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Vital Records “Kaizen” Change for the Better in North Carolina

Dr. Potrzebowski is the Executive Director of NAPHSIS.

Like all jurisdictions, North Carolina is doing all it can to move from "good to great" in vital records—striving to meet increasing demands for more, better, faster vital records data from the user community. As you all know well, it's often easier said than done. This January, with support from the Robert Wood Johnson Foundation, Association of State and Territorial Health Officials (ASTHO), and other public health partners, the North Carolina State Center for Health Statistics had the opportunity to host a kaizen event to take an in-depth look at the process from the receipt of a death certificate to the availability of preliminary death data for local public health agencies and explore opportunities for quality improvement.

"A what?"

In Japanese, "kaizen" means "change for the better." In a workplace context, the word refers to methods for work process improvement. Kaizen events are planned team exercises focused on systematically uncovering waste in workflow, and eliminating such process inefficiencies rapidly. This process is not for the faint of heart—it is very intense and for some, threatening—but it is inspiring what can be accomplished in just a short amount of time.

To navigate this process, North Carolina's State Center Director Eleanor Howell invited a number of the vital records and vital statistics staff, NAPHSIS staff and members, representatives from ASTHO, and other state and local health departments to participate. A neutral facilitator—Continual Impact—guided the group through the exercise and helped us focus on achieving results.

North Carolina does not yet have an electronic death registration system (EDRS), so paper copies of death records are sent by county health departments to the state vital records office (VRO) for processing and data entry. When the latest U.S. standard certificate of death was adopted at the beginning of 2014, a new data entry system was also implemented, bringing change to the registration process within vital records.

During the first two days of the kaizen event, the North Carolina vital records staff mapped the current process in detail. They then went through that process step by step, identifying bottlenecks and non-value added work, or waste – defined as effort that does not contribute to moving the process forward.

With the bottlenecks identified, staff could then focus on generating creative solutions. For example, the North Carolina vital records staff discovered that they could eliminate non-value added work by processing records more on a flow basis - decreasing batch sizes and increasing frequency of record submissions by county health departments as well as data transmissions to NCHS. These changes eliminated elapsed time at several steps during which the death records had previously been sitting and awaiting action.

By week's end, the North Carolina vital records staff identified ways to modify internal processes that when implemented, will enable them to achieve an almost 50 percent reduction in death processing time. "We are very proud of our own staff's engagement in this process and the results of their efforts," said Howell, who participated in the kaizen event along with the North Carolina staff.

The changes are being implemented as the 2015 deaths are registered and processed, and the local team continues to meet to identify modifications to the proposed changes in order to eliminate even more waste. Going forward, Howell expects that more than 80 percent of death records will be processed and data made available to key users, including the National Center for Health Statistics, state public health programs, and local health departments, within 25 days of date of registration.

I commend North Carolina's VRO management and staff for their willingness to take a leadership role in this quality improvement initiative. Their experience with this kaizen event shows the value of continuous quality improvement (CQI) in vital records, and that CQI should be embraced and not feared.

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