Special Thanks…
 Debra Isaac, Customer Service Supervisor – Vital Statistics
 Cheryl M. Williams, Deputy Registrar – Vital Statistics
 Simon Trevino, Senior Computer Operator – Vital Statistics
 Vital Statistics Cashiers
 Luis Carrillo
 Mary Coutee
 Esmeralda Gonzalez
 Cathy Grant
 Loretha Jimmerson
 Willie “Tweety” McClintok
 Juanita Velasquez
 Helen Smith
Larissa Estes
Julia Gee
Naomi Macias
Celina Garza Ridge
Varsha Vakil
Public Health Department Accreditation
 Measurement of performance against nationally recognized, evidence-
based standards
 Improve and protect the health of the public by advancing the
quality and performance of public health departments
 Benefits
 Systematic approach to public health
 Ensures quality services are provided to residents
 Enhances visibility and validates commitment to residents
 Means to obtain additional funding
 Provides an opportunity to identify areas of performance improvement
Why Quality Improvement?
 Foundation of public health accreditation
 Accountability
 Results of investment in public health
 Declining – do more with less
 Future funding requirement
 Getting better all the time
 Improving performance
 Improving health outcomes
 Improving customer satisfaction
Definition of Quality Improvement
In Public Health
“Quality improvement in public health is the use of a
deliberate and defined improvement process, such as PlanDo-Check-Act, which is focused on activities that are
responsive to community needs and improving population
health.
It refers to a continuous and ongoing effort to achieve
measurable improvements in the efficiency, effectiveness,
performance, accountability, outcomes, and other indicators
of quality in services or processes which achieve equity and
improve the health of the community.”
Defining Quality Improvement in Public Health; Journal of Public Health Management & Practice: January/February 2010
- Volume 16 - Issue 1 - p 5–7, Riley, William J. PhD; Moran, John W. PhD, MBA, CQIA, CQM, CMC; Corso, Liza C. MPA;
Beitsch, Leslie M. MD, JD; Bialek, Ronald MPP; Cofsky, Abbey -
Continuous Improvement
Act
Plan
Check/
Study
Do
The continuous improvement
phase of a process is how you
make a change in direction.
The change usually is because
the process output is deteriorating
or customer needs have changed
What Is Quality?
 Today the most progressive view of quality is
that it is defined entirely by the customer or end
user and is based upon that person's evaluation
of his or her entire customer experience.
 The customer experience is the aggregate of all
the Touch Points that customers have with the
organization’s product and services, and is by
definition a combination of these. (RFT)
 “Quality is not an act. It is a habit”
Aristotle 384BC-322BC, Greek philosopher and scientist, student of Plato and
teacher of Alexander the Great
Vital Statistics Lobby
AIM Statement
 An opportunity exists to improve the Vital Statistics
Customer Flow beginning with customer receipt of
ticket number from information window and ending
with being called by a cashier to complete financial
transaction. This effort should reduce wait time by 15
minutes for the customer.
AIM Statement
 This process is important to work on now because wait
times are experienced between the info desk and
cashier and to provide good, efficient customer service
 The baseline measurement is defined as the following
metric: Average wait time per cashier window of 28
minutes by cashier by day
Methodology
 Observed the customer waiting area
 Multiple one-on-one discussions with supervisor and
deputy registrar
 Observed cashiers during several time points during
the work week
 Summary analysis of operational reports
 Customer Wait Time
 Transaction Time
 Print Time
 Cashier Survey
SIPOC+CM
Begins with:
Customer
receiving ticket #
from info desk
Constraints:
•Language
•Signage
•Volume
•Incomplete documentation
•Printer
•Database, Network
•Problematic application searches
Measures:
Average Customer wait time
Cashier feedback
Customer feedback
Ends with:
Customer call to
cashier window
Process/Activities:
• Customer waiting for cashier call (in
lobby)
•Cashier call
Inputs:
• # of Customers
• # of Cashiers
•Supervisor triggers/alerts
• Previously completed application (at
home, office etc)
•Availability of all needed documents
Suppliers:
• Texas State database
• Network
Outputs:
• Check documents
• Begin database search
• Send to Print
•Complete transaction
Customers:
•General public
(Residents of Texas state)
Customer enters
Vital Statistics Lobby
Flow Chart
Is a correct application
section complete and
required documentation
available?
Info Desk
N
Y
Call # Assigned
Cashier Call
Is application
information
correct?
Customer Wait
Time: Unknown
Y
N
Complete correct
section
Customer
Wait Time
Avg.: 28
min
Obtain Correct
Information
Complete Search
Financial Transaction
Sent to Printer
Print Window Call
Pick up Certificate
at window #10
Customer Wait
Time, includes
SOD certificates
Avg.: 7 min
Leave if
cannot
complete
form or
missing docs
Fishbone – Cause and Effect
•Training, skill set
•Communication
Wo-Man
Power
•Database
•Equipment
•Network, server
•Software
Mechanical
Staffing level
•Staffing level
Triggers
Supervisor calling
for back up
Wait time of 28
minutes for vital
statistic customers
Staffing
adjustments
PROCESS
•“problem” certificates
•Printing process
•Signage/layout
Dist of tasks,
responsibilities
•Staffing Adjustments
# of windows open
Supervisor moderates flow
•Distribution of tasks, responsibilities
↓ customer flow – additional tasks
↑customer flow - ↑# of windows open
Pilot Test
 Idea – transfer 1 person from correspondence to
window #6; add lunch coverage
 4 windows open at all times
 Results – June 4th – 8th
Plan
1. Identify / Prioritize Opportunities:
Customer average wait time
more than 28 minutes
2. AIM: Reduce customer
wait time to 15 minutes
3. Current Process:
Limited number of cashiers
to process transactions
4. Collect Data On: Number
of cashiers and the wait time
per customer
5. Identify Possible Causes:
No. of cashier windows open,
Printer/network issues,
Incomplete documentation etc.
