An audit shows your immunization rate for well children to be 45%

What do you do?

The state periodically reviews primary care practices for their performance on childhood
immunizations. Your group is very disappointed by your score, which suggests that fewer than half of
the eligible children in your practice are receiving their recommended immunizations.

You verify the results and investigate further. The key to the analysis step of the FADE model is:

**IDENTIFY THE SITE OF THE DEFECT BEFORE YOU MAKE A CHANGE!**

A root cause analysis identifies missed opportunities and problems with recording immunizations.
That is:

1. Children overdue for immunizations often are seen in the office for other problems and no
one notices the need for vaccinations

2. Children who receive their vaccines elsewhere don’t always have these recorded in your
records

**BEFORE YOU CREATE A NEW SYSTEM TO FIX SOMETHING, BE SURE THE STEP YOU ARE FIXING IS
TRULY THE SOURCE OF THE PROBLEM!**

To address these problems, you develop a new system. You designate one nurse to be responsible
for immunizations, and have her do pre-visit chart reviews on all children.

About 18 months later, your immunization rate is now 82%

What would you do now?

Is 82% good enough?

You could pat yourselves on the back and say that you licked that problem. Or you could decide that
while better, 82% is still not what you want your rate to be. Your are shooting for 90-95%. You could
decide to do another round of the FADE process to see if you can make this rate even better.

Let’s move on to see what we can do….

This is a cyclic process.

1. You Evaluate the impact of your change

2. You Focus down further

3. You Analyze the problem to find the root cause/causes ***

4. Then Develop methods for further improvement

5. And Execute and Evaluate again!

Repeat the process until the goal is achieved.

Another commonly used QI model is the PDCA cycle:

1. PLAN: Change or test of how something works

2. DO: Carry out the plan

3. Check : Look at the results. What did you find out

4. ACT: Decide what actions should be taken to improve

Repeat as needed until the desired goal is achieved

It is very similar to FADE : Focus, Analyze, Develop, Execute/Evaluate