Occupational Health Rapid Process Improvement
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.
TO: Implement an occupational health process for employees to meet federal, state, and local immunization; bloodborne pathogen (BBP); and tuberculosis (TB) control requirements.
FOR: Minimizing the health risks of each division’s personnel.
SO THAT: Staff and clients are safe and healthy and Clackamas County’s liability risks are limited (or eliminated).
HOW (measures of success):
- Onboarding measure: By February 2015, all new hires within the Clackamas County Public Health Division will meet their occupational health requirements within 30 days of being hired (baseline: 5% met the 30-day target).
- Ongoing measure: By July 2015, all Clackamas County Public Health Division staff members will be current on their annual occupational health requirements (baseline: 33%).
Organization that conducted the QI initiative:
Clackamas County Public Health Division
Mason, P. Public Health Quality Improvement Exchange. Occupational Health Rapid Process Improvement. Mon, 05/02/2016 - 13:22. Available at https://www.phqix.org/content/occupational-health-rapid-process-improvement. Accessed May 31, 2023.
Background and Aim
Implement an occupational health process for employees to meet federal, state, and local immunization; BBP; and TB control requirements.
Need For The QI Initiative:
The public health director sponsored the creation of a Lean rapid process improvement project (Kaizen event) made up of key stakeholders within the health department to present recommendations on a revamped process for occupational health.
Area for Improvement:
According to the Clackamas County Risk Manual, state statutes, and guidance from the Centers for Disease Control and Prevention, specific ongoing occupational health requirements must be required for all organizations that employ at-risk health care workers (HCWs). In the past, the Communicable Disease Program had reviewed and kept occupational health records for all health department employees. Since an internal reorganization, along with changes in personnel and competing priorities, these roles needed to be evaluated and a new sustainable process needed to be developed for the health department.
Onboarding and ongoing root causes were as follows: • The laws and guidelines are not considered for HCWs in the county’s onboarding process. • Procedures for permanent, temporary, contractors, volunteers, and students/interns related to occupational health are unclear. • Job classifications need to be updated. • Time frames for completing requirements are unclear. • There is a disconnect between supervisors and human resources liaisons for the occupational health portion of onboarding. • Who houses records? Departments or the Department of Employee Services? BBP root causes included the following: • The BBP control plan needs updating. • Tracking and timeliness of annual refreshers are a concern. • Trainings are inconsistent. Immunization review root causes included the following: • Immunizations are not reviewed by a qualified person. • Immunizations cannot be provided to staff in-house with a current vaccine inventory. • Maintaining vaccines is costly.
Planning and Execution Details
• Day 1: Discuss current issues. Begin learning and researching all occupational health requirements with subject matter experts (SMEs). • Day 2: Finalize researching all occupational health requirements. Perform affinity charting. • Day 3: Conduct cost-benefit analysis and gain consensus on recommendations. • Day 4: Present cost-benefit analysis to leadership for decision making. • Day 5: Develop new process. Assign any remaining action items. • Day 6: Present new process to leadership. Begin implementation.
Other QI tools:
1/26/15 to 3/31/16
Between 12-18 months
Sample of materials produced
|Occupational Health Storyboard.docx||422.3 KB|
|Occupational Health RPI Report Out Slides_ 01 28 15.pptx||8.84 MB|
Measurable QI Outcomes:
Onboarding measure: All new hires within the Clackamas County Public Health Division are meeting the target of completing all occupational health requirements not only within 30 days of being hired, but also, 100% of new staff members are completing the requirements before starting. Ongoing measure: As of March 2016, Clackamas County Public Health Division staff members are current on their annual occupational health requirements as follows: immunization requirements (33%), BBP requirements (85%), and TB control requirements (85%).
Other QI Outcomes:
The ongoing measure is anticipated to be 100% completed by April 30, 2016.
Lessons Learned, Observations and Insights:
Leadership buy-in and support were critical. The whole team was passionate about this project and wanted to use it to fix the onboarding process. The appropriate SMEs were brought in at the right times throughout the project.
Onboarding/human resources liaisons updated desk manuals, developed flowcharts and a checklist, updated onboarding packets, practiced inputting data in PeopleSoft, and printed a mock report for managers/supervisors. The TB control, BBP control plan, and immunization requirements for employees policies were all updated and approved. Partnering with the human resources department: identified updates needed within the Clackamas County Risk Manual, and developed a list of potential conflicts related to labor relations for leadership. Employees’ occupational health requirements: developed documentation and criteria for the health officer and medical director to determine each employee’s occupational health requirements based on classification, role/job function, division, and location; and developed a plan for catching up on current staff members' ongoing occupational health needs.
Training and Preparation
QI Related Training Received:
All members had completed four basic quality improvement (QI) trainings that were required for all health department employees. A few team members had experience participating in QI projects in the past.
Information about the Community
Clackamas is one of the largest and most economically diverse counties in Oregon. Third most populous in the state, Clackamas is also home to the end of the Oregon Trail and Mt. Hood Territory. Many residents in suburban communities are closely tied to Portland's urban core for employment, whereas many residents in rural communities make their living from some of Oregon's richest farmland. The majority of the population growth is white, non-Hispanic; however, there has been rapid increase in residents identifying themselves as Hispanic and Asian/Pacific Islander.
Information about the Health Department
PHAB Accreditation Status:
Annual QI Initiative Frequency:
QI activity level:
QI Staff Information
Total number of Staff on QI Team:
Total number of FTEs on QI Team:
QI team members:
Clackamas County Health Centers Division
Partner Organization Types:
Contact Information of the Submitter
Clackamas County Public Health Division
Link to the resource where this submission is also published:
This is one of the terrific
This is one of the terrific Kaizen projects of the PHAB QI Academy, with coaching by Continual Impact. Great work Clackamas county! This is an issue for all health departments to address.....
Nice job Philip! Ty
Nice job Philip!