To identify barriers to WIC clients having their children immunized during their WIC visit, the team engaged in preparing a fishbone diagram. Team members brainstormed all possible factors that could have an impact on parents/caregivers following through with referrals. It became evident that lack of knowledge, on the part of health department staff, clients and possibly physicians emerged as a consistent barrier in the process. Data were collected for 2 weeks to gather pre-intervention referral rates.
During this period, new pneumococcal recommendations were released and the WIC clerk-tech was educated about this during MLC-3 team meetings. As a result, when a WIC client was determined to be not up to date by the MIWIC program, the WIC clerk-tech discussed with the parent that this was the probable cause of the client’s status.
Data were startling! 71% of those referred for immunizations who were told it was because of the new pneumococcal requirements were successfully referred. This was contrary to what preliminary assessments had suggested.
It was perceived that, because of the increased level of knowledge and confidence on the part of the WIC clerk-tech, parents were more likely to follow through with the referral and take their children to the Immunization Division for shots.
The significant problems with staff participation in QI activities remain unchanged as state and county budgets continue to dwindle. Much attention is focused on volume-based reimbursement, even at the local health department level. A balance between programmatic requirements and the value of refining, expanding, and assessing duties will remain challenging. It is important to foster a culture of willingness and desire for this activity to make it happen. This comes from leadership that values and promotes these qualities in themselves and in their staff. Maintaining QI activities requires at least one dedicated staff member who has been trained and assigned this task in his/her job description. Current economic conditions make this difficult but not impossible to accomplish.