and Analysis Program used a Kaizen event to streamline the process for identifying children with birth defects, decrease the median time from 49 to 37 days, and decrease the maximum time by 53%. Families may now be linked faster to...

The Kaizen event approach was selected to involve the Minnesota Department of Health (MDH) Public Health Laboratory (PHL) team in reducing the percentage of influenza tests taking longer than 6 days to verify and eliminate testing errors. Within 4 months, errors were eliminated and test time length...

Henry County Health Department’s (HCHD’s) strategic plan included addressing employee turnover and job dissatisfaction. Employee turnover and job satisfaction are related to how confident an employee feels when starting a new position, which links back to the effectiveness of the orientation...

Rapid response to new Salmonella cases is critical to decreasing the spread of disease and reducing the likelihood of an outbreak. The Santa Clara County Public Health Department in California used the Define, Measure, Analyze, Improve, Control (DMAIC)/Six Sigma approach to identify the root causes...

Deschutes County Health Services (DCHS) in Central Oregon is now able to provide more efficient preventive strategies for the county through creating and implementing an online process for reporting foodborne illness, restaurant complaints, hotel and motel complaints, pool and spa complaints, and...

The number of breastfeeding women who have access to a certified lactation counselor soared when Missoula City-County Health Department staff used QI to improve their internal processes.

Knox County Health Dept. demonstrates how use of partner developed communication standards can improve communication satisfaction among groups participating in a coalition.

Reducing adolescent tobacco use is a priority for Tooele County Health Department (TCHD) in Utah. Staff recognized the need to improve tobacco compliance check pass rates and identified that clerks who possess a valid permit were less likely to sell tobacco products to minors. TCHD used quality...

Cabarrus Health Alliance and partners used quality improvement to streamline their processes for referrals for pregnancy care management to improve overall handoffs and cycle times, resulting in more timely and effective referrals for care management to ensure healthier mothers and babies.

Johnson County Department of Health and Environment used a kaizen event to improve the supply ordering process cycle time and increased the order placement and delivery accuracy for all programs in the department. The results included decrease in cycle time – total ordering process time per order...

Team uses creativity to positively engage staff which enabled measurable improvements to be made to a critical agency process directly impacting the public. After the event, processing time was reduced substantially to a rolling average of 12.5 business days from the previous average of 30 business...

Kaizen events lend themselves to rapid improvements in routine health department processes. Tazewell County Health Department utilized Kaizen tools to full advantage--reducing administrative time related to food establishment inspections dramatically, exceeding the project aim. In the first month...

Washington County Department of Public Health and Environment improved the process of renewing annual hazardous waste licenses to over 500 hazardous waste generators. Approximately 75% of renewals contained one or more defects which slows the process, consumes unnecessary time by the inspectors...

Effective tobacco control and prevention outreach is vital to decreasing tobacco use, secondhand smoke exposure, and tobacco-related disease rates. In addition, the loss of significant resources and funding for tobacco control and prevention have made it all the more important to have efficient...

Vaccinating children is imperative in the prevention and spread of life-threatening communicable diseases. A rural regional health district conducted an improvement project using PDSA at three public health clinic sites to increase immunization rates among 19–35-month-old children seen at their...

This big city health department used QI to improve their intake processes and obtained dramatic results in connecting the highest risk people with substance use disorders to existing city services, which in turn results in improved outcomes for individuals who are homeless, have co-occurring health...

Using QI Tools and PDSA leads to significant improvement in the standardization of Final Inspection Reports.

Increasing participation in public health programs is a goal of many agencies. In this QI project, the Kenosha County Division of Health sought to expand and enhance its prenatal care coordination (PNCC) and reproductive health services. QI resulted in changes in the process with the addition of a...

Clark County Health Department increased the percent of eligible families that are referred to Kentucky’s home visitation program for new and expectant parents from 24% to 56%. Evidence indicates that increased participation in this program will positively impact preterm birth rates, low and very...

This QI project used many QI tools to identify and design improvement actions to increase the redemption of food vouchers by WIC clients. While this project did not achieve the improvement target, , the development and application of tools could be helpful to other community health programs seeking...

In order to simplify and standardize its formal contracts (numbering over 200) with the seven local health districts in Idaho, which led to great frustration and wasted time by both local and state staff in processing multiple different forms for contracts, the Idaho Division of Public Health used...

Pregnant women face economic barriers to receipt of pertussis vaccines, increasing risks for infant transmission of the disease. Using PDSA and rapid cycle improvement, the health department partnered with a prenatal care provider to increase Tdap coverage from 1% to 49% of pregnant women whose...

Using Kaizen Rapid Improvement Event, Denver Public Health not only made the vaccine administrative process more efficient, but helped to ensure the appropriate vaccine and fund source was applied, thereby preserving scarce privately funded vaccines.

WIC enrollment is well below the eligible population in Yellowstone, MT, and a substantial number of those enrolled do not regularly pick up their food coupons, resulting in automatic disenrollment and loss of benefits. Utilizing PDCA, RiverStone Health addressed the root causes of the drop off in...

Wicomico County had a salmonella infection rate twice as high as the state average. Their QI project found that by focusing on reducing critical violations in retail food service facilities through increasing its outreach and education services to those facilities, the Wicomico County Health...

Local health departments play a critical role in responding to public health emergencies and often test their ability to respond during exercises or drills. One local health department in Illinois used the PDCA cycle to improve its ability to assemble staff in a complete and timely manner during...

Due to a variety of barriers, including inefficient flow of clients during WIC visits, eligible families were not engaging with WIC services. The clinics at this health department improved their processes and exceeded their initial goals, allowing many more families to be able to eat well and be...

A local health department noted a high rate of early post-partum unintended pregnancies among women in the Women, Infants and Children (WIC) program, and used QI to identify three interventions to reduce the rate.

A systematic 9- step approach to manage access to prenatal care was the key to improving access to medical exams within the first 2 weeks of a positive pregnancy test. This systematic approach removed previous barriers that caused a delay in the process from pregnancy testing to initial medical...