FEBRUARY 25 – 27, 2013Executive sponsor – Dr. Judy Shlay

Process Owner – Sarah RodgersLean Lead – Kathy Root

Participants – Lori Ramirez, Dean McEwen, Alexis Juarez, Ashley Oliver, Marianne

Aguirre-Colon, Andrew Yale, Heather Weir, Melissa Edel, Kathie Chichester, Kristi

Yamaski

Inefficient use of resources – financial and staff

Improving/creating standard work Adhere to federal and state laws Adjusting inventory

• Standard practice• Easy process• Immunizations and apply to other

programs/agencies• Root cause• Minimize errors and safety• Decrease financial errors• Reduce staff burden• Patient satisfaction and wait times

•Clerk writing too much important info on routing slips•Lot # list not being used•Lot # list•Vaxtrax pulling incorrect lot #•Using the wrong lot #•Multi user friendly files•Order too often•Par levels•Too few people knowing the process•Missing QA of correct lot # being used•Routing slip does not have standard documentation•Self pay defaults to VFC eligible in Vaxtrax

• Nurse is faxing and copying• Handwriting• Wrong person is ordering• Nurse asking for payment and printing

records• Nurse/clerk charting

• Data entry into Vaxtrax• Confirmation fax• Streamline process• Determine lot # before bringing patient

into clinic room

• Multi inventory books• Visual assessment of vaccine needed• Rebalancing of inventory• Delay in billing/chart review

The back and forth of patients Standard process of vaccine boats Movement of forms

Fixing lot #’s VFC vaccine processing report Sending email twice to billing person if

denied claim Too many forms Using lot # form routing slip

Paperwork for patient Paperwork for inventory Un-useful Vaxtrax reports Billing reports QA every visit

Do quickly Prioritize

Do it soon Analyze Later

Level of effort each action requires

Impa

ct to

cus

tom

er

Low High

Low

H

igh

Forms & Stickers: Created new labels for the routing sheet to cover the lot #’s Developed new consent forms Wrote standard billing procedures

Fridge & Opening/Closing Procedures: Reorganized immunization refrigerator Developed Start/End of Shift Checklist Improved Inventory Lot Number list – Alphabetized, color-coded

by VFC/317/Private Ordering process

Par levels Standardized ordering process Improved ordering form for private vaccines Updated ordering procedures and process Updated binders

1) FinancialIncrease donations baseline is January’s donation amount goal – 10% increase by April

2) OrderingRetro report of # of times orderingPrivate order per monthTime study of old vs. new ordering systemBaseline done nowGoal - undetermined

3) Quality assurance – lot/site/program/wrong potBaseline – 30%Goal – less than 5%

4) Employee satisfaction – survey changes after 45 and 90 days

WHAT BY WHOM BY WHEN

Ordering

Use new ordering sheet Lori 1-Apr

Finish standard ordering process Lori/Dean 1-Apr

E-borrowing form Dean/Sarah 30-Jun

Patient Visit-Clerk

Standards for opening and closing Alexis/Ashley 8-Mar

Track donations Ashley 30-Mar

Standard for check out process Alexis/Sarah 1-Apr

Determine patient flow Kathy/Sarah 31-May

Assess vax trax self pay insurance Sarah/Andrew send email 30-Dec

Patient Visit-RN

Finalize Consents-Translate/Legal Sarah 8-Mar

Training sticker/create script Lori 18-Mar

Standard work/documentation/peer audits Marianne March 18/ April 31

Data Analysis

Complete the spread sheet Dean 29-Mar

Improve reporting Dean 30-Apr

Denial vaccine reconciliation process Dean/Sarah 30-Jun

Quality

Visual management board Sarah/Marianne/Kathy 18-Mar

Add QA process for checking lot/develop QA/audit tool Ashley/Heather 15-Apr

Employee satisfaction Heather/Judy April 19/ June 28

Organized Everyone participated More in-depth and intense than expected Opportunity for improvement Relieved Good team Right people in the room