Paula Carden

Recently our health department had the opportunity to participate in the QI 101 program offered by the Center for Public Health Quality (CPHQ).  As a health director, I was a bit concerned about the cost of investing in this initiative; but, I soon realized that regardless of the cost, I had to take the risk.  We were at a point where I knew we would either sink or swim; so, I threw the anchor from the boat in hopes that we could at least stay afloat and not drift too far away.

Now, in retrospect, I will have to say this is the single best investment that I have made for this agency since becoming health director.  After making the initial decision to move forward with this project, the most important step in the QI process is to select the right team leader and team.  The second most important part is to empower the team through health director authority to try new steps and procedures while revising and developing new policies to allow for needed changes to move in the right direction.

Admittedly, in the beginning it was difficult for me to relinquish authority to the QI Team; however, after attending their meetings I saw they were headed in the right direction. I quickly determined the best thing for me to do was stand aside and let them run with their ideas. I also learned that the coaching they were receiving from CPHQ was the very best and I had nothing to fear.

My goal for this agency was to identify and remove clinical inefficiencies. I had tried working with the Management Team and staff to address this issue; but, it seemed to be an insurmountable task.  Then, the QI Team along with the guidance of the staff from the CPHQ narrowed down the focus to Family Planning. We narrowed the focus down even more to assessing the clinical flow of new Family Planning patients.

The next thing to happen was the staff and supervisors became involved in the process and staff satisfaction began to improve. Patient satisfaction was already high and there was little or no room for improvement.

The real return on the investment began when the Kaizen event took place. I am not sure how we functioned on a day to day basis with all of the inefficiencies and waste that was uncovered during this event.  We discovered many unnecessary forms (paper waste), equipment, and much more. Supply closets were a disaster and our inventory system was almost non-existent.  The situation with forms was out of control. There were copies of forms in every nook and cranny imaginable – new forms, old forms, outdated forms, etc.  For me and the staff, we saw the investment in the QI project pay off by identifying all the waste due to the problems listed above. 

For now, we are continuing to work on clinic flow in other clinics, but the processes are all being evaluated. We have reduced initial Family Planning visits by 30 minutes; decreased the non-value added forms; and, increased staff satisfaction by 25%.

Just a few highlighted improvements made are:

  • Streamlined the registration process
  • Defined staff roles and responsibilities
  • Assigned RN’s to provide services in the exam room
  • Redesigned exam rooms for continuity
  • And finally my favorite  we began using “5S” (a workplace organization process) for the inventory supply closets and clinic forms

In dollars and cents, the reorganization and inventory of the supply closets have already saved $11,923.  At the end of this budget year we will see even a greater savings.   The streamlining of patient flow and staff time saves us $19,427 per year.

I cannot put a real dollar figure on the team building and overall staff satisfaction that has been accomplished. It is of great comfort for this health director to now know that time and supplies are not being wasted while the staff is providing the highest quality services.

So, the anchor is back in the boat with the life jackets – I don’t think we will need either. We will maintain our course because his investment has given us the tools needed to continue to achieve more quality improvements in an ocean that has many high tides.

Paula Carden
Health Director, Jackson County Health Department


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