Cause and Effect Diagrams

Tarrant County Public Health’s (TCPH’s) North Texas Regional Laboratory (NTRL) decreased the cost of a specific HIV test by 40% by testing and adopting an alternative control test method. NTRL has received level funding for a few years while laboratory expenses have continued to grow. Achieving...

Lake Cumberland District Health Department (LCDHD) in Kentucky receives grant funding for several program activities, and staff realized that it was not unusual for different divisions to apply for the same grant. A QI committee used QI tools to address this issue. New policies and procedures have...

Kane County Health Department (KCHD) in Illinois increased staff knowledge of the Emergency Operations Plan (EOP), which improved timely response to emergencies and protection of county residents.

Washington County Department of Public Health and Environment led a multi-sector quality improvement project and increased the recycling rate at a county park. Expansion of this model to all county parks will further protect the environment and contribute to Minnesota's statewide goal of a 75...

Kansas Health Institute (KHI) strengthened their ability to share information with clients by increasing the efficiency of its publication process and reducing staff stress associated with it.

By using the Six Sigma DMAIC method, Lake County Health Department streamlined their billing process for the Dental Program. This change resulted in a significant decrease in lost revenue, from an average of $5,354 per quarter down to an average of $2,076. The quarterly losses decreased steadily...

The Florida Department of Health in Seminole County (DOH-Seminole) improved the timeliness of filing Client Service Records (CSRs), positively affecting customer service and access to care.

Cerro Gordo Health Department decreased fear levels of bed bug exposure among field staff. The implementation of a risk reduction plan minimized staff discomfort and facilitated a more effective intervention to bed bug exposure in the community.

Cerro Gordo County Department of Public Health (CGCDPH) worked to improve immunization rates for both types of pneumococcal vaccine recommended for seniors. Through a multifaceted approach that emphasized increased awareness of the vaccine, CGCDPH raised the rate of immunizations with the newest...

By using Kaizen, Cabarrus Health Alliance (CHA) in North Carolina reduced food establishment violations by 22% and further protected residents from foodborne illness.

Staff at Deschutes County Health Services (DCHS) recognized that they had so many different programs in operation that it was difficult for staff to make all the appropriate referrals for clients. They did a QI project, and their improvement hypothesis targeted three areas: knowledge, workflow, and...

Harford County Health Department (HCHD) in Maryland increased the percentage of morbidity reports for chlamydia submitted by county health care providers, thus facilitating improved trend monitoring, ensuring proper treatment, and ultimately helping to reduce the spread of disease.

Franklin County Health Department (FCHD), a small local health department (LHD) in Kentucky, needed to improve the completion and timeliness of restaurant inspections to meet regulatory requirements. By using the Kaizen process and involving leaders from the LHD, the QI project team identified root...

Columbus Public Health (CPH), a local health department in Ohio, was bogged down by a slow, costly process to administer vaccines to children at schools. By using PDSA and a Kaizen event approach, CPH increased the timeliness and efficiency to document the immunization services and decreased its...

Mobile food units (MFUs) in Houston, Texas, now experience a faster, more efficient inspection process thanks to a Kaizen event held by Houston Health Department. The average time to complete the physical inspection and administrative paperwork has decreased from 3 hours to 30 minutes. Moreover,...

For health department services that have a major impact on citizens, ensuring high client satisfaction is important to the public’s understanding and support for these services. Three state health departments teamed together to improve the timeliness of death data, using the Kaizen method for...

Clackamas County Public Health Division has improved its onboarding processes to ensure that occupational health requirements are met within 30 days after hiring new employees and annually thereafter to ensure that risk is low and that employees and clients are safe and healthy.

Recognizing the critical role of timely and accurate death data for local health departments (LHDs) to perform surveillance and make informed decisions, the North Carolina Department of Health & Human Services used quality improvement to decrease the lag in posting identifiable death data from...

Client complaints and staff dissatisfaction with prenatal clinic wait times led the Seminole County DOH to use QI to decrease their client visit times. Focusing on modifying the prenatal scheduling matrix, eliminating duplicate charts, and decreasing the physical distance traveled between check-...

Staff are Customers too! How involving all staff in the identification of barriers to completing department offered QI Training resulted in greater acceptance of, participation in, and an increase in the number of staff completing six required training modules.

Using quality improvement to raise community awareness of the importance of annual private well water testing increased the number of tests performed, assuring a safe water supply for county residents all done without increasing processing costs!

Early intervention has been shown to positively impact outcomes across developmental domains. The Fond du Lac County Health Department increased the number of children being screened for developmental delays from 5 to 9 per month, allowing more children to be appropriately connected with services...

Clackamas County, Oregon conducted a comprehensive Kaizen project to design and implement a customer feedback system for the entire public health division. The process and tools used for the project are well described and easy to adapt by other health departments. While Clackamas has not yet...

Untreated chlamydia (CT) and gonorrhea (GC) can lead to serious health problems in men and women. In order to effectively track and treat these two sexually transmitted infections, CDC guidelines require that low-priority CT and GC reports be processed by health departments within 30 days of...

El Dorado County Health and Human Services Agency used a Kaizen event to improve customer satisfaction and reduce labor time in the County “request for information” process. The results of the project mean better and faster information to the incoming caller, so they can make more informed...

The DeKalb County Board of Health used a kaizen event to decrease the labor time and increase the accuracy of filing death certificate registrations. Improving the process resulted in labor savings, better cash flow and improved performance for customers in providing accurate and timely filing. The...

DOH-Seminole County realized savings of $7764 for goods and services from price negotiations during the first quarter following a Kaizen event – almost double the goal set by the QI team. Other improvements in the requisition process included a 38% decrease in process time, in addition to...

Washington County (OR) conducted a Kaizen Event to improve the volume of childcare facilities that used the LHD for their state required inspections. The agency implemented several new policies and protocols to standardize the entire inspection process. As a result, they anticipate a reduction in...

By streamlining their internal computer drive, creating an internal framework for its use/upkeep, and training staff on the efficient and effective use of the computer drive, the Three Rivers District Health Department has increased staff productivity.

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...

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...

A local health department in Washington was not able to serve all of the WIC-eligible clients in its jurisdiction. Process mapping led to three aims for increasing efficiency to make time for new clients: (1) Decreasing the average percentage of no-show appointments; (2) Increasing the WIC...

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...

Home visiting programs are an important intervention to improve the health of women and children, but they are generally done in programmatic silos. A state health department used QI to improve the process and systematically address both chronic disease and environmental health risk factors...

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.

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...

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...

The Prentiss County Health Department and Mississippi State Department of Health partnered on a project to reduce wait time in their WIC clinics, reassign staff as needed on higher traffic days, and provide customer service training to frontline staff to assure greater satisfaction and...

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...

Increasing participation in public health programs is a goal of many agencies. In this QI project, the Kenosha County Division of Health sought to expand and enhance its prenatal care coordination (PNCC) and reproductive health services. QI resulted in changes in the process with the addition of a...

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...

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.

Wicomico County had a salmonella infection rate twice as high as the state average. Their QI project found that by focusing on reducing critical violations in retail food service facilities through increasing its outreach and education services to those facilities, the Wicomico County Health...

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...

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...

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...