Between September 2015 and October 2015, two QI team meetings were conducted. Following is an outline of the tools that were used over the course of these meetings:
Flowchart: At meeting #1, the QI team walked through the current process for how staff members are collecting morbidity reports from the local health care providers. While analyzing the current process, the team identified that CD Program staff often get caught in a loop when requesting the morbidity report for positive chlamydia cases from the health care provider. Per DHMH guidelines, providers are required to report illness and treatment using the morbidity reports, which includes information (e.g., demographics, treatment) needed for CD Program staff to effectively perform case management, surveillance, and disease monitoring, and to ensure proper treatment. However health care providers are often not providing these. Therefore, CD Program staff often have to call providers to obtain the information generally provided on the morbidity reports, which can be time consuming. Given this, the team also discussed a proposed process, which would essentially eliminate the back and forth between CD Program staff and the health care provider. Instead, the health care provider would automatically submit morbidity reports for positive cases of chlamydia to HCHD.
Cause-and-effect diagram: Also at meeting #1, the QI team was led through a discussion to identify all possible causes that exist around the problem of health care providers not submitting morbidity reports for positive cases of chlamydia. The group created a fishbone diagram, putting all causes into one of the following categories: people, supplies, procedures, and environment. By using the 5-Whys technique, the group also identified secondary and tertiary causes. The cause-and-effect diagram was finalized at meeting #2. After finalizing the diagram, the group agreed that the root cause of the problem was that the health care providers and their staff lack knowledge and education about the morbidity reports and the submission process. This was determined after soliciting feedback from the health care providers via phone calls. Many of the providers stated that they did not know they had to submit the morbidity reports and/or who was actually responsible for submitting the reports. Some offices also stated that they did not have copies of the morbidity reports on hand or did not know how to access the reports.
Solution-and-effect diagram: At meeting #2, the QI team brainstormed all possible solutions that could address the root cause. The group created a solution-and-effect diagram, putting all possible solutions into categories similar to those used in the cause-and-effect diagram, including people, environment, procedures, and supplies. The group looked across all categories on the diagram and identified their solution as that which occurred most often (i.e., a solution that appeared in multiple categories). In this case, the solutions included creating a “catchy” flyer to encourage submission of the morbidity reports for chlamydia, creating clear and concise guidelines on when and how to submit the morbidity report, and providing a copy of the morbidity report to the provider. An improvement theory and action plan were then created. On October 1, 2015, catchy flyers and a copy of the morbidity reports were then faxed or mailed to 57 local Harford County health care providers. Many of the providers used the flyers, and most were displaying them above their fax machines as a reminder.