Domain 9: Evaluate and continuously improve health department processes, programs, and interventions

Kaizen events lend themselves to rapid improvements in routine health department processes. Tazewell County Health Department utilized Kaizen tools to full advantage--reducing administrative time related to food establishment inspections dramatically, exceeding the project aim. In the first month...

WIC coupons for use at famer’s markets are a precious resource for improving nutrition and reducing food hunger in low-income families, as well as supporting local farmers. Deschutes County Health Department noted a decreasing trend of redemption, which meant a literal wasting of coupons that other...

This initiative describes how quality leaders at the Salt Lake County Health Department challenged the status quo to transform organizational quality culture. Members of the SLCHD Quality Council identified a need to increase the health department's emphasis on quality after a review and...

The Maryland Department of Health and Mental Hygiene partnered with its local health departments and WIC clinics to increase the number of WIC clients referred to and receiving appropriate services to meet their needs.

Washington County Department of Public Health and Environment improved the process of renewing annual hazardous waste licenses to over 500 hazardous waste generators. Approximately 75% of renewals contained one or more defects which slows the process, consumes unnecessary time by the inspectors...

Effective tobacco control and prevention outreach is vital to decreasing tobacco use, secondhand smoke exposure, and tobacco-related disease rates. In addition, the loss of significant resources and funding for tobacco control and prevention have made it all the more important to have efficient...

Staff from Oregon MothersCare conducted a QI project to improve their processes for prenatal care, which led to decreased errors in tracking and faster flow through the system so that pregnant women received services in a more timely manner. Access to prenatal care was also improved.

Enforcement of food safety regulations plays a significant role in preventing food borne illness outbreaks. A local health department used the Lean method to increase efficiencies, standardize the process and reduce staff time and other costs for the administrative hearing process that enforces...

This state health department quality improvement (QI) effort sought to improve customer satisfaction and increase use of the Utah state laboratory. The intervention tested was the development of a website for use by local health department (LHD) staff, who achieved both of the QI project goals. In...

Vaccinating children is imperative in the prevention and spread of life-threatening communicable diseases. A rural regional health district conducted an improvement project using PDSA at three public health clinic sites to increase immunization rates among 19–35-month-old children seen at their...

Michigan’s Maternal Infant Health Program serves low-income families and pregnant women to improve birth outcomes. A local health district in that state used the PDSA cycle to reduce office-related work and increase time for direct client services in order to make the program more efficient and...

Responding to case reports of Lyme disease, the most common tick-borne infection in North America represented a very large time burden for a local health department in northwest New York state. The department used QI tools to decrease the number of steps and amount of time to respond to case...

Using QI Tools and PDSA leads to significant improvement in the standardization of Final Inspection Reports.

Tuberculosis is difficult to eradicate, it can have devastating health impacts, and one active TB case can result in budget-breaking expenses for small-to-medium local health jurisdictions. A local health department in Washington state implemented a quality planning and quality improvement project...

The tribal health department used QI to increase the number of parents using car child seats correctly from 30 to 65% using new dramatic visual presentations and enhanced car safety seat installation demonstrations. This will save children’s lives and reduce auto related injuries.

In an effort to improve customer satisfaction, Carroll County General Health District embarked upon a QI project to decrease waiting time in the reproductive health clinic. Their aim for a 10% reduction in waiting time was nearly achieved by taking a novel approach to addressing the identified...

This Michigan Department of Community Health QI project sought to increase the number of grants reaching priority populations in response to requests for proposals (RFP) for tobacco control. The team used a survey to gather data on the biggest barriers to applying for grants that would reach the...

A local health department increased early enrollment of pregnant women in smoking cessation programs to reduce risks of pregnancy complications, premature delivery, and their infants being low-birth weight, stillborn, or dying from SIDS.

Clark County Health Department increased the percent of eligible families that are referred to Kentucky’s home visitation program for new and expectant parents from 24% to 56%. Evidence indicates that increased participation in this program will positively impact preterm birth rates, low and very...

This QI project used many QI tools to identify and design improvement actions to increase the redemption of food vouchers by WIC clients. While this project did not achieve the improvement target, , the development and application of tools could be helpful to other community health programs seeking...

In order to simplify and standardize its formal contracts (numbering over 200) with the seven local health districts in Idaho, which led to great frustration and wasted time by both local and state staff in processing multiple different forms for contracts, the Idaho Division of Public Health used...

Taking the whoop out of a Pertussis outbreak and enhancing a community's pertussis mitigation effort by using improved early identification and isolation outcomes methods to decrease the number of days between onset and the report of disease.

Pregnant women face economic barriers to receipt of pertussis vaccines, increasing risks for infant transmission of the disease. Using PDSA and rapid cycle improvement, the health department partnered with a prenatal care provider to increase Tdap coverage from 1% to 49% of pregnant women whose...

The Harford County Health Department used QI to create a more welcoming environment for limited English proficiency populations by focused staff education, training, and standardization of processes, increasing the use translation services three fold.

