What is the best next step in the quality improvement process for a clinic with a low influenza vaccination rate of less than 10% among eligible patients?

Best Next Step in Quality Improvement Process for Low Influenza Vaccination Rate

Creating a flow chart of the current process is the best next step in quality improvement for a clinic with less than 10% of eligible patients receiving influenza vaccine.

Understanding the Problem

When facing a significantly low influenza vaccination rate (less than 10%) in a clinic setting, it's essential to first understand the current workflow before implementing interventions. This systematic approach allows for identification of specific barriers and bottlenecks in the vaccination process.

Why Flow Chart First?

1. Process Mapping Benefits:

   • Provides visual representation of the current vaccination workflow
   • Identifies gaps, bottlenecks, and missed opportunities in the current process
   • Establishes a baseline understanding before implementing changes
   • Helps engage staff by creating shared understanding of the current state

2. Sequence of Quality Improvement Steps:

   • Flow chart (current process) → Root cause analysis → Interventions → Measurement

Evidence-Based Approach

The Advisory Committee on Immunization Practices (ACIP) recommends a structured approach to improving vaccination rates that begins with understanding current processes 1. Successful vaccination programs require systematic assessment before implementation of multifaceted interventions.

Why Not Other Options?

• Patient Survey: While valuable for understanding patient perspectives, this should follow process mapping as barriers may be system-based rather than patient preference-based 1
• Fishbone Diagram: This is part of root cause analysis, which should be performed after understanding the current process flow 1
• Root Cause Analysis: This is a critical step but should follow process mapping to ensure all potential failure points are considered 1

Implementation Steps for Flow Chart Creation

1. Map the entire vaccination process:

   • Patient identification/eligibility determination
   • Vaccination offering/recommendation
   • Documentation of acceptance/refusal
   • Vaccine administration
   • Follow-up procedures

2. Identify key personnel involved in each step:

   • Front desk staff
   • Medical assistants/nurses
   • Providers
   • Pharmacy personnel (if applicable)

3. Document decision points and handoffs:

   • When and how vaccination status is assessed
   • Who offers the vaccine
   • How refusals are handled
   • Documentation procedures

Common Barriers to Identify in Flow Chart

Based on ACIP guidelines, look for these common barriers in your process map 1:

• System barriers:

  • Lack of standing orders
  • Unclear responsibility for offering vaccine
  • Administrative barriers (costs, accessibility)
  • Inadequate documentation systems

• Provider barriers:

  • Missed opportunities during visits
  • Lack of provider recommendation
  • Insufficient time during visits

• Patient barriers:

  • Fear of side effects
  • Misconceptions about vaccine effectiveness
  • Access issues (time, convenience)

Next Steps After Flow Chart Creation

After creating the flow chart:

1. Conduct root cause analysis using findings from the flow chart
2. Implement evidence-based interventions such as:
   • Provider education and reminders 1
   • Standing orders for vaccination 1
   • Making vaccine readily accessible (mobile carts, convenient locations) 1
   • Monitoring and feedback of vaccination rates 1

Pitfalls to Avoid

• Implementing interventions without understanding the current process - leads to wasted resources and ineffective changes
• Focusing only on patient education without addressing system barriers
• Single-component interventions - ACIP notes these "will likely have minimal effectiveness" 1
• Failing to engage all stakeholders in the flow chart creation process

By starting with a flow chart of the current process, the clinic will establish a solid foundation for subsequent quality improvement efforts, ultimately leading to improved influenza vaccination rates and better patient outcomes.