NNPHI Kaizen Program: Processing Low-Priority Chlamydia and Gonorrhea Reports

The QI outcomes that could be measured during the Kaizen event demonstrated that the revised morbidity form reduced data entry time by 18 seconds per report, on average. The standardized laboratory form reduced the data entry time by 14 seconds per report, on average. Changes to the sorting and bundling processes of morbidity and laboratory reports for assignment did not increase the rate of processing for the program director (eight reports per minute pre- and post-improvement) and removed a significant amount of duplicates (laboratory reports that were already submitted electronically to INEDSS did not need data entry). Using all of the data collected before and during the Kaizen event, the team demonstrated that the SDEOs are keeping up with the incoming low-priority GC and CT reports. The backlog time will always be more than 30 days because of the perpetual backlog carried over year after year. If SDEOs could begin entering morbidity and laboratory reports in real time, if HIV/STI management can find a permanent solution to backlog (e.g., get volunteers, hire temporary help, use overtime/comp time to enter any older reports), then the backlog time could be reduced to 13 days. As of May 16, 2014, the backlog time for low-priority GC and CT reports has been decreased to 77 days (10%). Only the change to the sorting and bundling process of reports for assignment to the SDEOs has been implemented. Once the morbidity and laboratory forms have been finalized and rolled out to providers and laboratories and HIV/STI management has addressed the backlog, it is estimated that the backlog time will reach the target of 30 days or fewer.

The revised morbidity form developed during the Kaizen event reduced the data entry time by 18 seconds per report because the form followed INEDSS windows/fields and had only necessary information, so it was cleaner (more white space). The standardized laboratory form developed during the Kaizen event reduced data entry time by an average of 14 seconds per report because the form had the facility name as a field, so SDEOs did not have to search for the facility name online; because the same form was used for all laboratories, the SDEOs did not need to search for information on the form because the data were in the same place. Bundling laboratory reports from the same laboratories and removing laboratory reports also submitted electronically did not add a significant amount of time to the sorting and bundling process overall. The rate remained the same for the program director. Sorting incoming reports in 5-day bundles instead of 20 and distributing them to SDEOs in those smaller bundles creates smaller but more frequent work assignments that should decrease the backlog time. For example, reports that are difficult to interpret will not be able to be shoved to the bottom of the pile and delay data entry. By eliminating the backlog of morbidity and laboratory reports, the backlog time can theoretically be reduced by 85% based on time projections. SDEOs are keeping up with the incoming low-priority GC and CT reports. The backlog time will always be more than 30 days because of the perpetual backlog carried over year after year. Using data and working through the Kaizen process led to improvements that were different from the initial assumption of the problem and pre-identified solutions, underscoring the need for using information and systematic methods to improve processes. Kaizen events engage the people who actually do the work to develop improvements, which has a significant change in management impact and helps develop positive energy and build morale among staff. Therefore, it is critical to not only gauge Kaizen event success as meeting or exceeding the goal, but to also include these softer "people issues" as a measure of event success. Full participation of ALL team members is critical to success, including engaging persons who are disconnected during the event, redirecting persons who are dominating discussions, eliminating outside interruptions (e.g., phone calls, e-mails, texts), and preventing scheduling conflicts that result in absence from the event. Communication from management to the Kaizen team before the event demonstrated to team members that management supported the QI process and the solution to the problem was in their hands. Preparation for a Kaizen event can be time consuming, yet absolutely necessary, especially data collection. Collecting and analyzing baseline data before the event makes it easier to understand the process, work through root causes behind each waste/issue, and capture the impact of improvements during the testing phase. Teaching the team about the eight kinds of waste and focusing on waste during the cause-and-effect analysis helped the team (1) to focus on the process and not the people and (2) to shift perspective to the item being processed as key (i.e., reports are waiting to be processed, not people waiting to process reports). Testing potential solutions during the event allowed the team to get immediate results/feedback and was an invigorating activity at the end of a busy week. Holding the event on site (gemba) provided the opportunity to pull in staff involved in different steps of the process, walk through the process during mapping, and test solutions. Access to and availability of resources, such as a projector, WiFi, and printers, is imperative to keep the process moving during an event.

A continual improvement system (CIS) for this project was implemented after the end of the Kaizen event. The program director and SDEOs meet weekly to discuss what is working and not working, to implement needed improvements immediately, and to keep momentum on action items from the Kaizen event. One of the key issues identified during the Kaizen event, cases being re-opened in INEDSS so that DIS can merge electronically submitted laboratory reports, is being addressed in a program-wide QI initiative as part of CDPH's QI Learning Collaborative. By communicating the results and successes of this Kaizen event, CDPH initiated another Kaizen event with the Breast Health Program in March 2014.