Oregon Center for Health Statistics: Vital Records Mail Order Improvement

Summary

Impact Statement:

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 days, and orders with missing information were reduced from over 25% to 13%.

Summary:

The aim of this project was to improve the current process used for mail-ordered vital records requests. The process begins when a request for a vital record is received in the mail and ends when the vital record has been sent to the customer. Before the improvement, this process required 45 business days to complete. The need for this improvement was originally identified during a quarterly target review (QTR) when performance data revealed that the current process was unable to meet the program-defined target of processing a mail order request within 3–5 business days of receiving the request. In addition to improving the current process, a secondary goal of this event was to reduce the backlog of requests, which required many hours of staff overtime to work on. The timing of this project was very rapid. The first meeting was with the process owner, and time was spent documenting a list of the steps of the process. The second meeting lasted approximately 2 hours, and participating staff members worked to build the current state process. Once the process was built and several tweaks were made, staff members quickly determined the first area for improvement. Instead of spending time going through the process again and discussing areas of waste, the group wanted to brainstorm steps to improve the current state. Through this brainstorming process, the group realized that designating one staff member to process all mail order requests was not a sustainable and efficient way to work through the process. One participant proposed that additional staff be designated as helpers who could be available to jump in if the demand for records increased quickly. Another proposed change was to enter the data from the vital records request into the program's online portal, called the Oregon Vital Events Registration System (OVERS). By entering this information in the beginning, staff designated to help with the process could quickly see the vital records requests needing to be completed. Benefits from this initiative include a decrease in the processing time of mailed-in vital records requests, from 45 business days to 6 business days. This decrease has also led to a decrease in the amount of overtime needed because of backlogged requests. Nontangible benefits for this initiative include an increased awareness among staff of quality improvement (QI) tools and coaching available as needed.

Organization that conducted the QI initiative:

Oregon Health Authority (OHA)–Public Health Division

Citation:

Gilman, M. Public Health Quality Improvement Exchange. Oregon Center for Health Statistics: Vital Records Mail Order Improvement. Tue, 08/26/2014 - 09:26. Available at https://www.phqix.org/content/oregon-center-health-statistics-vital-records-mail-order-improvement. Accessed October 10, 2024.

Background and Aim

Aim statement:

The aim of this event was to improve the process used for mailed-in vital event requests, from the baseline of 45 business days down to 3–5 business days. Secondary outcomes of this event included the dissemination of QI tools and methodologies in an effort to build a QI culture within the Oregon Center for Health Statistics. The timeline goal for this event was to complete the improvement, including testing the improved process, before the agency's next QTR. Another objective of the event was to reduce the number of mailed-in requests with missing information. Before the event, 25%–30% of requests were missing information essential to processing the orders.

Need For The QI Initiative:

During an OHA QTR meeting, the mail order request processing time was noted to be significantly outside of the defined target area. The QTR meetings are designated times for OHA leadership to examine the division's performance measures and track which processes are falling behind demand and which could be improved.

Area for Improvement:

The mail order processing unit is one of several subsections in the Oregon Center for Health Statistics. The primary function of this unit is to process vital records requests that are received via Internet, mail, and walk-in customers. Staff receive mailed vital records requests and process them for required information and necessary payment. Delays in the processing of this information result in delays for customers to receive their vital event information. Requests for vital event information follow a typical bell curve, with peaks in requests coming in the early fall and early spring. Before the improvement event, the maximum processing time to fill an order request was 45 business days, which resulted in overtime work for staff members in an effort to reduce the buildup of backlogged requests.

Root Cause:

While collecting background information about the mail order process, it was quickly apparent from conducting the interview that one of the potential root causes of the backlog was that only one staff member was responsible for processing mail order requests. This potential root cause was also supported when the process map was developed, and an overwhelming majority of the process steps resided within one person's job description. Adding to the processing time, many requests (20%–30%) were filled out incorrectly. A potential root cause identified for this problem was the lack of clarity in the instructions available to customers. Although directions are available on the program's web page, there may be confusion about what is required to be submitted to receive a vital record without delay. This specific cause was not addressed during this event. Data used to support the first root cause were assessed by reviewing the run data before and after the improvement was piloted.

Planning and Execution Details

QI Implementation:

Because staff members and project sponsors wanted a quick solution to the problem, a Kaizen approach was used for this project. Before the mapping event and improvement discussion, several in-person meetings were conducted with the process owner. Process steps were documented as a bulleted list and transcribed onto large (4" x 6") repositionable notes. During the setup for this meeting, the notes were placed in random order on an 8'-long sheet of brown paper. When the exercise was explained to meeting participants, they noted that the steps were in completely random order, and several steps were probably missing. The group was tasked with placing the steps of the current process in the correct order and filling in any missing steps in the process. Staff members were quickly engaged and excited about the exercise, and within 30 minutes, they had accurately documented the process. Once the process had been accurately captured, staff members discussed how the problem could be fixed. From the speed of the discussion, a few staff members had obviously already thought of better ways to complete the process and shared their ideas. The first step was to ensure that when the demand for mail order requests increased, staff members were available to help the person originally tasked with request processing. A second improvement step was to immediately enter the mailed-in data into the program's online system, OVERS. By entering the data immediately upon receipt, other staff members could access pending orders and help with processing them if and when a backlog began to occur. The group unanimously agreed that the two improvement ideas should be piloted immediately, and they decided to alter their current process immediately. Within the first few weeks of piloting the improved current process, check-in meetings were scheduled with staff members, and they reported that the improved process was working significantly better than before. This initiative was chosen during a review of performance metrics. OHA leadership and the section manager for the Oregon Center for Health Statistics took the first steps in improving this process by contacting the division's performance management program. Two groups have been affected by this improvement event. First, staff members who are using the process have benefited from a process that is easier to use and better able to meet the needs of their customers. Vital records customers are the second group that this event affected. Instead of waiting for 45 days for their records to be mailed, they can expect to receive them within a business week.

