QI in COVID-19 Response

Insights from an accredited health department – Tulsa Health Department

Tulsa Health Department located in Tulsa, Oklahoma utilized quality improvement early in COVID-19 response efforts to assist with managing information requests from the community. Tulsa Health Department achieved reaccreditation from PHAB in 2019.

Plan-Something had to be done!

In June 2020, Tulsa Health Department (THD) began to receive a high volume of inquiries and guidance requests from local schools, businesses, faith-based organizations, event organizers, and restaurants/bars on how to appropriately implement COVID-19 safety measures. To alleviate the increased continual flow of questions coming into the Liaison Officer, epidemiologists, and COVID-19 phone bank, THD quickly identified the need to refine the existing process using a condensed Kaizen event.

THD formed a planning team with representation from many staff, including environmental public health, food protection services, legal, marketing and customer service to create the COVID-19 Plan Review Process. Each team member brought their subject matter expertise to the table and each member was experienced in basic-level quality improvement tools. The project leader, trained as a Six Sigma Green Belt and serves as THD’s Quality Improvement Manager, provided leadership and guidance to steer the newly formed Plan Review Committee.

Due to COVID-19, the typical length of the Kaizen event was shortened. In the planning phase, the THD planning team held a brainstorming session to determine the best strategies to handle the large volume of inquiries and requests for information. The brainstorming activity identified and grouped questions from the community, which revealed the need to provide targeted guidance to specific organizations and/or groups. Based on this information, an action plan was developed. First, the COVID-19 Plan Review process would allow for THD to accept COVID-19 plans for review. This provided community members an opportunity to detail and document the proposed actions to implement safety measures. Additionally, the committee formulated a Check Sheet of all the information that would need to be accounted for regarding public health safety measures while assessing the plans. This Check Sheet later became the COVID-19 Checklists.

Do-Put this plan into action!

The planning team began transitioning their role to work on reviewing COVID-19 safety plans. Individuals requesting information from THD had the option to submit their COVID-19 safety plans for a complimentary assessment. THD was cautious in the language used since THD was not formally “approving” a safety plan, but rather offering additional guidance or feedback to bolster current safety plans. To be as accommodating as possible, THD accepted any format of COVID-19 safety plans. Using the information available through the CDC website, the COVID-19 Plan Review committee pulled together a comprehensive COVID-19 Checklist tool specific for faith-based organizations, schools/universities, events, businesses, and restaurants/bars. Within each Checklist, considerations were listed for individuals to implement as it relates to their specific needs. During the assessment of a COVID-19 safety plan, the consideration would be marked as In-Place, Not-in-Place or N/A. These Checklists can be viewed on the THD website. THD published the Checklists within the COVID-19 website to allow individuals an opportunity to glean ideas for their plan development and know exactly what information THD would be looking for within a safety plan. Also, THD utilized a central email address for partners to submit their safety plans. A confirmation email was sent to the plan submitter with a maximum two-week turnaround timestamp. The assigned safety plan reviewer would provide the individual with a completed Checklist and feedback on how to enhance and implement CDC safety protocols.

Check: Is this process working?

Initially, the COVID-19 Plan Review committee and Checklists were developed to streamline the large number of COVID-19 inquiries. However, as staff worked through this process, THD experienced many other benefits. Our current and newly connected community partners gained a sense of self-responsibility and personal education for COVID-19 safety measures. By having to develop and submit their own personalized COVID-19 safety plan, these organizations/groups had to study COVID-19 safety guidance and reference the CDC COVID-19 website to explain how they would keep their employees, patrons, and visitors safe. When the plan was assessed and information was found to be missing or inadequate, this allowed THD the opportunity to have a conversation with the individual to talk through any changes that needed to occur. It connected external clients with a THD point of contact for any additional questions that may arise during the pandemic. Additionally, by establishing this COVID-19 Plan Review process, the City of Tulsa Mayor issued a citywide ordinance requiring any event with 150+ attendees to submit COVID-19 safety plan for review by the Tulsa Health Department as part of the requirements for issuing a City of Tulsa event permit. In total, THD has received 366 COVID-19 safety plans to review.

Act: Where do we go from here?

As we look to the future and reflect on the past year, THD has the insight and ability to stand-up a similar process for any public health emergency. As THD begins to demobilize the Incident Command System and hotwash the events of COVID-19, this QI process, the tools utilized and the steps taken, and lessons learned will be documented for staff access. THD gained trust and developed partnerships through this work in quality improvement amid the pandemic!

Ashley Thompson, Manager, QI and Customer Service, Tulsa Health Department