Missoula City-County Health Department Infectious Disease On-Call Team QI

Based on how the ID On-Call team members ranked the top issues, the QI team decided to focus on the top five causes of dissatisfaction. Here is how the QI team addressed each issue, in order of its importance to the team: 1. ID On-Call team members are responsible for moving vaccine in an emergency. The QI team eliminated the need for ID On-Call team members to be primarily responsible for moving vaccine in an emergency. The supervisor trained a volunteer group to move vaccine. The ID On-Call team members are responsible for contacting the volunteer group if needed. The volunteer group was recruited from general staff and trained to respond. Seven drills were done with the volunteer group to test response, including two holiday weekends. 2. ID On-Call team members have to check on the infectious disease office during regular work hours, which interferes with their own job duties. The QI team eliminated the need for ID On-Call team members to check on the infectious disease office during regular work hours. The administrative staff members were trained to check voicemail messages when regular office staff members are unavailable for their scheduled shifts. If any of these messages require follow-up, the health department director or other ID On-Call team members will be contacted to follow up. 3. ID On-Call team members believe that they are scheduled to be on call too frequently. The QI team decreased the scheduling frequency by recruiting and training new staff members. Recruitment has usually been difficult or impossible. The QI team drilled down and determined that the reluctance of public health nurses (PHNs) to be on this team might stem from fears that the job requires knowledge, skills, or time commitments that they are not comfortable with. An informational meeting with qualified staff members to discuss the benefits of participating (on-call staff members receive on-call pay), the skills and knowledge needed, and the relative ease of providing the service resulted in four new team members. New team members have expressed satisfaction with being on the team. New members will continue to be recruited in this manner by holding an informational meeting with newly hired PHNs after 3 months of employment. 4. ID On-Call team members are never allowed to rotate off the team. Beginning on September 1, 2015, existing members will be allowed to rotate off the team. As new members join, existing team members can rotate off based on who has served on the team the longest. The first opportunity to rotate off will be in September. New team members will be recruited by providing newly hired PHNs with the education they need to be comfortable being a team member if desired. The team’s enhanced reputation will encourage new members as well. It is also the hope that the increased staff satisfaction will reduce the desire to rotate off the ID On-Call team. 5. ID On-Call team members dislike the process for scheduling, especially on holiday weeks. It was viewed as inequitable. Scheduling was addressed. The team was signing up on a calendar, and there was no sense of “fairness” about assignments, especially on holidays. The calendar was posted on a wall, and staff signed up on a first-come/first-served basis. If a staff member was out of the office when this process initiated, she might end up with shifts she found undesirable. There was no equitable plan for addressing holiday coverage. The staff member on call must be in the vicinity of the health department, so holiday coverage was a big issue for staff. The QI team developed and tested a plan in which the ID On-Call team members sign up for weeks using a survey format (SurveyMonkey) and decision matrix that ensure that a fair assignment of desirable and undesirable weeks of duty. The QI team tested this process through three quarterly scheduling periods before adopting it.

The QI team evaluated results with a post-survey re-assessing staff satisfaction with being an ID On-Call team member.