Using Kaizen Rapid Improvement Event, Denver Public Health not only made the vaccine administrative process more efficient, but helped to ensure the appropriate vaccine and fund source was applied, thereby preserving scarce privately funded vaccines.

WIC enrollment is well below the eligible population in Yellowstone, MT, and a substantial number of those enrolled do not regularly pick up their food coupons, resulting in automatic disenrollment and loss of benefits. Utilizing PDCA, RiverStone Health addressed the root causes of the drop off in...

A local health department in rural Wisconsin was missing opportunities to immunize a significant number of teenagers who would potentially benefit from mandated or optional vaccines. They implemented an improvement project to standardize the process and educate staff in order to decrease missed...

Local health departments play a critical role in responding to public health emergencies and often test their ability to respond during exercises or drills. One local health department in Illinois used the PDCA cycle to improve its ability to assemble staff in a complete and timely manner during...

To improve the reach of chronic disease management in Nebraska, an evidence-based chronic disease self-management program, Living Well, was implemented using awareness and communication techniques in Lancaster and Buffalo counties to improve participants' ability to manage their health...

Local health departments in Washington state monitor the quality of the Vaccine for Children program to ensure vaccines administered by the private sector maintain high quality and immunization rates improve. To eliminate redundancies, decrease inconsistencies between staff and improve clarity of...

A local health department noted a high rate of early post-partum unintended pregnancies among women in the Women, Infants and Children (WIC) program, and used QI to identify three interventions to reduce the rate.

Denver Health used rapid cycle improvement to implement a brief tobacco cessation intervention (2As &R) in a high risk urban family planning and sexual health clinic. The intervention was enhanced by modifications to the electronic medical record system. They plan to spread this intervention...

A systematic 9- step approach to manage access to prenatal care was the key to improving access to medical exams within the first 2 weeks of a positive pregnancy test. This systematic approach removed previous barriers that caused a delay in the process from pregnancy testing to initial medical...

This northern Kentucky health department wanted to increase the percentage of properly licensed mobile food vendors to correct unsafe food handling and prevent foodborne illness related to mobile food vendors such as food trucks. With the large light-industry and numerous warehouses located...

Through several PDCA cycles, the Madison County Health Department was able to increase revenue from billable service fees in two program areas -- one by 13% and the other by 16%. The process improvements gradually will be applied to all direct service program areas, followed by other improvements...

By engaging health department staff across all divisions in the process of developing proactive media messages based on local health needs and priorities, the Zanesville-Muskingum County Health Department was able to improve its provision of timely, needed public health information to the community.

This mixed semi-urban and rural county had the lowest rate of kindergartners completely immunized in New York State (89%), with baseline data for the immunization rates among schools in the county ranging from 15.4% to 90%. The QI initiative aimed to improve the immunization rate for children...

The CT DPH innovatively improved its ability to collect and report sociodemographic information, so health disparities could be identified throughout the state and efforts could be taken to improve population health and better address health inequities.

The public health community has lagged in using digital communications to make its presence and services delivered known to the general public. Gwinnett, Newton, and Rockdale County Health Departments found that creating a better experience and better information for website visitors was better...

Although located in an area with significant need for teen family planning services, a public health teen clinic in Spartanburg County had low rates of use. The South Carolina Department of Health and Environmental Control followed a Plan-Do-Study-Act (PDSA) approach and used QI tools to understand...

Fast and effective investigations into foodborne illness outbreaks are an important part of a food safety program because they reduce the time that people are exposed to a pathogen. Toledo-Lucas County reduced the cycle time for an effective investigation and closure of foodborne outbreak cases...

Even the implementation of evidence-based public health interventions poses challenges for most health departments. Using rapid-cycle tools and regular status monitoring, Cleveland County Health Department dramatically improved completion of the 5A’s smoking cessation service.

Wisconsin’s Prenatal Care Coordination (PNCC) program has been shown to decrease low-birth weight among single women, increase family support and involvement of the father, decrease preeclampsia, and decrease smoking among pregnant women. Clark County health department used QI to achieve 100%...

The Snohomish County Health Dept used QI on its immunization process.. By analyzing causes of error, introducing a new and standardized work flow, and using job aids that help to verify client records and data, the immunization error rate was reduced by over 50%.

The Allegan County Health Department used QI to increase of the percent of department programs that perform client satisfaction surveys from 33 to 81%. As a result valuable feedback from clients is enabling the department to provide services and programs that better meet the needs of its community.

By improving its grant application process, the Bethlehem Health Bureau increased the success rate of funded grant applications and increased the amount of grant funding received. The improved process now enables the organization to better meet the needs of the community it serves.

By improving processes in its WIC program, the Wood County Health Department has made WIC education more accessible to clients, increased client satisfaction, and freed up staff time to complete other work assignments.

St. Croix County Public Health nurses were concerned that the time needed to complete required paperwork was taking them away from serving postpartum mothers and newborn babies. To put clients first, they conducted a quality improvement initiative that reduced the time for documentation by 37%....