Quality Improvement

The Zanesville-Muskingum County Health Department (ZMCHD) is committed to the concept of continuous quality improvement. Continuous quality improvement is one of the focus areas in the Strategic Plan and is included in individual work plans. This QIP is intended to provide a framework and guidance within the agency to ensure that resources and processes are available for continuous quality improvement. This plan specifically addresses the current and future state of quality within the agency, workforce training, structure of a Quality Improvement Council (QIC), and linkages to other key documents, including the Strategic Plan, the Community Health Improvement Plan, and the Workforce Development Plan. A process for determining QI projects is also included.  This plan will serve as a foundation for enhancing quality in current agency processes and will instill a culture of quality improvement throughout the agency. Implementation of this plan will also be a foundation for ZMCHD’s efforts to become nationally accredited.

Our first quality improvement project was completed in 2009 with assistance provided by the Ohio Voluntary Accreditation Team.  Following this project, ZMCHD has continued to complete atleast 1 project a year.  In 2011 ZMCHD established a Quality Improvement Council (QIC) to oversee the selection of QI projects and to build QI throughout the agency.  Projects ideas are identified through customer feedback or surveys, division meetings, annual employee survey, Community Health Assessment and after action reports.  All employees are also encouraged to submit QI project ideas.


ZMCHD applies the continuous quality improvement process by following the Plan Do Study Act (PDSA) approach.  Trainings and resources have been provided by The Ohio State University College of Public Health.  ZMCHD has also taken advantage of additional training and resources through LeanOhio.


Current Projects

Improve the new employee onboarding process

Started January 2018



ZMCHD implemented BambooHR over two years ago. The software created an electronic flow of the onboarding process for new employees. The purpose of onboarding includes providing new staff with a good general knowledge of the entire organization. This includes the ability to answer public questions not related to their role and helping establish a strong internal network. There are several concerns about potential variation and gaps across divisions and onboarding activities.



The goals are centered on developing consistency and standardization for the process such as on time completion of assignments and strong knowledge about ZMCHD as well as employee satisfaction.


2017 QI Project Results

Equipment Inventory Team

Project completed in 2017



  • Develop a uniform system to manage equipment inventory
  • Have the ability to locate items quickly and accurately to prepare for audits
  • Avoid duplicating purchases
  • Create an accurate inventory for liability insurance coverage


A clear and standardized definition of equipment to be inventoried was created along with an easy to use flow chart.  An inventory coordinator role was developed to coordinate the purchase of equipment and maintain inventory records.  Finally, a standardized electronic format for maintaining inventory records was developed.  Along with these improvements several additional forms were also created to assist with tracking equipment.  A procedure and form was created to track equipment that is stored off site or loaned out.


Streamline Cross Department Processes Team

Project completed in 2017


  • Reduce staff time spend on redundant and duplicated efforts
  • Reduce the number of opportunities for a missed visit
  • Reduce the number of no show appointments
  • Develop a framework for other cross department processes


A web-based documentation system was created to share operational data between departments and buildings.  A central coordinator role was created to make contact with the potential client and make referrals to facilitators.  This additional role eliminated missed opportunities to reach a potential client.  Additional trained facilitators were utilized.  The project was also able to create a framework to improve other cross department processes within the agency.


2016 QI Project Results

Fleet Vehicle Management Team

Project completed in 2016


Plan for improvement:  The process for managing fleet vehicles is time consuming for the fleet manager with challenges that include keeping the vehicle availability calendar updated, staff using personal vehicles when a fleet vehicle is not available, the perception of unfairness on vehicle assignments and staff not requesting vehicles.


The goals of the project included:

  • Reducing the amount of time spent managing the process
  • Increasing staff satisfaction with vehicle requests
  • Increasing the utilization of fleet vehicles
  • Improving the time to confirm or deny a vehicle request


Results: The team decreased the complexity and number of steps to request a fleet vehicle.  The simplification and standardization reduced the amount of time the fleet manager spends on the process. The process improvement reduced the number of steps from 67 to 22.

Fleet vehicles with seasonal duties were made available during the offseason. This better utilized them and increased vehicle availability for staff with daily driving assignments.

The team eliminated a paper driven process to adjust program expenses through the use of a spreadsheet.


Community Health Assessment Project

Project completed in 2016


Plan for Improvement:

  • Increase common CHA indicators and measures by 75% of more by May 30, 2016
  • Complete selection of common electronic dashboard; align administration cycle; and determine viability of a single vendor for 3 or 4 counties conducting the survey by May 30, 2016


Results: As a part of this standardization project, partners have identified a 300% improvement on the number of standardized indicators and a 1,200% improvement on the number of standardized measures. When conducting their upcoming Community Health Assessments, all four LHDs have agreed to use consistent sources for secondary data and use uniform questions for primary data across 28 indicators and 78 measures. The partnership also made recommendations for future CHAs that would provide measureable improvements, such as a consistent cycle, a shared data-collection contract, and a shared dashboard software to display regional as well as county-level data.