Five whys

Deschutes County Health Services (DCHS) in Oregon improved its process to increase clinic show rates and caseload for clients of the WIC program. This improvement optimized staff time and ensures access to care and benefits for these needed services in the community.

Missoula City-County Health Department in Montana drastically increased its reach to clients who are eligible for its Health Services programs by improving program referral processes for existing clients. As a result, the health department can much better serve eligible women, infants, and children.

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.

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.

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.

The Louisiana Public Health Institute (LPHI), a nonprofit organization dependent on grant funding, engaged in a Kaizen process to decrease the amount of time it takes to prepare a grant proposal. After a 5-day Kaizen event, a new process and job aid were developed, and labor time for proposal...

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...

Missoula City-County Health Department used quality improvement to improve the functionality and satisfaction of its infectious disease after hours response team members, thus ensuring that emerging infectious disease issues in the community would be managed appropriately.

Health Alert Network (HAN) messages provide vital public health information to the community’s health care providers, schools, churches, day care centers, and so on. The RiverStone Health team used a 5-day Kaizen event to improve the HAN process, create job keys, involve more staff, and decrease...

Budget literacy of health department staff is a key attribute necessary before decentralizing financial management and program oversight. After an assessment that determined that staff had knowledge gaps, an educational intervention was initiated to increase their financial management competency....

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.

Saginaw County Department of Public Health (SCDPH) conducts strategic planning every 2 years. After noting that not all staff were engaged, the four previous strategic planning groups conducted a PDSA cycle on the strategic planning process. As a result, staff are now more committed to setting and...

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-...

Knox County Health Dept. demonstrates how use of partner developed communication standards can improve communication satisfaction among groups participating in a coalition.

This health department was able to achieve a 51% improvement in HIV testing rates, which can result in identifying more people with HIV and better, more immediate treatment. In order to reduce redundancy, the QI project team eliminated one of the demographic forms that had been required, saving...

Cabarrus Health Alliance and partners used quality improvement to streamline their processes for referrals for pregnancy care management to improve overall handoffs and cycle times, resulting in more timely and effective referrals for care management to ensure healthier mothers and babies.

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...

Johnson County Department of Health and Environment used a kaizen event to improve the supply ordering process cycle time and increased the order placement and delivery accuracy for all programs in the department. The results included decrease in cycle time – total ordering process time per order...

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...

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...

The local health department noted waning engagement of the coalition working to implement the collaborative 2011 community action plan. Through a PDSA approach they were able to re-energize the coalition by collectively reassessing the community action plan, improving its clarity, re-developing...

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...

A large county health department used effective data gathering, analysis, and interpretation with PDSA to enable increased WIC caseloads that in turn decreased the number of negative health outcomes among low-income mothers and their families who had not been receiving WIC benefits.

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...

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...

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...

It has been shown that home visiting and other supportive services provided during pregnancy improve perinatal outcomes. Sullivan County Public Health Services used QI to improve its internal processes for reaching women with high-risk pregnancies, so more mothers and babies can have healthy...

The Washington state health department conducted a Kaizen event to streamline the application process for HIV positive Washington state residents with low incomes to receive coverage. Multiple improvements were made, several target goals were exceeded, resulting in quicker access to life-saving...

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...

Because surveillance for communicable disease had been provided by the state, the Red Cliff Community health department had limited knowledge of communicable diseases in their community. They used quality improvement to bring communicable disease reporting, surveillance, control and prevention...

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.