Focus activities

Data collection, Epidemiology and Surveillance:

Vital statistics

Other Public Health Services:

Vital records

Administration:

Capacity Development

Customer Service/satisfaction

Organizational effectiveness

Performance Management

Quality Improvement and Accreditation Readiness

Workforce development

QI Methods:

Kaizen

QI Tools:

Process maps

Run Chart

QI Tool Documentation:

Swimlane process map (improved current process)

Run chart with mean, upper control limit (UCL), and two standard deviation lines plotted

Process map (original process)

Initiative Dates:

10/4/13 to 12/13/13

Initiative Duration:

Less than 6 months

Methods of evaluation:

The impact of this event was measured using data that the program generates weekly. Each week, staff members document the current processing time of mail order requests. These data were used to create the attached run charts and were used post-improvement to determine whether an improved process was actually achieved. Impact was measured using tracking sheets and through observational interviews with Oregon Center for Health Statistics staff members. Data were gathered before and after the event to ensure that a baseline measurement was documented and available for comparison purposes.

Other Information:

N/A

Results

Measurable QI Outcomes:

Processing time was measured before and after the improvement event. Before making any improvements, the maximum processing time was 45 business days, with a rolling average of 30 business days. After the event, processing time was reduced substantially to a rolling average of 12.5 business days. Additionally, orders with missing information were reduced from 25%–30% to 13%. These data were gathered using tracking sheets. When this project was identified for improvement, the 45-day measurement was a one-time snapshot of the processing time. Upon further review of the data, a rolling average was considered to be a better metric for showing whether an improvement had been achieved. These data are under constant scrutiny by Oregon Center for Health Statistics staff members. Should there be any process backsliding, additional process improvement work will be conducted.

Other QI Outcomes:

Staff members in the Oregon Center for Health Statistics exhibited a strong desire to take on more QI initiatives. QI coaching and mentoring will be available so that the center can take on a larger part of the planning and documentation of the event, in hopes of building a strong QI culture within the office.

Lessons Learned, Observations and Insights:

N/A

Future Plans:

This particular initiative was implemented and became the new standard for how mail order vital records requests are processed. The process map included in this submission (titled Vital Records Mail Order Process Spring 2014) shows how the office is performing the process. The specific activity of placing process steps in a random order, with some steps missing, has now been replicated with three additional groups. At the end of each mapping event, staff members present have been asked whether this method works at not only building a functional map, but also at learning how process maps are constructed. On the basis of the feedback received from all of these groups, this practice will be used at future mapping events.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Submission Status:

Completed

Comments

Great work! I would be

Great work! I would be interested in knowing how you got staff engaged in the QI process. I see that staff were given brief instructions no how to build a process map and an overview of goals but was it difficult to get them motivated? Did you provide them with any other QI information beforehand or were they already knowledgeable about QI initiatives?

Christina Perea, MA
Office of Policy and Accountability
1190 St Francis Drive S 4253
Santa Fe, NM 87505
Phone: 505-827-2531
Fax: 505-827-2942

Thanks! The staff who

Thanks! The staff who participated in this initiative arrived fairly motivated to make changes. However, I believe additional motivation came from the administrator of this office, who urged staff to make the changes needed to make the process more efficient. When we discussed the problem statement, there was quite a bit of "head-nodding" and agreement that the process they were using needed some significant improvement. The group I worked with came with an awareness of QI, but not much in terms of applying specific QI tools. I gave them a really big picture overview of QI. and used PDSA to set up how we would go through the work. Next, I showed them all how their steps fit into the PDSA model. From there, I got out of their way and let them figure it out.

Though a smaller volume

Though a smaller volume office, we too have struggled with reducing turnaround time, and your efforts give me hope! Would you mind sharing a little more about how you reduced the rate of missing information? We are in the midst of re-designing our website to clarify the instructions for ordering certificates by mail or online, as part of a QI initiative. Our current rate of incomplete appplications is around 25%. Did you find success with clarifying instructions, or did you try another intervention? I understand this is beyond the scope of this particular project, so please feel free to contact me offline if you prefer.

RebeccaShultz@ongov.net

Rebecca Shultz, MPH
Director of Surveillance and Statistics
Onondaga County Health Department
Syracuse, NY

The Vital Records team tried

The Vital Records team tried to clarify instructions that were available on their web page. They included (in bold and red font) that records would not be provided if information was missing from the required order forms. Beyond that, no major changes were made.

Here's a link to their website: http://public.health.oregon.gov/BirthDeathCertificates/GetVitalRecords/P...

Link to the resource where this submission is also published:

No.

Oregon Center for Health Statistics: Vital Records Mail Order Improvement

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

Comments

Great work! I would be

Thanks! The staff who

Though a smaller volume

The Vital Records team tried

QI Spotlight

quality improvement together.

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Oregon Center for Health Statistics: Vital Records Mail Order Improvement

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

Comments

QI Spotlight