Success Stories

Improving Data Flow

Death Data Delivery

Decrease time to transfer applicable and accurate death certificate data from state to local health departments was the goal of a Kaizen event at the North Carolina State Department of Health.  Within three months the team achieved the targeted time goal (from date of registration to date data posted for use) from 99 days to 60 days.  Two months later they reached their new state of 16 days (average) an 84% time reduction.

Kaizen participants included MN DOH, NAPHSIS, Maricopa County DPH, NYC Health, Hartford County HD, ASTHO

Kaizen sponsors:  ASTHO and Robert Woods Johnson Foundation

Kaizen event led by Continual Impact LLC (Chris Bujak & Pam Vecellio).

Resultsflow-ss-1 flow-ss-2 flow-ss-3  


Data is an important part of helping State and Local health departments achieve better health outcomes for their constituencies.  Currently there appear to be gaps in the timeliness, accuracy, and usability of data provided to local health departments which hampers effectiveness in its use. The current paper processes consume significant labor to register state death data.


To improve the availability of timely, identifiable death data from state to local health departments so that state and local health departments have data for surveillance, program planning and evaluation, making informed decisions, guiding programs, and ultimately improving health outcomes; vital records and vital statistics tasks are more efficient and require less labor; and state and local employee relationships are improved

Approach & Methodsflow-ss-4

  1. Established improvement goal
  2. Mapped out the process Value Stream
  3. Collected time and waste data
  4. Conducted Kaizen event (5 days)
    1. Understand the current work processes (Sub Process Map and & Going to the Gemba)
    2. Identified, analyzed wastes, and prioritized
      improvement focus
    3. Root caused high priority wastes
    4. Identified and prioritized solutions
    5. Developed and tested solutions; learned lessons from tests; developed standardized work and training material
  5. Installed solutions


The process was re-sequenced and redesigned to eliminate unnecessary steps, recycle loops, and wait time and other wastes. Flow concepts and techniques were put in place.

Reducing the batch sizes were critical to decreasing inter-process times

  • Batch size is consistent for everyone ~ 100 certificates / batch (original batches were 500 and 250)
  • Building books of 500 is after registration and data entry is complete (at the end vs. the beginning of the process)
  • LHD to mail certificates weekly.

Some unnecessary process steps were removed

  • Corrections pulled out and given to Corrector (no copies)
  • No formal Final Arrangement; #ing and data stamping will occur weekly
  • Data Verification will NOT verify every field; all fields were being entered/reviewed two times.

Improved job aids used within the process

  • New batch coversheet will be with the batch through the entire process
  • Streamlined tracking logs.


Thank you for listening and caring about what I do.

To read more, this project summary can be found on the Public Health Quality Improvement Exchange site:  North Carolina Timeliness of Provisional Death Data Project