WIC Immunization Referral Process

Participation in video clip viewing declined over time. Computer hardware programs were a barrier to all staff having the opportunity to view video clips. Distribution of vaccine quick reference sheet was not widespread 176 clients were seen by WIC staff during the 1 month of data collection. 111 (63%) were deemed eligible for vaccination. 70 (63%) of the 111 clients indicated willingness to receive vaccines. 77% of those were successfully vaccinated. A attempt to survey those who failed to receive vaccines failed, because clients were difficult to reach via phone calls.

As a result of the initiative, we have continued to review MCIR data on every child arriving for a WIC visit who in not up to date in the Michigan WIC system. WIC clerks took responsibility for printing the MCIR sheets for each client who were determined to be not up to date or eligible for immunizations. The need for organizational restructuring was partially based on the clear barriers illustrated through this process. Improved familiarity between programs has fostered cross-training between departments, which is inherently important in a diminishing work force.

The tools and strategies learned from the MLC-3 process have greatly contributed to improved teamwork and collaboration of St. Clair County Health Department. Many barriers were broken down in a very short time, and the need for further workgroups was enthusiastically embraced. Administration has a well-defined process to apply to areas needing improvement and a core team has been trained to develop and maintain this process. Like a central core of a wheel, the spokes that represent each participant will radiate out to other areas they interact in. In this way, the whole “wheel” becomes stronger and faster. A difficulty identified in this initiative was the significant problem with staff participating in meetings, teleconferences and webinars due to the inflexibility of schedules. This likely will remain a significant barrier. Particular resistance was noted in the WIC supervisory staff due to the success of the WIC program—change was rebuked as the program was performing well prior to the initiative.

WIC clerks will pull MCIR assessments for all WIC infants and children determined to be either eligible or not up to date who are presenting for service. A WIC staff person will review MCIR findings with the client and refer to immunizations for service that day. Close communication will be maintained between divisions to facilitate expedient client service, particularly during lunch and at the end of the day. Infant/child immunization rates will consistently be reviewed during WIC and Nursing Division staff meetings. Video clips as an educational tool will be utilized again with format changes and equipment updates. Identify alternative WIC staff person (dietitian) to review MCIR data in absence of WIC clerk-tech. The team celebrated its success! Project team members were “gifted” with scientific method t-shirts from Dr. Mercatante. Project team members all believed the project was a great opportunity to “walk a mile” in a co-worker’s shoes and gain respect and appreciation for each others’ roles in public health service delivery. Plans to share with Board of Health, Board of Commissioners and other HD staff: Project information was shared at annual staff training in September 2010. Special recognition was given to project team at staff development event in December 2010. Administration plans to share information on the project with the Board of Health and the Board of Commissioners. Selected team participants will lead future QI projects. Plans for future projects: Administration has selected another project for QI, and team member selection is under way. Plans to sustain QI efforts: A designated QI coordinator will be identified with duties assigned. QI will be integrated into health department operations and will become a routine activity for staff. It is administration’s goal to eventually involve all health department staff in the process by rotating the projects throughout all divisions. A multi-divisional approach will be utilized to create unity and heighten awareness among all staff of each other’s role in providing service.