Improving VFC and AFIX Site Visit Efficiency


Impact Statement: 
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 forms, one local health department implemented tools from lean six sigma and PDSA methods to increase efficiencies in its immunization program. The time saved amounted to a cost savings of $79.16 and a total time savings of 1.121 hours per visit.

Initially, the Whatcom County Health Department (WCHD) team conducted a detailed review of the Vaccines for Children (VFC) compliance and Assessment, Feedback, Incentives, and eXchange (AFIX) site visit process flow that identified redundant and inefficient steps, including internal tracking forms and an optional individualized summary letter that was given to each provider clinic after its VFC or AFIX site visit. Several potential solutions were identified, including using laptops during the VFC and AFIX site visits, creating an electronic system for on-site reporting to VFC clinic staff and the Washington State Department of Health (DOH), and completing the provider summary reports in the field rather than at the office. Completing these reports electronically eliminated the need for printing, copying, and mailing them to DOH and the clinic. Pre– and post–VFC and AFIX site visit and process times were calculated for each public health nurse. The results showed that for the VFC site visits, the average visit and process time was reduced from 7.25 to 6.71 hours, thus saving 0.54 hours per visit. In addition, a gain of 0.67 hours of staff time was achieved because printing, copying, and mailing of VFC reports were eliminated. Overall, using field computers during the provider VFC site visit provided modest cost and time savings in reporting findings to providers and the DOH. Pre– and post–AFIX site visit and process times remained the same. In addition, the immunization program’s internal forms were reviewed. Because several forms contained redundant information, all were eliminated, and one VFC and AFIX site visit tracking form was developed.

Organization that conducted the QI initiative: 

Simmons, A. Public Health Quality Improvement Exchange. Improving VFC and AFIX Site Visit Efficiency. Fri, 02/27/2015 - 12:39. Available at Accessed July 25, 2024.

Submission Status: 
1 user has voted.


Submitted by ahayes on

This is a great example of QI within the VFC program. I have heard from many in Washington State (including myself) that the assistance provided by the Centers for Excellence has been invaluable to quality improvement efforts. I am excited to hear more about your progress.

0 users have voted.

Alexandra Hayes, MA. LSSGB

Submitted by mthorne on

This is a great project! I NEVER would have thought of doing QI on a CDC required task.  Your process flow sheets ALONE will help my staff better understand the process to go thru and help me train new staff more easily.  Thank you for all your documents.

Michelle Thorne

0 users have voted.

Submitted by asimmons on


I am delighted that the flow sheets and project will be beneficial for your program. Thank you for your comments!

0 users have voted.
Link to the resource where this submission is also published: 
This submission is not published elsewhere on the Internet.