Cabarrus Health AllianceWIC LEAN KAIZEN EVENT

QUALITY IMPROVEMENT PROJECT2010-11

TEAM MEMBERS

Sponsor/Champion

1. Cappie StanleyCross-functional Representatives

6. Betty Braxton, HR7. Bobbie Rowe, Clinic8. Cindy Walker , Clinic9. Julie Hurt , Regional

Consultant10.Tammie Harkey,

Finance

WIC Stakeholders

2. Flor de Liz Bustos3. Kathleen Tucker4. Regina Kurtz 5. Susan Anderson

WIC AIM STATEMENT• The Cabarrus Health Alliance WIC clinic will make major improvements in access and

efficiency for our participants while at the same time improving staff satisfaction. We will continue to improve our open access scheduling system over the next year by identifying processes that will eliminate unnecessary delays in the system and benefit our participants and staff. The goals we hope to reach by [March 31st, 2011] are as follows:

• Increase participant satisfaction to 96% or higher – Baseline: 89%• Keep appointment availability to 0 days by making 100% of participant visits same

day access • 90% of staff strongly agree they would recommend our WIC department as a great

place to work – Baseline: 75% agree, 19% strongly agree• Increase staff satisfaction to 85% or higher– Baseline: 69%• At least four full-time WIC staff will be formally trained in the Kaizen quality

improvement process.

Rev 12.10.2010

Rev 12.10.2010

PDSAsWIC Kaizen Event

Model for Improvement Objective for this PDSA Cycle: To test the effectiveness of placing a receptionist in the WIC lobby to route traffic, instruct clients, answer question and distribute paperwork. PLAN: To modify flow to positively impact waiting and efficiency Questions:

1. What would be the receptionists role 2. What would be the receptionists responsibility 3. What will be clients’ response? Will they ask receptionist questions?

PREDICTIONS: 1. Reduce cycle time by 15-20% 2. Help Nutritionists and Clerks 3. Decrease staff interruptions (traffic at window, traffic in clerk area from other staff, etc.) 4. Increase staff satisfaction 5. Increase client satisfaction 6. Push participants through as opposed to pulling them PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Flor will set in WIC lobby 9:30-11:00 a.m. on January 6, 2011 to test out the need for and reaction to this person. PLAN FOR COLLECTION OF DATA: WHO, WHAT WHEN, WHERE: 1. 9:30-10 a.m. 2. Flor will have sign in sheet, tablet computer, walkie talkie and wireless headset. 3. She will also have WIC forms and clip boards and pencils and buzzer 4. She will record number of clients checked in, time check in and time sent to next available clerk,

number and type of questions from clients who have appointments, number and type of questions from walk-ins without appointments. Will measure cycle times also.

5. Will huddle at 10:00 a.m. to get report of first half hour experience DO: CARRY OUT THE CHANGE OR TEST: COLLECT DATA AND BEGIN ANALYSIS. January 6—Flor was stationed in the front WIC lobby from 9:40-10:30 a.m. She registered 15+ participants. She answered questions from walk-ins. She prepared the participants purple folders for the next step in the process. She recorded information on the controller slip and she collected PDSA data. STUDY: COMPLETE ANALYSIS OF DATA: SUMMARIZE WHAT WAS LEARNED. Results yielded that the WIC Receptionist position should have the following duties:

a) Income card when required b) Distribute appropriate questionnaire c) Initiate and complete controller slip d) Verified Demographics (name, address, phone, etc.) e) Verified WIC wallet/Medicaid

Cycle Time prior: 72 minutes Cycle Time Post Kaizen: 54 minutes Improvement: 25% change / Wait steps reduced from 5 to 1 (see value stream flow map) ACT: ARE WE READY TO MAKE A CHANGE? PLAN FOR THE NEXT CYCLE. Continue with the receptionist located in the WIC lobby for 1/6/11 PM and 1/7/11 AM and evaluate. Discuss with WIC staff and decide if receptionist is assigned fulltime 1/10/11 thru 1/14/11.

WIC Kaizen Event

Model for Improvement Objective for this PDSA Cycle:

1. Modify Open Access appointment scheduling to accommodate special subset of participants with school/work or called 3 days/busy. Frustrated caller—unsuccessful attempts, students and some working people.