6. Identify Potential Improvements:
Increase the number of cashier
windows open(especially at rush hour)
Vital Statistics
7. Develop Improvement Theory:
Create trigger system for supervisor to
improve customer flow.
Maintain wait time to 15mins.
8. Develop Action Plan: Pilot Program –
One additional cashier added from
Correspondence and additional cashier/s
when wait time exceeds 15 minutes
Do
Check/
Study
1. Reflect on the Analysis:
Data obtained for wait time - 1 Week
pilot program. Cashier Survey data
2. Document Problems: Unavailability of
Staff and Communication issues.
Observation: Smooth running of pilot
Lessons learned: Customer Wait time
directly proportional
to # of cashier window open
1. Implement the Improvement:
Implementation of Pilot
Program for a week
2. Collect and Document the data:
Wait time reduced by 50%
3. Problems, Observations, Lessons Learned
Pilot Program Implementation
Day 1: Ran a snag – 4 staff out
Day 2: Successfully implemented Pilot
Program (5 cashier windows open)
Day 2-5: Pilot Successfully implemented
Act:
Adopt
Adapt
Abandon
Standardize
Do
Plan
Houston Department of Health and Human Services (HDDHS) aims to reduce Vital Statistics customer wait time.
Situation
HDHHS Vital Statistics
currently experiencing
average customer wait
time of 28minutes.
Among the reasons for
these difficulties is few
cashier windows open to
serve customers.
Inputs
Staff:
HDHHS
QI STAR Trak Team
Vital Statistics
Priorities:
Enhance the
ability to serve
customers in timely
fashion and
reduce long
wait times
Goal: Build avenues
to instruct supervisor/s
on available resources
that can be implemented
to reduce customer wait
time and assist them to
adopt multiple trigger
modules to use the
available resources.
Avenues created are
flexible to accommodate
all barriers.
Materials:
Office supplies
Cash boxes
(Vital Statistics)
Equipment:
Printers
Xerox machines
Computers
Outputs
Activities
Outcomes- Impact
Participation
Short term Medium Term Long Term
Develop:
Avenues and
trigger modules for
Vital Statistics
Supervisor/s to
access other
resources/manpower
Develop:
MOU’s, SOP’s
Demonstrate:
Develop:
Measurable
Agreements
improvement
Execute:
between
in HDHHS
Project
Participants:
HDHHS
Vital Statistics
implemented
Supervisor/s,
Vital Statistics
customer
after studying the
Cashiers,
for implementation
wait time.
Prepare:
pros and cons of
and Staff of
of pilot program
Pilot program
and fine-tuning the
HDHHS
Overcome:
program , maintain
Vital Statistics
Prepare:
Language barriers
Instruct:
any progress.
Roadmap to
and geographical
Supervisor/s,
implement pilot
(satellite location)
Cashiers
Feedback:
Agencies:
program
barriers.
Cashier feedback
Satellite location
and overcome
Identify:
(Pilot project)
partners and other
any foreseen
Encourage:
Supervisor, Cashier
Customer Survey
Affiliated partners
barriers
Staff
and staff roles
and partners
/ responsibilities
Incentive:
Document:
to maintain
Satisfied customers
Pros and Cons
usage of available
Implement: Pilot
reflect job well
of Pilot program
resources /
program for 1 week
done by HDHHS
manpower.
Vital Statistics.
Evaluate: Data
Assumptions
External factors
Vital Statistics will work collaboratively
to implement the project
Staff feels alienated, incentives not good
enough to motivate and organizational bureaucracies.
Evaluation
Demonstrate measureable improvement in Vital Statistics customer wait time. Customer Feedback Survey
And Cashier Feedback. Increase in customer satisfaction to access HDHHS Vital Statistics resources.
RESULTS
Cashier Survey
Bureau of Vital Statistics - Cashier Feedback
STAR Trak (Blue Team) Pilot program initiative
(To be completed by Cashier)
Cashier Initials (optional):
_________________________________________________
Cashier Work Days and Hours:
_____________________________________________
Did you like the STAR Pilot Program Initiative? Yes/No: _______________
Why? (please provide details): ___________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Please provide any suggestion/comments to improve the program:
____________________________________________________________
____________________________________________________________
Thank you for your participation!
Customers waiting in lobby with 4 Cashier Windows Open
Pilot program - Friday 06/08/12 at 2 pm
Cashier Feedback (N = 6)
Q. Did you like the Star TRaK Pilot Program? A. Yes = 5
No = 0
Cashier Comments:
 “Were able to assist customers faster, continue with more windows open.”
 “Compliments from customers really made me feel good.”
 “One [extra] window does make a difference.”
 “Need to keep more windows open.”
 “Enjoyed all windows being open, made everything flow smoothly and faster.”
 “Need more bilingual staff.”
Update on improvement efforts
 Update Cashier Standard Operating Procedures (SOP)
 Brought on board temporary staff for Vital Statistics
 Streamlining tasks
 Workload analysis, results
 Performance expectations – improved Bureau & staff
functionality
 New vacation/ sick time policy
 Staffing levels to improve efficiency & effectiveness
Next Steps
 Employee Survey
 Continue to monitor & Plan Do Check Act
 Customer Survey
Lessons Learned
 Black box / Ripple effect
???
 Cashiers
 Great customer service skills
 Efficient and FAST
 Excellent troubleshooting
 Control what you can control…
Customer
Cashier
Lessons learned from Vital
 Open to change, constructive criticism
 Goal improved customer services
 Listen to others
 Suggestions are a way to improve
 Improvements
even better
≠ failure it is an opportunity to make it
Questions…