Ann Absher

Fortunately, Wilkes County Health Department was an early adopter of Quality Improvement. My background and previous experience included Quality Improvement in a hospital and home health setting so early in my public health experience I could see benefits from implementing these initiatives. Thanks to the NC Center for Public Health Quality for training and expertise and we have teams that participated in three Lean Kaizen events.

Our first Kaizen event allowed us to improve the visit process in our clinic for adult health patients to reduce wait times and the overall visit time (“value-added” time versus “nonvalue-added” time).  This was not an easy task since our adult health clinic consists mostly of uninsured patients who postpone health care until he/she has several chronic diseases all needing immediate attention by the time the patient presents to our clinic.  This event, through data collection and analysis, allowed us to realize these patients always need more than a 15 minute visit so trying to squeeze the patient into this time slot created a backlog for the provider even though we used other staff to expedite the other processes of the visit.   Thus, we were able to create a schedule that allowed longer visit times for these complex patients.  The result decreased patient wait times and provider frustration with always being behind on the schedule, missing lunch and leaving late.  It is still a challenge, but we are constantly conducting small PDSA cycles to improve this process.  Balancing scheduling with no-show rates and complex patients keeps us on our toes but now we know we have a model for making improvements.  My background from the hospital was the Juran Method which is very detailed and time consuming, so using a simple model like the Model for Improvement has intensified our efforts and given us greater success.   Testing small changes are more acceptable to staff, so the engagement process has improved.   Also, we do not waste time or resources implementing a big change to realize six months later this change has not produced the desired effect.

Our next Kaizen event allowed us to streamline work processes for Management Support Staff when we knew we were losing several staff members through retirement and we would not be allowed to re-hire all of the positions.  It is amazing how much managers can accomplish when we include those doing the work!  The end result allowed us to restructure job duties and positions to accommodate this county mandate successfully.  Several staff employees were reassigned to very different job functions so we were able to use strengths we did not realize we had until we performed this Lean Kaizen event.  We are still fine tuning with each resignation and/or retirement.   Most employees want to stay busy and do meaningful work.  There are always opportunities for creating efficiencies.

We were fortunate to be chosen to participate in a Kaizen event with the Children and Youth Branch at DPH to implement Bright Futures.  With our previous experience under our belts, we were delighted to be a leader in this project with the Children and Youth Branch.  Using the Model for Improvement, we decreased our lead time significantly during the implementation process. 

As we move forward in our health department, we already have a Quality Council, but we are balancing including supervisors and our staff who do the work in the health department as representatives on the Council.  I want this to be a decision-making and data-driven group that evaluates our current activities while encouraging new projects.  As we look to the future of Public Health, we know we must become more efficient and outcome-oriented.  What is the value of Public Health in our community?  I am counting on the Quality Improvement Model for Improvement, Kaizen Lean initiatives and the Center to assist us to achieve this important answer.

Ann Absher, RN MPH
Health Director, Wilkes County Health Department


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