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Story of Measurable Improvement in Public Health

Name of Health Department/Agency: Frederick County Health Department
State: MD
Contact Name: Monica Grant
Contact Information: mgrant@frederickcountymd.gov
Date Added: 3/26/2012
Program/Topic Area: Flu immunization
QI techniques/tools:  Control Chart, PDCA, Brainstorming, check sheet
Description of the process and intervention: Frederick County Health Department (FCHD) utilized an appointment-only process for the first time during the 2009-2010 H1N1 Pandemic Flu season. Clients registered through PlumVoice, a web based appointment scheduling service purchased and facilitated by Frederick County Emergency Management Division. As clients registered, their names were compiled on a list. In order to provide fair access to a limited amount of available vaccine, the list of registered clients was randomized. FCHD employees then staffed a call center and contacted clients according to their randomized order to schedule appointments for H1N1 flu vaccination. Staff then entered appointment information into an ACCESS database developed in-house by Interagency Information Technology staff. At the completion of the process, staff and clients completed surveys to evaluate the scheduling process. A review of staff and client evaluation surveys revealed that appointment-only clinics were preferred over a traditional “walk-in” clinic model by both clients and staff. Clients praised the short wait times and overall organization of the clinics. Staff appreciated the ability to manage staffing, scheduling and supplies for a pre-determined number of clients. However, the registration and appointment scheduling process alone required the support of 7.4 FTE staff during the first week of scheduling. This level of staffing proved too time intensive to support for future years’ immunization efforts. In planning for the 2010 Mass Immunization Exercise, FCHD decided to build on the staff and client reported success of H1N1 clinics. We wished to determine a way to again schedule appointments for immunization clinics but use a process requiring fewer FCHD staff. The Quality Improvement Team brainstormed potential solutions and explored a variety of possibilities. After a cost/benefit analysis, FCHD decided to contract with the company eMedischedule for client-managed appointment scheduling. eMedischedule gave clients the ability to electronically schedule and change appointments online 24/7 without directly contacting FCHD. A virtual call center, supported by 1 FCHD employee, handled the scheduling of appointments made by clients who preferred to use a telephone. Clients were immediately successful in scheduling their appointments with limited support from the FCHD during the first week of clinic scheduling using eMedischedule. Client and staff surveys distributed at the first clinic of 2010 showed that the new scheduling process was well-received and contributed to the overall efficiency of the clinics. Only 1 FCHD staff member was required to support eMedischedule during the first week of scheduling for the 2010 flu season.
Result/outcome: As a result of changing the appointment scheduling process, the Frederick County Health Department was able to reduce the number of staff required to support appointment scheduling for flu clinics by 86% while maintaining client satisfaction with the scheduling process.
Next Steps: Continue to use eMedischedule for seasonal flu clinic scheduling. Evaluate the use of eMedischedule for additional FCHD clinics.

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