Quality Improvement

• Learn more about a Quality Improvement Process: Plan-Do-Check-Act (below)
• Ensure a QI definition is included in board orientation and on-going education materials
• Talk to the Health Officer about the Agency’s continuous quality improvement (CQI) efforts.
• Add quality improvement as an agenda item to every board meeting and engage every board member.
• Complete the NPHPSP Governance Assessment and identify areas where your board can improve.
• Read "Stories from the Field" to identify ways boards of health are engaged in Quality Improvement. View one now.
• Celebrate progress by sharing your story!

• Continuous quality improvement (CQI) will strengthen your board, your agency, and the overall health of your community.
• The focus is set on a vital few priorities.
• A sense of urgency for measurable results is created.
• Every board of health member and agency employee is engaged.
• Fact-based decision making is used.
• A QI Plan is required documentation for National Accreditation.

Public Health Foundation: Performance Management & Quality Improvement webpage offers research and tools specific to evaluating and building the capacity of public health systems.

 

Centers for Disease Control and Prevention: Post-assessment and Performance Improvement Resources includes sample tools and links to resources for groups that have completed the National Public health Performance Standards assessment and have entered the post assessment phase, and the Performance Management & Quality Improvement webpage offers concepts, resources, and links intended to support state, tribal, local, and territorial health agencies.

 

National Network of Public Health Institutes: Stories from the MLC representing the broad array of effective approaches underway in state and local public health departments across the nation, and are intended to help others navigate and reflect upon their own preparations for accreditation and quality improvement.

 

National Association of County & City Health Officials: Quality Improvement Toolkit designed for Local Health Departments for quality and performance improvement.

 

Association of State and Territorial health Officials: Master Resource List offers resources that explain performance management, quality improvement, and accreditation concepts.

 

Quality Improvement Consultants can assist with internal or external QI projects. Advantages exit for using either an internal QI leader or an external QI consultant. If interested in engaging a QI consultant, contact NALBOH for a list of individuals in your area.

 

The Journal of Public Health Management and Practice (JPHMP) January/February 2010 Special Edition. The journal focuses on the current and future states of QI in public health including issues that affect quality improvement in public health and processes that can serve to implement effective change.

 

Consensus Statement on Quality in the Public Health System. (pdf) Dept. of Health and Human Services. (2008).

 

Core Competencies For Performance Improvement Managers. National Public Health Improvement Iniatives (NPHII)

 

Quality Improvement: Implications for Public Health Preparedness. (pdf) RAND. (2006).

 

Embracing Quality in Local Public Health: Michigan’s Quality Improvement Guidebook. (pdf) Tews, Sherry, Butler, & Martin. (2008).

 

The contents of above links are solely the responsibility of the authors and do not necessarily reflect any official recommendations from NALBOH.

 

Core Concepts of PDCA Model

PLAN: Investigate the current situation, identify and prioritize quality improvement opportunities, and develop an action plan with potential solutions.

DO: Carry out the action plan.

CHECK: Look at the results and reflect. What did you find out? Remember to document lessons learned, knowledge gained, and any surprises.
(This step is sometimes referred to as STUDY)

ACT: Decide what actions should be taken to improve. You can Adopt, Adapt, or Abandon the changes made.

Board of Health Example: Advocating for Evidence-Based Policies

 

1. The Board completed the NPHPSP Governance Assessment.
2. The Board reviewed Assessment results to prioritize the quality improvement opportunities. It was identified that the Board should advocate for adequate resources and organizational support for the health agency.
3. The Board worked with the Health Officer to develop an AIM statement: “The Board of Health will advocate for resources to support one additional evidence-based policy that is a community priority during the 2011 calendar year.” An Aim Statement is a written, measurable, and time-sensitive description of the accomplishments the Team expects to make from its improvement efforts.  The Aim Statement answers the question:  “What are we trying to accomplish?”
4. The Board talked about possible reasons as to why they had not advocated for resources and organizational support in the past. Using a cause and effect (fishbone) diagram, the Board believed that the root cause was a lack of knowledge about what to advocate for.
5. The Board identified potential improvements and worked with the Health Officer to review the Community Health Assessment and the Community Guide to target a priority area and identify a recommended evidence-based policy. The Board selected “Physical Activity” as the priority area and identified the specific policy “Community-Scale Urban Design Land Policies.” The Board recognized that other stakeholders were also involved, and recognized the importance of including other stakeholders, such as the Planning Commission, in their advocacy efforts.
6. The Board drafted and approved the improvement theory: “Advocating for resources and organizational support for the health agency will lead to improved health outcomes in the community.”
7. The Board worked with the Health Official to develop an action plan: a Board of Health/Planning Commission sub-committee would meet on a monthly basis in order to listen to reports, analyze data, talk to the community, and draft policy recommendations over a 9-month time period; the Board of Health would then use the policy recommendations to advocate to the Commissioners for approval of an Urban Design Land Use Policy, which would include resources to assure the health agency budget supported the recommended intervention. The action plan indicated what needed to be done, who was responsible, and when it should be completed.

1. The Board implemented the action plan (see #7 under Plan). The Board was mindful of all State and Jurisdictional laws while implementing the plan.
2. The Board and sub-committee were attentive and collected all meeting minutes and reports provided during this period. The Health Officer received a copy.
3. The Board also documented the lessons learned and knowledge gained. The Board members knew this would be helpful for future Board members, and the information might also help other Boards facing similar issues.

 

1. The Board reflected on the effect of their advocacy efforts and reviewed their AIM statement. They were able to successfully ensure agency resources to support an evidence-based policy that was a priority in the community. As an extra bonus, their plan had an unintended consequence of increasing community partnerships and general community involvement.
2. In talking with the Health Officer and key health agency staff, the board ensured the agency was evaluating the effects of the Land Use Policy.
3. Again, the Board documented the lessons learned and knowledge gained. They submitted their story to NALBOH for printing in the NALBOH NEWSBRIEF.

 

1. The Board was very happy with their progress and celebrated by having a local reporter post an article about the new policy with a picture of the sub-committee in the local newspaper and the Health Official verbally recognized the national publication of the story in the NALBOH NEWSBRIEF during a board meeting.
2. While the AIM statement was reached, the Board realized they could improve on their efforts. The Board adapted the action plan to identify 2012 priority area for advocacy and also included a follow-up item after policy implementation: provide and receive a quarterly report from health agency staff on the priority area.
3. The board continues with their advocacy efforts and has plans to use the PDCA cycle to address the issue of outdated health agency HR policies.

For more on the PDCA cycle, visit the Public Health Foundation Performance Management & Quality Improvement webpage and read the White Paper, “ABCs of PDCA,” by Grace Gorenflo and John W. Moran (April 2010).

 

“PDCA offers a data-based framework based on the scientific method. This simple yet powerful format drives continuous and ongoing efforts to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.