The following steps were taken to implement the quality improvement (QI) initiative:
1. A logic model was created to map the QI initiative.
2. The team participated in a webinar on December 5, 2012, to gain basic knowledge of the QI process.
3. Cycle 1: The team participated in its first coaching call on January 30, 2013. The team brainstormed and began mapping the text messaging process for the STD clinic. The Family Planning clinic documented its current process map of STD testing. Training was scheduled for the Family Planning clinic staff on February 14, 2013, by one of the disease intervention specialists, a surveillance specialist, and one registered nurse from the STD clinic. The purpose of the training was to make Family Planning staff aware of the proper consent form and required information for the text messaging service. Project implementation was scheduled for March 1, 2013.
4. Cycle 2: The team participated in a coaching call on March 4, 2013. The team members met to discuss the initial implementation of the project in the Family Planning clinic. The team identified the need for a script for the staff to use for client consent of the text messaging option because of conflicting information provided by different staff members. The team discovered that none of the staff members had ever seen an STD no-reply text message. Staff from the STD program communicated that clients had expressed confusion in the past over the message they received. During this cycle, discussions also began to determine the data that would be collected to analyze the project. A list of metrics was established. Responsibility for collecting this information was assigned to members of the team in their respective clinic or program areas. The team determined that this information would be sent electronically to the project manager for inclusion in the metric spreadsheet.
5. Cycle 3: On March 18, 2013, the team received via e-mail an updated process map, text message script, and screenshot of the correct text message for review before the next scheduled meeting. New cards were ordered with the correct information to provide to the clients about the text message option for STD results. One staff member noted that two separate cards (English and Spanish versions) were being used and suggested that both languages be combined on a single card, front and back, to decrease expenses. The team agreed, and the change was made before ordering new cards. Collection of the data for the project was initiated. The need for a client satisfaction survey to measure customer response and feedback was established. The draft policy and procedure for the text messaging service was reviewed, and revisions were agreed upon that more accurately reflected the corrected processes and forms. Team members were assigned to each need identified. Planning for the implementation of the project in the Prenatal clinic began on April 1, 2013; it included a process map of the current prenatal testing process. Training for the prenatal nurses was held on March 28, 2013.
6. Cycle 4: The project was implemented in the Prenatal clinic on April 1, 2013. The team decided to meet at the end of the day for a brief evaluation. During the review, the team was made aware that the STD text message option may only be appropriate for the new or initial prenatal appointment because of the frequency of prenatal clinic visits. One of the goals of the text messaging project is to notify clients of test results for early treatment sooner and to decrease the need for a follow-up appointment if results are negative. Because clients are routinely scheduled to return for their prenatal visits, the text messaging option may not be advantageous for this population for all visits. Components of the client survey were clarified, and age and program number fields were added for data collection. The team identified staff members who would conduct client surveys.
7. Cycle 5: The team participated in a coaching call on April 17, 2013. The customer service survey changes were reviewed, and updated data on the metrics chart were discussed. Discussion of the impact on clinic schedules led to the decision to measure the financial impact or cost savings that would result from the project. A need to develop criteria for measurement of the financial impact of the project was identified. The team also discussed QI tools for charting the project. The team requested a demonstration of QI tools that could be applied to the project on the next coaching call via videoconferencing.
8. Cycle 6: The team participated in a coaching call on May 14, 2013, which focused on applying QI tools for submission of the project to PHQIX. The team openly discussed the status of the project in each clinic. No significant complaints or changes were identified. Initial data and customer service survey feedback were evaluated. The team agreed to chart and quantify the responses and obtain client feedback on reasons for declining or opting out of the text message option.
9. The team participated in a coaching call on May 24, 2013, and reviewed a slide presentation for the National Network of Public Health Institutes conference. The coach recommended using the change strategies tool for communicating project processes for the presentation.