In June 2019, the Michigan Department of Health and Human Services (MDHHS) FIMR Program, within the Division of Maternal and Infant Health, worked with the MDHHS Lean Process Improvement Section and convened local FIMR teams to improve the FIMR recommendation process through lean process improvement methodology.

Four lean process improvement workshops took place to improve how recommendations are written, sorted, and elevated to state leadership for analysis and action. Through the workshops, local teams recommended a new FIMR recommendation form and log be developed to assist in writing and tracking actionable, equitable, and specific recommendations. Additionally, local teams identified a strong need to better integrate health equity into the FIMR process. As a result, local and state program staff formed working committees to develop and test six resources identified during the workshops:
1) FIMR Health Equity Toolkit
2) FIMR Interview Guide
3) FIMR Case Review Team Recommendation Form
4) Log of Local FIMR Recommendations
5) Local and State Data Sources for FIMR Case Abstraction
6) FIMR Community Action Team Roles & Responsibilities guidance document.

In September 2019, FIMR network members reviewed the developed materials and provided feedback. In December 2019, FIMR network members held a mock FIMR case review team meeting to practice using the recommendation tools. Between January and August 2020, the FIMR Network members began field testing the new materials with their respective local teams.