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Helping Vital Records Do Better - Perspectives from Continual Impact, LLC

NAPHSIS and the vital records jurisdictions are on a mission to provide "more, better, and faster" data to improve public health and prevent waste, fraud, and abuse. North Carolina and Minnesota state vital records offices and Continual Impact, L.L.C. have worked on improving efficiencies and enhancing processes by providing valuable health information used to plan and evaluate public health programs and measure the health of our populace. In this interview with NAPHSIS's Patricia Potrzebowski and Continual Impact's Pam Vecellio & Chris Bujak, we delve deeper into what quality improvement is and how it is working to improve vital records.

NAPHSIS: What is continual quality improvement?

Continual Impact: Improvement is simply about helping people make things better. It is achieving sustainable performance (increased efficiency and/or effectiveness) beyond what is thought possible to the benefit of your customers, teams, funders, and society. Good quality improvement is always a win-win-win-win.

Successful quality improvement activities leverage the power of the people who perform the work; engages leadership in a meaningful and supportive fashion; focuses the improvement so it aligns with the organization's needs and can be done rapidly; uses learning from the work site to identify practical solutions; applies numerous, detailed improvement methods during the event to empower the individual and effectively solve problems; and implements the solutions quickly and sets the stage for further improvements.

Improvement activities alone, with a team, with customers all follow an improvement cycle based on data driven problem solving and eliminate non-value added work or simply, waste.

NAPHSIS: How can quality improvement help in vital records?

Continual Impact: Staff members use improvement methods to close gaps, reduce/eliminate work process 'pain points.' Past improvement projects included improving the community's experience, decreasing internal certificate processing times, improving data quality, and increasing partner collaboration, just to name a few.

NAPHSIS: What results have you seen so far from states' quality improvement initiatives?

Continual Impact: Several leaders of vital records offices sought to improve the timeliness, accuracy, and usability death data and ultimately their responsiveness to the user community, both consumers of data such as local health departments, and families of decedents. As most NAPHSIS members probably recognize, the demand for real-time death data is growing as more and more customers want more and more data, sooner.

The teams we worked with ultimately had one improvement goal: reduce the time for death records to be available to both families seeking certificates, and for consumers seeking data.

The teams we worked with have utilized the Kaizen improvement method, described in the March 2015 article from Dr. Potrzebowski, Executive Director of NAPHSIS. And the results have been remarkable. In North Carolina, the vital records office:

  • Reduced time from date registration to available data from an average 99 days to 16 days.

  • Decreased county corrections by 11 percent.

  • Increased records submitted to the National Center for Health Statistics within 25 days or less from 0 records to an average to more than 70 percent of records!

In Minnesota, the vital records office was able to:

  • Reduce data sharing time from 9-22 months to 1 week,

  • Increase ICD-10 auto coded records by 15 percent, and

  • Employ better use of technology such as MR&C & SharePoint to enhance efficiencies.

NAPHSIS: Did the participating vital records offices benefit in other ways?

Continual Impact: Absolutely. Both states experienced additional benefits from their quality improvement enhancements beyond better timeliness and accuracy. For example, the Minnesota state vital records office experienced an "explosion of energy and involvement," with staff wanting to improve more and more. They received many invitations to present/share their experiences and assist in training others, received unsolicited stakeholder feedback and inquiries to get real-time data, and were recognized by leadership. These positive responses facilitated a sense of ownership and pride among staff, who continue to seek ways to make quality improvement a part of routine operations. The vital records offices also saw their partners' relationships improve at all levels—both inside and outside the health department. These relationships helped enhance the culture of quality and fostered a supportive environment among funeral directors and medical examiners who provide death data, the local public health department, NCHS, and NAPHSIS (see this article from Minnesota for more: "Regional funeral directors meeting valuable").

Finally, and perhaps most importantly, the vital records offices were able to revive local surveillance and be more relevant to public health practice (see this article from Minnesota for more: "Timely death data of great value to local public health"). Local public health departments want to "feel the pulse" of the mortality landscape at all times so they may be more responsive to more emerging issues, such as drug overdose related deaths. More timely data enhances analytic capacity and ultimately "move the dial" on persistent public health challenges such as traffic fatalities, infant mortality and sudden, unexpected infant death, and other efforts.

NAPHSIS: How can other vital records offices learn more about quality improvement?

Continual Impact: Vital records offices can learn more about improvement by talking with peers, reading, training, and attending conferences. They can contact Continual Impact, L.L.C. directly at or 877-252-5804, Molly Crawford ( to discuss Minnesota's experience, and they can learn more about other public health vital records improvement projects at:

But sometimes the best way to start on the path to quality improvement is to embrace it. Look for waste in your role and try to eliminate it. Engage customers & partners—both internal and external—at all levels. Listen to data, information, and pain points; you'll find there are many opportunities to improve. Set up or join an improvement project team. And challenge the amount of results that can be achieved. You'll be surprised just how much you can accomplish.​

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