Oregon Center for Health Statistics: Vital Records Mail Order Improvement


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%.

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

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 June 21, 2024.

Submission Status: 
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Submitted by christinaperea on

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?

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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

Submitted by mattgilman on

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.

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Submitted by rshultz on

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.


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

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