Come Together

Building relationships can improve quality

by Kim Hawkins

After working several years in the health promotion field for private industry, I found myself wanting to help others in a broader sense, so I pursued opportunities in the world of public health. I started in the public health field as the quality assurance coordinator for the Division of Immunization Services in West Virginia. Though I pride myself on doing quality work, I had never been primarily responsible for the quality of something as important as children’s health.

This role involved ensuring the safety of vaccines for children throughout the state and supporting physicians in their efforts to vaccinate these children safely and effectively. My work in the health promotion field had always been important to me, but protecting children meant bringing quality to a new level.

Improving processes

Entering this role, I had limited experience with preventive care for children and no experience with pediatric immunization. I received about three months of on-the-job training on how to conduct provider visits and did extensive research on immunization schedules and vaccine contraindication to better understand the subject area.

I began participating in Centers for Disease Control and Prevention (CDC)-sponsored conference calls and webinars on increasing immunization coverage rates, conducting provider visits and giving feedback on ways to improve. I also spent a great deal of time talking to public health nurses who gave me a lot of insight into vaccinating children from a clinical perspective.

It became clear to me that childhood and adolescent vaccination is a key resource in preventive care. In 1994, West Virginia became one of the first states to enroll in the federally funded Vaccine for Children (VFC) program. Through this program, about 400 medical providers in the state receive vaccines at no cost to administer to children up to 18 years old who are eligible. The program’s goal is to keep children safe and healthy by administering all vaccines the CDC recommends.

Providing vaccines alone is not enough to improve vaccination coverage rates; outreach also is needed to ensure children and adolescents receive these recommended vaccines in a safe and effective manner. A key source of outreach is a quality assurance visit, which is critical to ensure a vaccine is stored properly, that the Advisory Committee on Immunization Practices’ guidelines are being followed and that the Standards for Pediatric Immunization Practices are followed.

In 2006, less than half of enrolled providers received an annual quality assurance visit. I knew that to improve quality, we needed to find a way to be more visible to these providers.

Cross-trained staff

I began to direct my efforts toward increasing the number of VFC providers that receive visits on an annual basis. To achieve this, staff began cross-training on a variety of things.

No longer could only a specific person do a certain type of visit, but all staff could share responsibility for things such as VFC, day care and school visits. I worked to implement processes to allow less time in the offices when visits were conducted. These processes included condensing feedback forms into one simple, easy-to-understand document and using the statewide immunization registry database to obtain information prior to arriving at the office.

By making VFC staff available to providers on a more frequent basis, I anticipate improvements in immunization coverage rates. The state has increased site visits from less than 50% in 2006 to 100% of eligible providers receiving a visit in 2009. Though the immediate impact has not yet been seen because coverage rates are determined for children 24 to 35 months old, the rate improvement should be evident by 2012.

The process has been rewarding in other ways. Conducting these visits serves as an opportunity for VFC staff to share new vaccine-related information and to obtain provider feedback about ways to improve childhood vaccinations. The process has allowed VFC staff members to be visible as resources for providers rather than just outside program administrators.

This experience has created a two-way learning street, as the providers teach us, the VFC staff members, as much as we teach them. I would have never imagined I would enjoy quality assurance so much, but I have come to realize that with quality, it is more about people than policy. Understanding that we must never sacrifice quality for quantity, the VFC staff has worked hard to achieve both and has earned a well-deserved mutual respect with the VFC providers throughout West Virginia.

Kim Hawkins is the director of grants management and administration for the West Virginia Center for Threat Preparedness in Charleston. She has a master’s degree in community health education from West Virginia University in Morgantown.

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