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Special Thanks…. Debra Isaac, Customer Service Supervisor – Vital Statistics Cheryl M. Williams, Deputy Registrar – Vital Statistics Simon Trevino, Senior Computer Operator – Vital Statistics Vital Statistics Cashiers Luis Carrillo Mary Coutee Esmeralda Gonzalez Cathy Grant

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Special thanks

Special Thanks…

  • Debra Isaac, Customer Service Supervisor – Vital Statistics

  • Cheryl M. Williams, Deputy Registrar – Vital Statistics

  • Simon Trevino, Senior Computer Operator – Vital Statistics

  • Vital Statistics Cashiers

    • Luis Carrillo

    • Mary Coutee

    • Esmeralda Gonzalez

    • Cathy Grant

    • Loretha Jimmerson

    • Willie “Tweety” McClintok

    • Juanita Velasquez

    • Helen Smith

Vital statistics quality improvement project

Vital Statistics Quality Improvement Project

Larissa Estes

Julia Gee

Naomi Macias

Celina Garza Ridge

Varsha Vakil

Public health department accreditation

Public Health Department Accreditation

  • Measurement of performance against nationally recognized, evidence-based standards

  • Improve and protect the health of the public by advancing the quality and performance of public health departments

  • Benefits

    • Systematic approach to public health

    • Ensures quality services are provided to residents

    • Enhances visibility and validates commitment to residents

    • Means to obtain additional funding

    • Provides an opportunity to identify areas of performance improvement

Why quality improvement

Why Quality Improvement?

  • Foundation of public health accreditation

    • Accountability

  • Results of investment in public health

    • Declining – do more with less

    • Future funding requirement

  • Getting better all the time

    • Improving performance

    • Improving health outcomes

    • Improving customer satisfaction

Definition of quality improvement in public health

Definition of Quality Improvement In Public Health

“Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. 

It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”

Defining Quality Improvement in Public Health; Journal of Public Health Management & Practice: January/February 2010 - Volume 16 - Issue 1 - p 5–7, Riley, William J. PhD; Moran, John W. PhD, MBA, CQIA, CQM, CMC; Corso, Liza C. MPA; Beitsch, Leslie M. MD, JD; Bialek, Ronald MPP; Cofsky, Abbey -

Continuous improvement

Continuous Improvement

The continuous improvement

phase of a process is how you

make a change in direction.

The change usually is because

the process output is deteriorating

or customer needs have changed

What is quality

What Is Quality?

Today the most progressive view of quality is that it is defined entirely by the customer or end user and is based upon that person's evaluation of his or her entire customer experience.

The customer experience is the aggregate of all the Touch Points that customers have with the organization’s product and services, and is by definition a combination of these. (RFT)

“Quality is not an act. It is a habit”

Aristotle 384BC-322BC, Greek philosopher and scientist, student of Plato and

teacher of Alexander the Great

Vital statistics lobby

Vital Statistics Lobby

Aim statement

AIM Statement

  • An opportunity exists to improve the Vital Statistics Customer Flow beginning with customer receipt of ticket number from information window and ending with being called by a cashier to complete financial transaction. This effort should reduce wait time by 15 minutes for the customer.

Aim statement1

AIM Statement

  • This process is important to work on now because wait times are experienced between the info desk and cashier and to provide good, efficient customer service

  • The baseline measurement is defined as the following metric: Average wait time per cashier window of 28 minutes by cashier by day



  • Observed the customer waiting area

  • Multiple one-on-one discussions with supervisor and deputy registrar

  • Observed cashiers during several time points during the work week

  • Summary analysis of operational reports

    • Customer Wait Time

    • Transaction Time

    • Print Time

  • Cashier Survey

Sipoc cm

  • Constraints:

  • Language

  • Signage

  • Volume

  • Incomplete documentation

  • Printer

  • Database, Network

  • Problematic application searches

  • Measures:

  • Average Customer wait time

  • Cashier feedback

  • Customer feedback

Begins with: Customer receiving ticket # from info desk

Ends with: Customer call to cashier window

  • Process/Activities:

  • Customer waiting for cashier call (in lobby)

  • Cashier call

  • Inputs:

  • # of Customers

  • # of Cashiers

  • Supervisor triggers/alerts

  • Previously completed application (at home, office etc)

  • Availability of all needed documents

  • Outputs:

  • Check documents

  • Begin database search

  • Send to Print

  • Complete transaction

  • Customers:

  • General public

  • (Residents of Texas state)

  • Suppliers:

  • Texas State database

  • Network


Flow chart

Customer enters Vital Statistics Lobby

Customer Wait Time: Unknown





Info Desk

Is a correct application section complete and required documentation available?

Complete correct section

Leave if cannot complete form or missing docs

Customer Wait Time

Avg.: 28 min

Call # Assigned

Cashier Call

Is application information correct?

Obtain Correct Information

Complete Search

Financial Transaction

Sent to Printer

Customer Wait Time, includes SOD certificates Avg.: 7 min

Print Window Call

Pick up Certificate at window #10

Flow Chart

Fishbone cause and effect

Wo-Man Power


  • Database

  • Equipment

  • Network, server

  • Software

  • Training, skill set

  • Communication

Wait time of 28minutes for vital statistic customers

  • Staffing Adjustments

    • # of windows open

    • Supervisor moderates flow

  • Distribution of tasks, responsibilities

    • ↓ customer flow – additional tasks

    • ↑customer flow - ↑# of windows open


  • “problem” certificates

  • Printing process

  • Signage/layout

Fishbone – Cause and Effect

Staffing level

  • Staffing level

    • Triggers

    • Supervisor calling for back up

Staffing adjustments

Dist of tasks, responsibilities

Pilot test

Pilot Test

  • Idea – transfer 1 person from correspondence to window #6; add lunch coverage

    • 4 windows open at all times

  • Results – June 4th – 8th

Special thanks


Vital Statistics



7. Develop Improvement Theory:

Create trigger system for supervisor to

improve customer flow.

