Showing Up and Not Giving Up: Improving WIC Show Rates and Caseload in Deschutes County

Please see the attached storyboard. To align the WIC team around a common purpose, the first meeting included review of current show rates by location, appointment type, and month. The team also reviewed the Whatcom County Public Health (Washington) cause-and-effect fishbone diagram on show rates. With this information in mind, the team created the goal and aim statement and began brainstorming reasons why the show rates might be lower than desired. Root causes were identified and prioritized by severity and frequency. Solutions were brainstormed and prioritized by impact and feasibility. Because piloting each solution before implementing the next would force this project to take an excessive amount of time, many of the solutions were implemented at the same time. An approximate time frame for solution implementation can be found in the QI storyboard. Because of this overlap, it is difficult to tell which solutions were most effective. Qualitative feedback from staff during team meetings may indicate effectiveness of solutions. Staff discussions and feedback during team meetings provided a useful opportunity to engage in Plan, Do, Study, Act dialogue. Before implementing solutions, staff talked through the new process and vetted potential problems before pilot implementation with clients. Client feedback to staff when implementing new processes and staff feedback on new processes were used to further determine and implement potential improvements, reassess, and repeat. Most effective solutions were as follows: • Improve the reminder process to increase reminder calls to clients and to provide information and alternatives when an appointment cannot be met. • Modify operating hours to include appointments during lunch or after hours. • Creating a one-page sheet to help clients activate their WIC card and engage in services after a referral from the Perinatal Care Program. Additional useful solutions were as follows: • Create and install a family parking spot or sign with easy access to the sidewalk and door. • To increase ease of making follow-up appointments for clients, home visitors include follow-up appointments for WIC clients when appropriate. • Create and disseminate a poster or flyer to explain the health and monetary value of WIC for families and how to appropriately cancel an appointment in advance. • Create and disseminate a 1/3-page brochure insert to explain why coming to an appointment is important and how to appropriately cancel an appointment in advance. • Provide information about transportation or funding options to eligible clients. • The WIC supervisor reached out to the state to discuss TWIST System limitations and ideas to improve future systems.

1. Quantitative: Analyze monthly show rates by location and appointment through the WIC database, TWIST. 2. Quantitative: Review caseload report e-mailed from the state. 3. Qualitative: Receive feedback from staff via discussions during staff meetings. 4. Qualitative: Staff asked clients for feedback on WIC and used responses to guide improvement implementation.