How Benton-Franklin Health District used Lean to make its immunization process work better

Kennewick, Washington: The Benton-Franklin Health District building is a clean, modern facility, shining brightly from its location tucked behind a shopping center and other businesses. The waiting room is spacious, and the interior brims with helpful pamphlets about preventing common diseases, staying healthy and knowing when to visit your doctor. The facility is designed to put clients at ease as they wait for their appointments. Health District employees care about their clients and have designed their space around their clients' comfort.

But what about the Health District's internal processes? Employees, championed by District Administrator Jason Zaccaria, knew their day-to-day work could reflect the peaceful, client-centered flow of their external building. That's why they contacted the Performance Center at the Office of the Washington State Auditor.

The Performance Center helps local governments improve so they can better serve the public. The Performance Center's Lean Academy provides specialized, custom Lean tools and training to local governments interested in process improvement — from small projects to very complex processes. That's what Benton-Franklin Health District asked for.

In 2016, the Performance Center began working with District employees on the payroll process. Employees mapped out all of the required steps from filling out a time card to processing payroll in the back office. Gaining awareness of everyone's role gave all the players in the process a better understanding of how missing deadlines affected process timeliness and some employees' capacity to focus on important work. Clarification of expectations and responsibilities changed the entire culture around the payroll process. As one employee commented, “it was inspiring to see them work like a team rather than protecting their individual departmental territory.”

This process improvement was so successful that District Administrator Zaccaria called the Center again to get help with an even more complex problem: how to improve the highly regulated, multi-departmental process of immunization tracking and billing.

A complex chain of events begins when a client enters the Health District building to receive an immunization. It starts with client check-in, followed by documents, charts and other information being passed from the front desk to the nurses and other clinic staff. The process ends with a final bill for services being sent to the client or an insurer such as Medicaid.

The Lean Academy process helps participants identify all of the complex process decision-points and begin to build new workflow to address issues and improve performance. To improve the immunization process, Lean Specialist Debra Hentz assembled a team of subject matter experts at the Health District – those who actually perform the steps in the immunization process. This team then committed to a workshop designed to create small process improvement in a well-defined time period. With a team that was not familiar with this methodology, it was important to have a facilitator guide them through the mapping the process, identifying key issues and determining ways the process could be improved.

One of the most useful aspects of this kind of workshop is its ability to focus on the process steps, rather than the employees performing the work. In this case, that meant shifting the focus from frustrations with individual people or departments to understandings about how the process steps themselves were causing extra work in an already stressful environment.

In turn, this shift in focus helped to calm what many staff members described as “emotional tension” or “heightened emotions” surrounding ownership of individual steps within the complex immunization process. Once employees sat together and talked about their individual parts and their interplay, the staff then understood why the process created extra work and inefficiencies. The staff then helped each other develop new and innovative solutions to address the major “pain points” in the immunization process. The result was a plan to make deliberate changes and improvements to how the Health District handles immunizations, from the time the immunization serum arrives at the District's doors to when the client or insurer pays the final bill.

Computer systems don't always solve problems, but in this case, automating more of the process improved the patient experience, reduced staff frustrations and improved efficiency. Involving the Information Technology manager as part of the team helped identify and develop a paperless encounter process. This eliminated the need to “watch” for clients leaving the building, which at best resulted in front office stress and at worst meant tracking down clients to complete the billing process at a later date.

The newly developed culture of continuous improvement and Lean methodology adopted at the Health District goes beyond the improvements in payroll and the immunization processes. District staff are now incorporating a Lean culture into how they go through their work day as well as how they tackle other large and complex District processes. The result is a health district with happier employees that functions more efficiently and better serves its clients, thereby increasing health and wellness in Benton and Franklin counties.

Resources for your government

Lean in Government Starter Kit

Leading Process Excellence: A Leader's Role in Process Improvement Initiatives

Tools for Starting a Process Improvement Team

Want to learn more?

We want to help. The Performance Center brings the high-level concepts of performance auditing, like identifying process improvements, best-practices and more to local governments across Washington. Our services are provided at no cost, and local governments across the state can access expert help in gaining the tools they need to improve for the public they serve. To learn more about our Lean Academy program, or any of our other service offerings, visit our Performance Center.