This transcript has been lightly edited for clarity.

How have you been able to use PHIG funding?

PHIG funding has allowed us to obtain certifications for folks in Lean Six Sigma in Yellow, Green, and Black Belt. That’s given us great experience in using Quality Improvement (QI) tools and, more importantly, facilitation. When they get back to our health district and they start working on a project inside their department, they’ve got the confidence and ability to work with folks who may not have a great experience with QI or have perceptions that may not be true – “it’s too much work, it takes too much time” – and having them work through a project and see results quickly. A good, well-trained facilitator can do that, someone who has a Green or Black Belt. We’re making the Yellow Belt available to our top leaders, so they’re not going to be running projects but they can hold their folks accountable that are running the projects, ask the right questions, and give them the support that they need. PHIG funding has allowed us to pay for this training, get our people trained, and when they come back to our agency they’re able to make a bigger difference faster.

How is Lean Six Sigma training improving services?

Recently, we were trying to drum up new QI business, looking for what programs could use the help the most, so we hosted office hours. We had a consultant come in and help me for a little bit, and we had office hours posted, and the Healthy Start program showed up. The Healthy Start program makes such a big difference. It connects expecting or new mothers to services – including some services they don’t even know that they need. They get guidance and linkage to services through prenatal care, also sometimes access to discounts to diapers, baby food, other supplies, car seats, and a support system for these folks that they may not have otherwise. Their enrollment numbers were trailing our national average and they wanted to fix it.

We worked with their group using Lean Six Sigma tools. Through a process map, we discovered that the process wasn’t working. What we found was that blocking us was that our folks were reading from a script. It’s really difficult to connect with someone, especially in this kind of state of expecting maybe their first child, or another child which is a whole other level of challenges. So we threw away the script and the team worked together to build a scorecard. They use this scorecard not as a punishment for the boss to look at, but each of these community health workers after every call rates themselves on the scorecard to document, “How did I do on making a personal, emotional connection with that mother on the other end of the phone?” And that has turned things around. We saw an immediate lift in their morale and their engagement because they could feel that connection. It’s more fun for them to do this work instead of having to read from a script, knowing that the chances of the person on the other end of the line actually enrolling in the program may not be great. Now, they’re connecting with that other person, usually the mother on the phone, finding out what their needs are, what their concerns are, and then they’re able to match the services that we provide to them.

What’s been the impact?

Let’s review the evidence for Healthy Start. The first three months trailed the national average of 40%. We began our Lean intervention in March and saw the numbers climb immediately. We more than doubled our enrollment numbers over the prior six months from 31 families to 64.

I see the impact in two areas: one is in our staff and our people and the other is in hard results. The staff feels better about their work. They’re in public health for a reason. To enable them to make a bigger difference than they were yesterday, in the same work is having a huge impact on how they feel about their work, which can empower them to bring others along, get new people interested, always trying to build our quality improvement mindset. So, that people part is really important.

Another project where we were able to actually eliminate the wait list to our behavioral health clients that previously was over three months long and by making some changes to our process without changing anything in the resources, it’s a huge difference. And without some of this focused training that we get from Lean Six Sigma, it would’ve been very difficult if not impossible.

Why is this work so important?

The structure of the PHIG grant has been a huge benefit to our agency. Instead of depending on pass-through grants, we were able to write our own application and create the program that’s going to serve us best. That has enabled us to have a much bigger impact by putting staff members where they’re needed, where they can do the most work, and having the discretion once the grant starts over this five-year period, with the help of our CDC project officer, to move some of the funds around where it makes sense for us to have a bigger impact because the environment changes over time. And I’ve never seen this kind of flexibility before in a grant, and that’s had a huge impact on how we serve our community.