Maple City Health Care Center Vista Community Health Center

1. Maple City Health Care CenterVista Community Health Center Goshen,IN James Nelson Gingerich, Guardian of Vision

4. Make Preventive and Screening tests accessible and affordable • No out of pocket expense • Demand scheduling • Carpe diem • Screening tests as housekeeping

5. Clean up data • Structure data for hysterectomies • Check for outside records

6. Analyze variation • Reduce variation between teams bring all to level of strongest teams • Analyze for system improvement capability

7. Maximize system function (tune up the alert system) • Weekly Azara quality updates for entire teams on successes and misses • Huddle culture where everyone provides encouragement to meet alerts

8. Implement System Change (Recall system) • Rationale • If average woman 21-30 y.o. comes once a year, and is on a 3 year pap smear cycle, then by the time an alert for a pap smear appears she will on average be 6 months late. So we can expect a 16.7 % delinquency rate with these assumptions if everybody does their job perfectly. • If average woman 30-65 y.o. comes once a year, and is on a 5 year pap smear cycle, then by the time an alert for a pap smear appears she will on average be 6 months late. So we can expect a 10 % delinquency rate with these assumptions if everybody does their job perfectly. • So we weren’t going to get to 93% by just paying attention to alerts • Inreach workers at each site make targeted calls to all women not shown as up to date on paps, obtain info re. hysterectomies or records of paps elsewhere, and schedule them. • Aggressive followup on missed appointments

9. Celebrate success!