ASQ Quality Report: H1N1: What Have We Learned?

Christel Henke

Agencies Find Prescription for Dealing With Public Health Threats

Milwaukee, Wis., April 7, 2010 — Amid continuing H1N1 influenza concerns and shrinking budgets, U.S. public health departments face tough challenges. At the top of the list: fewer resources to help ensure that residents get vaccinations and other services in a timely manner. But more agencies are finding a prescription for improved efficiency and public safety with the help of process improvement methods, according to a new report released today by ASQ (American Society for Quality),

The report notes the experiences of several public health agencies, which with the help of quality professionals and organizations such as Public Health Foundation (PHF) and the National Network of Public Health Institutes, are integrating continuous improvement tools and techniques. Results include improved vaccine distribution, waste elimination, more client satisfaction with vaccination services and strengthened communications to ensure a smooth flow of information.

To view the complete report H1N1 Influenza and Quality Tools: What Have We Learned?, visit

Quality consultant Grace Duffy, in collaboration with PHF, has been working with public health departments throughout the nation including two counties in Orlando, Fla. There she is teaching the staff to use tools such as cause and effect diagrams, affinity charts, interrelationship digraphs and flowcharts for process mapping to help them improve their responses to the outbreak of H1N1 and other pandemics.

"We suggested that staff do a gap analysis to review what did and didn’t work in spring 2009 to improve services for a fall 2009 outbreak," Duffy said. "Using a PDSA (Plan Do Study Act) problem solving process helped them to improve the immunization process so that vaccine was delivered on time to the people who need it and was not sitting unused past its expiration date."

Duffy adds that while the community may not notice internal improvements, they are ultimately going to see fewer lines outside the door to the health department, and disabled clients and veterans will be approved for services more quickly than in the past.

Customer Feedback Drives Continuous Improvement

Incorporating customer satisfaction surveys in H1N1 mass vaccination clinics enabled the Northern Kentucky Health Department to capture valuable input about its immunization process. Interviews of clinic clients and staff helped determine what the clinic was doing great and what things were proving a hindrance. This enabled the department to make changes resulting in reduced waiting times while providing friendly, efficient service, according to Louise Kent, planning administrator for the department.

"Residents who came in to get their shots were blown away. They could not believe how efficient we were and how quickly they got through," Kent said. Documenting customer satisfaction fueled the department’s desire to keep doing things better while showcasing their professionalism.

Using QI Essential in Preparedness Activities, Communications

Quality tools are becoming a key way for public health agencies to improve emergency preparedness activities as well as communication processes, according to the Kansas Department of Health and Environment (KDHE).

The Shawnee County health agency in Kansas developed a PDSA report for implementing a process to monitor the receipt of vaccination doses and procedures for providing vaccines to public sites and coordinating distribution to private vaccination sites. This exercise supported real-time inventory control and facilitated timely and accurate data on vaccine doses throughout all the mass vaccination clinics.

According to Shirley Orr, director of local health in the Bureau of Local and Rural Health Systems at KDHE, quality tools are used to help monitor and improve many issues like staffing, equipment set-up, training and communications, which is a major challenge considering the diverse audiences served.

"We did a lot of process flow mapping to help us provide consistent, efficient communications with emergency management, schools and healthcare providers," Orr said. "As we identified how we could organize our communications structure, we continued to use quality improvement tools to plan and refine our strategies as we went along."

Orr also believes that the public health industry in general is finding results from using continuous improvement tools. "There’s quite a push within the public health system to learn about quality improvement, begin to learn the tools and find ways to apply them to our work."

About ASQ

ASQ, (The American Society for Quality), has been the world’s leading authority on quality for more than 60 years. With more than 85,000 individual and organizational members, the professional association advances learning, quality improvement and knowledge exchange to improve business results and to create better workplaces and communities worldwide. As a champion of the quality movement, ASQ offers technologies, concepts, tools and training to quality professionals, quality practitioners and everyday consumers. ASQ has been the sole administrator of the prestigious Malcolm Baldrige National Quality Award since 1991. Headquartered in Milwaukee, Wis., ASQ is a founding sponsor of the American Customer Satisfaction Index (ACSI), a prominent quarterly economic indicator, and also produces the Quarterly Quality Report.

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