Health Services Internal Referrals

The three programs simultaneously engaged in Plan, Do, Study, Act (PDSA) cycles for this QI effort. Staff members in each program began by using a 5-Whys tool to determine the root causes of the low internal referrals. The 5-Whys tool was followed by a flowchart to determine how and where within a typical appointment a staff member could refer a potential client and by brainstorming potential ideas and theories to increase internal referrals. The current/future state was used to identify all of the current issues and to determine potential solutions (e.g., from "WIC not telling WIC Clients to bring records" to "WIC has a successful system for getting clients to bring records or allow access"). The QI team members in each program then chose the solutions they believed would be most effective and created a plan to implement them. The QI team also developed a plan to collect data on the number and type of referrals made across all three programs. A draft protocol for each program was developed and shared with program staff. The protocols were easy and fast, and they entailed universal offering of services to all clients, thus addressing the root causes. The protocol was implemented for 1 month, after which data were collected and analyzed.

The QI team recorded the number of documented client referrals among OPC, MCH, and WIC and recorded baseline (pre) and post-data to determine whether improvement occurred.