Maintain wait time to 15mins.

1. Identify / Prioritize Opportunities:

Customer average wait time

more than 28 minutes

8. Develop Action Plan: Pilot Program –

One additional cashier added from

Correspondence and additional cashier/s

when wait time exceeds 15 minutes

1. Reflect on the Analysis:

Data obtained for wait time - 1 Week

pilot program. Cashier Survey data

2. AIM: Reduce customer

wait time to 15 minutes

2. Document Problems: Unavailability of

Staff and Communication issues.

Observation: Smooth running of pilot

Lessons learned: Customer Wait time

directly proportional

to # of cashier window open

3. Current Process:

Limited number of cashiers

to process transactions


1. Implement the Improvement:

Implementation of Pilot

Program for a week

4. Collect Data On: Number

of cashiers and the wait time

per customer


5. Identify Possible Causes:

No. of cashier windows open,

Printer/network issues,

Incomplete documentation etc.

2. Collect and Document the data:

Wait time reduced by 50%



3. Problems, Observations, Lessons Learned

Pilot Program Implementation

Day 1: Ran a snag – 4 staff out

Day 2: Successfully implemented Pilot

Program (5 cashier windows open)

Day 2-5: Pilot Successfully implemented



6. Identify Potential Improvements:

Increase the number of cashier

windows open(especially at rush hour)



Special thanks

Houston Department of Health and Human Services (HDDHS) aims to reduce Vital Statistics customer wait time.


HDHHS Vital Statistics currently experiencing average customer wait time of 28minutes. Among the reasons for these difficulties is few cashier windows open to serve customers.



Activities Participation

Outcomes- Impact

Short term Medium Term Long Term



QI STAR Trak Team

Vital Statistics


Office supplies

Cash boxes

(Vital Statistics)



Xerox machines



Avenues and

trigger modules for

Vital Statistics

Supervisor/s to

access other



Pilot program





Supervisor, Cashier

and staff roles

/ responsibilities

Implement: Pilot

program for 1 week

Evaluate: Data




and Staff of


Vital Statistics


Satellite location

partners and other

Affiliated partners





Vital Statistics

for implementation

of pilot program


Roadmap to

implement pilot


and overcome

any foreseen



Pros and Cons

of Pilot program


MOU’s, SOP’s




after studying the

pros and cons of

and fine-tuning the

program , maintain

any progress.


Cashier feedback

(Pilot project)

Customer Survey


Satisfied customers

reflect job well

done by HDHHS

Vital Statistics.





Vital Statistics


wait time.


Language barriers

and geographical

(satellite location)




and partners

to maintain

usage of available

resources /



Enhance the

ability to serve

customers in timely

fashion and

reduce long

wait times

Goal:Build avenues

to instruct supervisor/s on available resources that can be implemented to reduce customer wait time and assist them to adopt multiple trigger modules to use the available resources. Avenues created are flexible to accommodate all barriers.


Vital Statistics will work collaboratively

to implement the project

External factors

Staff feels alienated, incentives not good

enough to motivate and organizational bureaucracies.


Demonstrate measureable improvement in Vital Statistics customer wait time. Customer Feedback Survey

And Cashier Feedback. Increase in customer satisfaction to access HDHHS Vital Statistics resources.



Cashier survey

Cashier Survey

Bureau of Vital Statistics - Cashier Feedback

STAR Trak (Blue Team) Pilot program initiative

(To be completed by Cashier)

Cashier Initials (optional): _________________________________________________

Cashier Work Days and Hours: _____________________________________________

Did you like the STAR Pilot Program Initiative? Yes/No: _______________

Why? (please provide details): ___________________________________




Please provide any suggestion/comments to improve the program:



Thank you for your participation!

Customers waiting in lobby with 4 cashier windows open pilot program friday 06 08 12 at 2 pm

Customers waiting in lobby with 4 Cashier Windows Open Pilot program - Friday 06/08/12 at 2 pm

Cashier Feedback (N = 6)

  • Q. Did you like the Star TRaK Pilot Program? A. Yes = 5No = 0

  • Cashier Comments:

  • “Were able to assist customers faster, continue with more windows open.”

  • “Compliments from customers really made me feel good.”

  • “One [extra] window does make a difference.”

  • “Need to keep more windows open.”

  • “Enjoyed all windows being open, made everything flow smoothly and faster.”

  • “Need more bilingual staff.”

Update on improvement efforts

Update on improvement efforts

  • Update Cashier Standard Operating Procedures (SOP)

  • Brought on board temporary staff for Vital Statistics

  • Streamlining tasks

  • Workload analysis, results

  • Performance expectations – improved Bureau & staff functionality

  • New vacation/ sick time policy

  • Staffing levels to improve efficiency & effectiveness

Next steps

Next Steps

  • Employee Survey

  • Continue to monitor & Plan Do Check Act

  • Customer Survey

Lessons learned

Lessons Learned


  • Black box / Ripple effect

  • Cashiers

    • Great customer service skills

    • Efficient and FAST

    • Excellent troubleshooting

  • Control what you can control…

    Customer Cashier

Lessons learned from vital

Lessons learned from Vital

  • Open to change, constructive criticism

  • Goal improved customer services

  • Listen to others

  • Suggestions are a way to improve

  • Improvements ≠ failure it is an opportunity to make it even better



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