2. GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT Where the “WIC” Things Are WE HAVE SOLUTIONS!!!

3. THE QUALITY IMPROVEMENT TEAM CORE TEAM MEMBERS: DEBORAH GRIFFIN, RN, CARE MANAGEMENT CASEY CHAMPION, REHS - ENV. HEALTH LOU ANN ELAM, RN - CLINIC NURSE BILLIE JAMES, MANAGEMENT SUPPORT LAUREN FAULKNER, WIC NUTRITIONIST SHASHEENA ATKINS- HEALTH EDUCATOR HEALTH DIRECTOR – LISA M. HARRISON AD HOC MEMBERS – MESINA REDDISH, WIC SUPERVISOR WENDY MILON, WIC STAFF SPECIAL ADVISOR - JAMES GOOCH, DRPH

4. WHAT WE NEEDED TO CONQUER LONG WAITING TIME FOR WIC CLIENTS PERIODS OF “DOWNTIME” FOR WIC STAFF IMPROVING CONFIDENTIALITY FOR WIC AND CLINIC CLIENTS INADEQUATE PHONE SYSTEM IN WIC OFFICE LACK OF ACCOUNTABILITY FOR HANDLING OF PHONE MESSAGES FLAWED FLOW PATTERN TO THE VISIT…EXCESSIVE WALKING BETWEEN CLINICS 3

5. OUR AIM… TO IMPROVE THE OVERALL WIC EXPERIENCE FOR THE WIC CLIENT AND WIC STAFF. THIS WILL BE ACCOMPLISHED BY INCREASING THE EFFICIENCY OF THE VISIT AND ENHANCING STAFF PRODUCTIVITY. WE WANT TO ELEVATE THE CLIENT AND STAFF SATISFACTION WITH THE MANNER IN WHICH SERVICES ARE OFFERED.

6. OUR GOALS DECREASE OVERALL LEAD TIME FOR WIC ASSESSMENT DECREASE OVERALL CYCLE TIME FOR WIC MEASUREMENTS DECREASE THE NUMBER OF STEPS STAFF TAKE TO RETRIEVE CHARTS. INCREASE RATE OF RETURN CALLS BY WIC STAFF IMPROVE WIC CLIENT SIGN-IN PROCESS IMPROVE CLIENT SATISFACTION WITH THE WIC VISIT IMPROVE STAFF SATISFACTION 5

7. OUR JOURNEY TO THE SUMMIT … OUR JOURNEY TO THE SUMMIT …

8. KAIZEN EVENT RESULTS OUR FOCUS: IDENTIFYING A SPACE IN AN ALREADY SMALL HEALTH DEPARTMENT TO CREATE A SPACE FOR WIC TO DO THE HEIGHT AND WEIGHT ASSESSMENTS. 7

9. KAIZEN EVENT RESULTS OUR ACCOMPLISHMENTS:  IDENTIFIED A SPACE FOR WIC TO MOVE THE ASSESSMENT EQUIPMENT BUT HAD TO WORK OUT DETAILS.  INTRODUCED A NEW “FLOW” PATTERN FOR CLIENTS TO SIGN IN THAT DECREASED STEPS FOR THE CLIENT.  ADJUSTMENTS MADE TO THE WIC PHONE LINE UNTIL FUNDS CAN BE APPROPRIATED TO UPDATE PHONE SYSTEM, A BILINGUAL MESSAGE ADDED.  COLLABORATED WITH MANAGEMENT SUPPORT IN DEVELOPING A PLAN THAT ALL CHARTS PULLED FOR WIC ARE ACCOUNTED FOR AT THE END OF EACH DAY.

10. PROJECT MEASURES PROJECT MEASURES  DECREASED LEAD TIME FOR APPOINTMENTS  IMPROVED PROCESS FOR OBTAINING CHARTS THAT IMPROVED EFFICIENCY OF WIC STAFF.  IMPROVED STEPS FOR CHART RETRIEVAL AND RETURN RATE. BEFOREAFTER

11. KEY IMPROVEMENTS Telephone with a new second line with rollover and a bilingual message Filing Cabinets Charts pulled daily and put in portable box New Sign In Process Old Sign In Process Old Height & Weight Room shared with Clinic Nurses New Height & Weight Room next to WIC The New Signal Process

12. WHAT WE LEARNED OUR “AHA” MOMENTS OUR CHALLENGES THE WILLINGNESS OF OTHER EMPLOYEES TO ADAPT TO CHANGES BROUGHT ABOUT BY OUR PROJECT. WIC HAS A SMALL SPACE TO ACCOMMODATE A LOT OF PEOPLE. QI AND ACCREDITATION PROCESSES COMPLIMENT EACH OTHER. OUR PDSA’S OVERLAPPED AND REQUIRED GOOD COMMUNICATION TO ENSURE OUTCOMES. TEAM DYNAMIC BROUGHT MUCH EXPERIENCE, UNDERSTANDING AND APPRECIATION. H.D. STAFF ASKING WHAT WE WERE DOING NEXT! TIME, TIME, TIME ROLLING WITH RESISTANCE COMMUNICATION- MAKING SURE THE MESSAGE IS DELIVERED. CULTIVATING THE QI CULTURE AND INTERSPERSING IT THROUGHOUT THE HD WITH SUCCESS 11

13. GRANVILLE VANCE DISTRICT HEALTH DEPARTMENT RETURN ON INVESTMENT (ROI) TANGIBLES AND INTANGIBLES OVERALL IMPROVEMENT OF WIC VISIT CYCLE TIME IMPROVED LEAD TIME IMPROVED BY 30.7% AS A RESULT IMPROVED FLOW OF WIC CLINIC INCREASED CONFIDENTIALITY TO WIC CLIENTS POTENTIAL TO ADD TO WIC CLIENT-BASE INCREASED CAPACITY TO GROW WIC PROGRAM NO ADDITIONAL COST TO WIC PROGRAM TO INCREASE CAPACITY POTENTIAL QI PROJECT TO IDENTIFY MARKETING STRATEGIES TO REACH POTENTIAL CLIENTS IMPROVED PRODUCTIVITY TIME SAVING PRACTICES ENHANCE STAFF PRODUCTIVITY IMPROVED COMMUNICATION THAT WILL FOSTER CQI IN WIC IN THE FUTURE. COLLABORATION WITH OTHER HEALTH DEPARTMENT UNITS

14. ROI CALCULATIONS REALLOCATION OF STAFF TIME: 20 MINUTE OF REALLOCATED STAFF TIME DUE TO DECREASED WIC PATIENT LEAD TIME 20 MINUTE (LEAD TIME SAVED) X 2,486 (TOTAL CASELOAD X 2 ASSESSMENTS/YEAR = 49, 720 MINUTES 49, 720 MINUTES / 60 MINUTES = 829 HOURS 829 HOURS X $26.66 (2 PA STAFF SALARIES PER HOUR) = $22,101.14 96 DAYS (1/2 STAFFED IN WIC) = 96 X 7.5 (HRS PER DAY) =720 HOURS 720 HOURS (1 FULL STAFF) X $13.33 (1 PA HOURLY SALARY) = $9, 597.60 $22,101.14 (2 PA SALARIES) - $9,597.60 (1PA SALARY) = $12,503.54 (TOTAL SAVINGS)

15. THANK YOU SO THIS IS WHERE WE LIVE AND ARE EVOLVING!!!!