Rapid Cycle Quality Improvement during a Public Health Emergency Response

Although the concept of rapid cycle quality improvement is not new to local health departments, its utilization during a public health emergency has not been examined. During the H1N1 response, the Kane County Health Department utilized rapid cycle QI to continually evaluate and improve our response. Typically, evaluations and improvement plans are conducted and generated post-exercise or post-event. The ongoing nature of the H1N1 pandemic forced KCHD to tackle QI issues sometimes in the heat of ‘battle'. KCHD utilized the Incident Command System (ICS) Planning P concept to frame its rapid cycle QI. Staff met early in the week to define the next operational period's goals and objectives and develop an Incident Action Plan. After an implementation and observation period, the IC staff met again to review QI issues and attempt to understand the root cause of barriers or challenges experienced. The next weeks Incident Action Plan focused on addressing the QI issues identified as well as the ongoing response. When H1N1 vaccine became available, mass vaccination clinics were stood up, rapid cycle QI became even more critical as biological products and sharps entered the operating picture. Through a combination of on-site evaluation, participant hot-washes and After Action Reviews, each clinic was examined with a critical eye towards QI. During our first night of clinic operations, over 11,000 individuals were vaccinated. However, we missed our throughput targets by 7% overall due to dramatic wait times and had four needle sticks and two vaccine mis-administrations, not great results from a quality or safety standpoint. As a result of changes made based on the rapid cycle QI process through the next 4 weeks, the next mass vaccination clinic reached 100% of anticipated demand, had no needle sticks or mis-administrations of vaccine and saw throughput times decreased to 25 minutes door-to-door.