Improving the Paperwork Process for Rabies-Susceptible Animal Bites

Summary

Impact Statement:

When a rabies susceptible animal has bitten a human, it is imperative that health departments responsible for the investigation and quarantine of these animals respond a timely manner. A local health department in Oregon used a PDSA approach to reduce the time to process rabies bites reports by 29%, saving about 30 hours each year and improving employee morale in the process.

Summary:

Marion County Environmental Health, in Oregon, investigates and quarantines rabies-susceptible animals that have bitten a human. The investigation and quarantine process has multiple steps, and the paperwork responsibilities involved have been assigned to three support staff members. When these staff members examined the possibilities of a quality improvement (QI) project, they believed that the main problem they all wanted to tackle was reducing the time it took to process the animal bite paperwork. As a team, the Environmental Health staff used a workflow tool, which had a minimum of 10 steps to complete the process for each animal bite. Next, the staff asked themselves how much time it takes to process the paperwork. In the baseline study, each step was timed and recorded to understand which step might have the greatest benefit if an improvement was instituted. The next step was to do a cause-and-effect analysis. The team chose to use a fishbone diagram. After that step, the team redefined its original aim statement. The statement was tested, and staff were able to reduce the time by 29% using the same time study method. The side benefits included better staff morale, less stress, a more efficient work environment, and better customer service. On the basis of the number of animal bites in 2013, the team saved a grand total of 29.62 hours per year.

Organization that conducted the QI initiative:

Marion County Health Department

Citation:

Stegall, C. Public Health Quality Improvement Exchange. Improving the Paperwork Process for Rabies-Susceptible Animal Bites. Thu, 11/12/2015 - 11:05. Available at https://phqix.org/content/improving-paperwork-process-rabies-susceptible-animal-bites. Accessed October 5, 2024.

Background and Aim

Aim statement:

Initially, the aim statement read, "If we improve the completeness of the paperwork received on rabies-susceptible animal bites, we can reduce the time to process the reports by 10%." It soon became apparent that this aim statement could be successful only if the team could control which staff member filled out the paperwork, which could not be done. After using some tools to clearly define the problem, the team developed a final aim statement: "If the support staff have equally shared responsibilities and designated, uninterrupted time, we can reduce the time to process rabies-susceptible animal bites by 10%."

Need For The QI Initiative:

The initial idea for a QI initiative was born out of the frustration of support staff in the Environmental Health office. These staff members felt pressure to complete paperwork for rabies-susceptible animal bites but believed that they did not have the time to do so. The support staff had approached the professional staff to review the written policy and ensure that it was complete. Marion County Health Department emphasized the importance of involving support staff in QI initiatives, and this appeared to be the perfect opportunity for that. As a team, staff decided to apply QI principles to assess the process instead of assuming that the process was appropriate and complete. They reviewed the current process and became committed to improving it through a QI initiative.

Area for Improvement:

Oregon Revised Statute 433.345 states, "If an animal bites a person and the bite causes a break in the skin, or if an animal is suspected of rabies or has been in close contact with an animal suspected of rabies, the facts shall be immediately reported to the local health officer by any person having direct knowledge." In Marion County, staff had to follow up on 686 animal bites in 2013. The follow-up affects all Marion County citizens because staff continually monitor the county for rabies through the follow-up process and are able to administer prophylaxis in a timely manner as needed.

Root Cause:

The root cause was time. Because work was not equally shared, and there was no uninterrupted, dedicated time to complete the necessary paperwork for rabies-susceptible animal bites, all support staff were frustrated.

Planning and Execution Details

QI Implementation:

The team took the following steps to implement the QI initiative: 1. Working on the flowchart with all staff helped to ensure that each step was identified and included in the problem. 2. The time study was very important in helping staff to determine the current state of the process and to understand how to measure improvement. 3. The fishbone diagram helped with cause and effect and was useful in taking personalities out of the situation. The team's fishbone diagram consisted of four areas (causes): people, guidelines, time, and paperwork. Everyone was given three sticky notes, and the fishbone diagram was placed in the break room. Everyone had to identify a possible reason for why so much time was spent on the animal bite paperwork. It was stressed that this activity was about a cause, not about an individual. When the fishbone diagram was complete, staff reviewed the suggestions and categorized them into similar comments. Time became the cause but not in the way some expected. Staff believed that if they could control the time allotted to complete the paperwork, they could control the overall time spent. 4. During the test phase, the support staff created a rotation schedule based on the three employees, so each staff member had "animal-bite duty" every fourth day. When the staff member was on "animal-bite duty," he or she was given dedicated time to make any necessary calls. The dedicated time was announced with a sign that said the staff member was busy with animal-bite paperwork. When the sign was displayed, the staff member was not expected to answer phones or help at the front counter. Before the process change, staff members would try to work in the phone calls and follow-up with multiple interruptions from other staff or people at the front counter. The time was not quantified because the staff member could not predict how many animal bites he or she might be responsible for on any given day, but everyone respected the time needed to complete the task. The simple step of dedicating time to animal-bite paperwork took an enormous amount of stress off the support staff. The front staff responsible for processing the paperwork were the first people affected, so they were able to contact the victim of the animal bite in a timely manner.

Focus activities

Data collection, Epidemiology and Surveillance:

Environmental health

Other Environmental Health Services:

Animal control

Other Public Health Services:

Animal control

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Initiative Dates:

1/28/14

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Time was the measuring stick, and the team would reach its goal if it could reduce the time by 10%. The team started with a baseline of 8.86 minutes, so a 10% reduction would mean that the process would take 7.97 minutes or less. The second time study was done after the initiation of equal distribution of work among staff and uninterrupted, dedicated time to finish the paperwork. For both time studies, the different sequences were timed and recorded.

Other Information:

Lessons learned and extra benefits to using the QI process were as follows: (1)The problem is not always what you think it is. (2) Jumping to conclusions can sidetrack improvement. (3) It was hard for some staff not to take things personally. Staff began the process expecting to develop a better form for victims of animal bites to fill out, but by sticking to the process and not trying to "put a band-aid" on the problem, they reached a solution that made a vast improvement to the process.

Improving the Paperwork Process for Rabies-Susceptible Animal Bites

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

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Improving the Paperwork Process for Rabies-Susceptible Animal Bites

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight