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

A state health department used LEAN tools to improve customer service by streamlining the process for reviewing licensure applications for residential facilities, reducing the average time from 50 to 17 calendar days.

Three counties in central Oregon, Crook, Deschutes, and Jefferson, were faced with rates of only 60%–70% of 2-year-old children having received all recommended vaccinations. The counties used QI methods; elected to implement an evidence-based process, AFIX (Assessment, Feedback, Incentives,...

The Wyoming Department of Health discovered a low rate of screening of Ryan White clients (RWCs) for STDs and hepatitis. Staff did a series of rapid PDSAs to improve the rate of screening and detection, and they are continuing to test further modifications to obtain even better results.

The Maricopa County Department of Public Health (MCDPH) SNAP-Ed (Supplemental Nutrition Assistance Program–Education) team used rapid-cycle PDSA to make the school lunch “plate waste” process more efficient and more accurate and updated it to cause the least disruption to the students and staff.

Using a QI process, the Mercer County Health Department significantly increased the number of survey responses from its customers. This feedback is used to help identify areas for improvement and thus is an important part of the health department's strategy to apply QI to its operations.

The number of flu vaccines provided by Cerro Gordo County Department of Public Health (CGCDPH) has risen greatly, with many flu vaccination sites around the rural county. As the number of vaccines rose, the ability to enter the vaccines into the state immunization registry fell, and 57% of flu...

The Cerro Gordo County Department of Public Health (CGCDPH) used PDSA to improve its process for applying for grants and involving all staff in understanding the process.

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.

Using a PDCA approach, the Philadelphia Department of Public Health (PDPH) achieved a more efficient process for onboarding new employees. The amount of paper used went from 136 pages to 16 pages, an 88% reduction. The mean monthly staff time dedicated to the onboarding process dropped from 653...

Maricopa County Department of Health (MCDPH) used QI methods to achieve a 90% decrease in callers to the health department who selected the "zero-out" option (transfer of call to a live operator), thereby freeing staff time to focus on other projects and ensuring that more callers quickly...

Charting errors increased in Scott County Health Department's (SCHD's) STD clinic when a new electronic database was introduced. Anticipating the transition to the new database, the STD team implemented a QI effort to identify and correct problems with the charting process before they...

Tarrant County Public Health’s (TCPH’s) North Texas Regional Laboratory (NTRL) decreased the cost of a specific HIV test by 40% by testing and adopting an alternative control test method. NTRL has received level funding for a few years while laboratory expenses have continued to grow. Achieving...

The Boston Public Health Commission worked across departmental areas to improve the invoice payment process for their vendors. Timely payment contributes to improved relationships with these partners to collectively meet the community's health needs.

Lake Cumberland District Health Department (LCDHD) in Kentucky receives grant funding for several program activities, and staff realized that it was not unusual for different divisions to apply for the same grant. A QI committee used QI tools to address this issue. New policies and procedures have...

Butte County Public Health Department (BCPHD) in California used QI to expedite the annual medical review (AMR) process for eligibility into the California Children's Services (CCS) program. More children and their families now have improved access to these specialty health care services.

Kendall County Health Department implemented successive PDSA cycles to better protect their population from West Nile Virus. The QI activities eventually led to a nearly 200% increase in the number of mosquito tests performed. Moreover, the implementation of a GIS management system has led to...

Kane County Health Department (KCHD) in Illinois increased staff knowledge of the Emergency Operations Plan (EOP), which improved timely response to emergencies and protection of county residents.

Deschutes County Health Services (DCHS) streamlined the referral process for its Nurse Family Support Services(NFSS) and Oregon MothersCare (OMC) programs. Staff satisfaction with the process has improved and program clients are now more efficiently being served.

Washington County Department of Public Health and Environment led a multi-sector quality improvement project and increased the recycling rate at a county park. Expansion of this model to all county parks will further protect the environment and contribute to Minnesota's statewide goal of a 75...

Through a series of PDSA cycles, a division of the Boston Public Health Commission increased staff knowledge of ongoing program updates from 69% to 86% (a 25% increase).

By improving the perceived value of staff meetings, the Boston Public Health Commission can be more effective in its role to advance population health.

Customer satisfaction is key to any health department, and ensuring new employees’ satisfaction is no exception to this tenet. Deschutes County Health Services (DCHS) achieved tremendous success in orienting and onboarding these important “internal” customers through a comprehensive process that is...

Cecil County Health Department (CCHD) redesigned the onboarding process for new staff. As a result, most new staff reported that they understand their role at CCHD and found the onboarding process to be informative and useful. Onboarding education can improve staff members’ ability to meet...

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.

Oneida County Health Department’s (OCHD’s) QI team increased QI project submissions from staff, thus strengthening ongoing performance improvement in the agency.

By using the Six Sigma DMAIC method, Lake County Health Department streamlined their billing process for the Dental Program. This change resulted in a significant decrease in lost revenue, from an average of $5,354 per quarter down to an average of $2,076. The quarterly losses decreased steadily...

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.

Cerro Gordo County Department of Public Health (CGCDPH) worked to improve immunization rates for both types of pneumococcal vaccine recommended for seniors. Through a multifaceted approach that emphasized increased awareness of the vaccine, CGCDPH raised the rate of immunizations with the newest...

By using Kaizen, Cabarrus Health Alliance (CHA) in North Carolina reduced food establishment violations by 22% and further protected residents from foodborne illness.

The Tarrant County Public Health (TCPH) Tuberculosis (TB) Division in Texas improved completion rates for latent TB infection (LTBI) treatment focusing on three targeted populations: homeless shelter residents, refugees, and people exposed to TB cases. Quality improvement of the process and a new...

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.

Developing effective public health communications via social media is very much a work in progress. One critical success factor is the ability to converse with a broader audience and to create messages that allow interaction between the messenger and the audience. During the test phase of Kane...

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.

Working together, the Tulare County Public Health Department’s tuberculosis (TB) team and nurses increased the on-time completion rates from 80% to 100% for referrals of suspected TB cases. The QI project resulted in a newly defined and consistent work process that improved communications and team...

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....

This medium-size local health department improved and standardized the effectiveness of environmental health (EH) plan reviews for new restaurant establishments. The QI team used Kaizen and Lean Six Sigma methods and tools to successfully reduce the EH plan review approval time frame from 30 days...

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.

The Stratford Health Department’s aim was to ensure that at least 75% of faith-based organizations (FBOs) were licensed, so they could provide food during public events throughout the year and minimize the risk of food-borne illness. While working through their QI planning project, staff fixed a...

In becoming ready for PHAB accreditation, the City of St. Louis Department of Health’s performance management team used quality planning to create, test, and install a performance management system. The process included a fishbone diagram of the barriers to a culture of quality, an affinity diagram...

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...

Communicable disease (CD) follow-up: Staff let their fingers do the walking using social media to significantly improve the timeliness and effectiveness of client contact and case completion procedures for CD clients.

Henry County Health Department’s (HCHD’s) strategic plan included addressing employee turnover and job dissatisfaction. Employee turnover and job satisfaction are related to how confident an employee feels when starting a new position, which links back to the effectiveness of the orientation...

The health department improved the process for tracking data requests from internal and external partners. The interventions made the staff more aware of the tracking process and offered education on the use of the Access database. The results included greater use and an increased number of staff...