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Stories of Measurable Improvement in Public Health


See how health departments around the country, preparing for accreditation or otherwise working toward strengthening their practice, are using QI tools and techniques. This database comprises examples of measurable improvements as a result of implementing QI processes or otherwise preparing to meet accreditation standards and measures.

Disclaimer: This information is intended to assist local health departments (LHDs) by sharing reports of useful practices and other lessons learned from peers. NACCHO does not endorse nor have we evaluated these practices. What works in one jurisdiction may not work in another.

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QI Techniques:
Health Department State Topic Area Outcome
Spokane Regional Health District WA Communicable disease reporting Post intervention results indicate improvements as the overall reporting average of targeted clinics decreased to 9.5 days: 13 of 27 clinics were reporting within the county average, 10 clinics did not meet the 10 day reporting goal and 4 clinics had no reportable cases in the measurement period. Additionally, this effort achieved a 64% increase in the number of clinics reporting within the county average (42% (2010) vs. 69% (2011)). Targeted interventions with clinics can improve reporting timeliness.
Frederick County Health Department MD Flu immunization As a result of changing the appointment scheduling process, the Frederick County Health Department was able to reduce the number of staff required to support appointment scheduling for flu clinics by 86% while maintaining client satisfaction with the scheduling process.
Licking County Health Department OH Service coordination for women eligible for breast and cervical cancer screenings or treatment. The Licking County Health Department was able to increase the successful enrollment rate of the program by 5% and reduce the amount of scheduling activities conducted by staff by 50% as a result of this project.
Davis County Health Department UT Incresing signage for compliance with the Utah Indoor Clean Air Act DCHD was able to increase signage and compliance of county regulated agencies from a baseline of 40% to 80%.
Oneida County Health Department WI Inspections of Tourist Rooming Houses Oneida County Health Department increased TRH inspections by 40%.
Tooele County Health Department UT Internal policy review As a result of the SOP for reviewing policies and procedures, the percent of policies and procedures that were reviewed and updated increased from 6.6% to 56%.
Kane County Health Department IL Immunizations, statistics/data collection As a result of the intervention, the process was improved to eliminate manual statistical collection, and now utilizes a single electronic system of data collection. Vaccine accountability improved from 92% to 100% and has maintained this level of accountability for 4 months. Developers of the computer tracking system have also found the cause of the discrepancy.
Kane County Health Department IL Emergency Preparedness and Response In response to the interventions implemented, Emergency Preparedness now has a 100% accurate list of contact information for staff, a newly developed procedure for call-down drills, and a staff that are more knowledgeable about the process for call-down drills. Results of the interventions revealed an increase in response rates, which average 85% on a monthly basis. It is important to note that staff who are out of the office on the day of the drill (due to vacation or sick time) are not counted toward the total compliance.
Kane County Health Department IL Immunizations, Public Health Nursing Within 5 months of implementing these interventions, the percentage of Public Health Nurses who had reached a level of Competent (Benner Model) increased from the baseline of 25% to 93.33%. All but one nurse had been deemed "Competent" by the Public Health Nursing Supervisor, and specific plans were made to assure that nurse was deemed "Competent." In addition, each Public Health Nurse self-evaluated their skills and was in agreement of the level determined by the Supervisor. As a result of this process, all new-hire Public Health Nurses will use this model when undergoing training, and a modified version of this POD system (an expert is on site for technical assistance, but also provides services) has been implemented with demonstrated success.
Public Health Solutions District Health Department NE Workforce competency As a result of the comprehensive training program, the percent of staff that scored a 100% on the post-test increased from 57% to 100%.
Norton County Health Department KS Reportable disease investigation As a result of the training and presentation of the flowchart of the disease surveillance process, knowledge and understanding of the process increased from 71% to 100%.
Franklin County Health Department KY Repair request process As a result of the streamlined repair process and staff training, staff understanding of the repair request process increased by 61.1% and staff satisfaction increased by 55.5%.
Deschutes County Health Services OR Immunizations As a result of the new courier schedule and additional training and staff, timeliness of immunization data entry increased by 31%.
Comanche County Health Department OK Community engagement As a result of the meeting planning, community sector participation increased from 40% to 70% and meeting satisfaction scores increased from an average of 3.4 to 4.6.
Coconino County Health Department AZ Workforce competency As a result of the training, the number of staff that could correctly identify the 10 EPHS after the training increased from 17.7% to 72.3%.
Central Valley Health District ND Environmental health As a result of the new filing system, the percentage of properly documented sewer inspections increased from 14% to 80%.
Carson City Health and Human Services NV Internal auditing process As a result of the new auditing process, data revealed that 89% of components on the tool passed the audit with only three items remaining in need of change.
Cabarrus Health Alliance NC Verification of qualifications As a result of the educational session, all the managers and supervisors responsible for hiring RNs scored 100% indicating a significant increase in knowledge.
Austin/Travis County Health and Human Services Department TX Internal communications As a result of the dissemination of resource packets, the number of managers and supervisors knowing who to contact when questions arise increased by 6% and there was an 11% increase in knowledge of how to send pertinent information.
Miami-Dade County Health Department FL Clinic wait times After four weeks of the new client scheduling system, the client cycle time greater than 2 hours dropped from 37% to 24%.
City of Portland Public Health Division ME Clinic show rates After eight weeks of implementing the new procedure to update contact information, the no-show rate dropped from 22% to 12%.
Genesee County Health Department MI Staff trainings As a result of the staff trainings, the percentage of undocumented staff trainings in the central training database decreased from 31 to 20. The percent of incomplete entries in the database decreased from 85 to 0.
Levy County Health Department FL Animal bite reporting As a result of the campaign, residents demonstrated an increased awareness of 4 of the 6 key components of animal bite reporting.