2. To reduce calls by pre-scheduling classes and pick up only

PLAN: To modify Open Access Scheduling Questions:

1. How do we know which participants qualify for modified open access? 2. How do we qualify them? 3. What questions do we ask to qualify? 4. How many slots to save? What type? 5. How far out do we open them?

PREDICTIONS: 1. Improve satisfaction and decrease complaints amongst staff and participants 2. Improve accessibility 3. Decrease call volume PLAN FOR CHANGE OR TEST: WHO, WHAT, WHEN, WHERE Thursday, January 6 8:30-9 a.m.—WIC clinical office, 6 or 7 phone operators Susan pulled to help with questions PLAN FOR COLLECTION OF DATA: WHO, WHAT WHEN, WHERE: 1. Develop criteria questions 2. Train staff on questions and how to do alerts 3. Determine schedule for Friday, January 7, 2011 4. When do we qualify – every time – who? DO: CARRY OUT THE CHANGE OR TEST: COLLECT DATA AND BEGIN ANALYSIS. Attempted January 6 morning, established standard work questions and re-ran it on Friday, January 7, 2011 STUDY: COMPLETE ANALYSIS OF DATA: SUMMARIZE WHAT WAS LEARNED.

a) Thursday, January 6 – Added 4 non-nutritional appointments for Friday. Appointment filled up at 9:06 a.m.

b) Friday, January 7 – Added 4 non-nutritional and 4 nutrition appointments for Friday and 4 for Monday.

c) Appointment filled up at 9:04 a.m. but were still taking calls at 9:45 a.m. ACT: ARE WE READY TO MAKE A CHANGE? PLAN FOR THE NEXT CYCLE.

Still in pilot mode. Need to try again Monday. Need to work on how to transition from taking phone calls to handling participants already in

building. Need to look at when we stop documenting calls for when “no appointments” are available – or

do we just continue?

Receptionist Area

• To test the effectiveness of placing a receptionist in the WIC lobby to route traffic, instruct clients, answer question and distribute paperwork.

• Equip area with supplies– flu mask, forms, phone, desk, chair, computer,

walkie-talkie, hand sanitizer (non-alcoholic),etc

Receptionist Area (cont’d)

• Clerical staff decided to keep “receptionist” position inside the issuing area to allow that person to be more flexible in their duties.

Scheduling

• Modify Open Access appointments to accommodate a special subset of participants with school/work or transportation issues

• Pre-book class appointments• Pre-book appointments for people with

special problems

Scheduling• For the last 9 weeks there have been open

appointments every day. • When appointments have been filled in

Kannapolis and there are available appointments at Logan, the participant is offered the choice to go there.

• XOAW appointments for each of the pick-up weeks for each of the 3 cycles in Kannapolis being reviewed to see exactly how evenly spaced out the appointments are.

WIC AIM STATEMENT• The Cabarrus Heath Alliance WIC clinic will make major improvements in access and

efficiency for our participants while at the same time improving staff satisfaction. We will continue to improve our open access scheduling system over the next year by identifying processes that will eliminate unnecessary delays in the system and benefit our participants and staff. The goals we hope to reach by [March 31st, 2011] are as follows:

• Increase participant satisfaction to 96% or higher – Baseline: 89%; Post: 95.5%• Keep appointment availability to 0 days by making 100% of participant visits same day

access Met• 90% of staff strongly agree they would recommend our WIC department as a great place

to work – Baseline: 75% agree, 19% strongly agree;

Post: 53% agree, 16% strongly agree• Increase staff satisfaction to 85% or higher– Baseline: 69%; Post: 60%• At least four full-time WIC staff will be formally trained in the Kaizen quality improvement

process. Met

NewsPaper Action Items

• Cycle time, completed • Revise WIC Instruction Wallet, completed• Update WIC on Cabarrus Health Alliance

Website, completed• Improve website to be more informative,

more inactive, prettier, more language friendly, and income calculator, questionnaire and forms, completed in English

NewsPaper Action Items

• Data (cycle times, customer service) ongoing• Create scripts and train staff on to use the

appointment process, completed• Review with staff the confidentiality/HIPPA,

completed

Next Steps• Dedicated vitals staff• Cross training of staff throughout the WIC

dept.• Signage to assist participants and staff with

the flow• Evaluate appointment mix• Evaluate contingence plan• Investigate flex staffing and rolling morning

starts