title: A systematic approach to improving intrauterine device services in family planning clinics.
abstract: OBJECTIVE
  To improve the quality of intrauterine device (IUD) services at Title X clinics.
  
  
  METHODS
  Failure Modes Effects and Criticality Analysis (FMECA) is a step-by-step approach, adopted for healthcare, in which team members evaluate the systems and processes of a specific type of clinical care (e.g., IUD care) in order to identify practices that contribute to poor quality, unsafe, unreliable, or inefficient care. These weaknesses are termed "failures." The FMECA uses qualitative (e.g., meetings) and quantitative (e.g., clinical operations) data to determine failure frequency and impact in order to prioritize the parts of a clinical care system or process to be redesigned and improved. An FMECA was conducted in three community-based Title X family planning clinics on the South and West Sides of Chicago, IL with all care team members; IUD clients were also interviewed regarding their visit. Clinic administrative data was also assessed to determine the frequency and impact of the identified failures.
  
  
  RESULTS
  After combining the FMECA and clinical operations data, "critical" areas across all three clinics were: (1) client does not show up for or cancels appointment; (2) client is ineligible for an IUD insertion due to unprotected intercourse; and (3) limited time for counseling, informing, and placing IUDs. As most insertions were successful, failed IUD insertion was not considered a high-risk failure.
  
  
  CONCLUSIONS
  This process revealed that the failures most in need of improvement and redesign were the scheduling and intake processes and the lack of time for counseling during certain types of visits.
  
  
  CONCLUSIONS
  A systematic assessment of the underlying problems in IUD-care revealed three important issues across three clinics: (1) client does not show up for appointment or cancels appointment; (2) client recently had unprotected intercourse; and (3) limited time for counseling, informing, and placing IUDs.
authors.affiliation: Section of Family Planning & Contraceptive Research, Department of Obstetrics & Gynecology, The University of Chicago, Chicago, IL, USA. Electronic address: mgilliam@babies.bsd.uchicago.edu.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Gilliam
authors.affiliation: Section of Family Planning & Contraceptive Research, Department of Obstetrics & Gynecology, The University of Chicago, Chicago, IL, USA.
authors.forename: Stephanie Q
authors.initials: SQ
authors.lastname: Mistretta
authors.affiliation: Section of Family Planning & Contraceptive Research, Department of Obstetrics & Gynecology, The University of Chicago, Chicago, IL, USA.
authors.forename: Summer L
authors.initials: SL
authors.lastname: Martins
authors.affiliation: Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D017064:Process Assessment, Health Care; D034121:Reproductive Health Services
keywords: Adolescent; Contraception; Quality improvement; Risk assessment; Young adult