QI Project – Improving Child Health Vaccination Clinic client flow

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Trevor Weigle
QI Project – Improving Child Health Vaccination Clinic client flow
What’s On Your Mind?: 

As part of the Local Performance Management Initiative (brought to you by NJDOH Office of Local Public Health and Rutgers Office of Continuing Professional Education), the Paterson Division of Health used Rutgers’ practical QI approach to examine and improve the way it conducts vaccination clinics.

In late summer and early fall, Paterson’s biweekly child health vaccination clinics were often overwhelmed with large numbers of parents bringing children in for vaccines needed for school admittance. Clients often waited for hours, as demand for this service exceeded clinic capacity. Language barriers and confusion about what information and paperwork parents needed to bring to the clinic sometimes meant that clients who had waited at the clinic could not receive services. The result was clinics that didn't end on time, nurses who didn't get to eat lunch or get out on time, and unhappy citizens and staff (although many children did receive their vaccinations at each clinic).

We wanted to improve the clinic flow for patients, both by reducing overall wait times and communications for clients and by reducing the amount of time clinic staff spend on paperwork for each client. More efficient clinics could let us serve more clients per clinic (improving vaccination rates among children and ensuring that children are getting all -- and only -- the vaccines they need), and could reduce wait times for community residents and their children, who often have trouble waiting. Clinics that run more smoothly and end on time also could improve staff morale.

Paterson has completely revamped its clinic process, beginning with the decision to move over to appointments-only clinic system, and the department has worked to inform the public about the change. Staff now makes appointments and people are told in advance what documentation they need to bring. Appointments are tracked using a computerized system. We’ve managed to reduce the amount of paperwork that clinic staff need to complete for each client by 50%, and improved clinic flow charts have been implemented and shared with staff. At the end of each clinic, staff holds a de-briefing to discuss what went well and how to further improve operations. Clinics are working more smoothly, we’re serving even more clients, and staff are getting to leave work on time.

Rather than seeing an inability to get vaccines immediately as an inconvenience, clients are happier to be more certain of when they will be seen and to get done sooner.

When making a change this big, implement a full-scale public information campaign as early as possible to make as many people as possible aware. That will help bring more positive outcomes.