Creating Quality Improvement Culture in Public Health Agencies

Davis, Mary V.; Mahanna, Elizabeth; Joly, Brenda M.; Zelek, Michael; Riley, William J.; Verma, Pooja; Fisher, John F.

doi:10.2105/ajph.2013.301413

Cited by 24 publications

(32 citation statements)

References 18 publications

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“…In contrast, agencies that have more informal QI processes are more likely to consider QI a part of accreditation and see those barriers as overwhelming or insurmountable. 29 This was reflected in the differing responses between high-capacity and low-capacity LHDs about program evaluation, as well as program adaptation. High-capacity LHDs were more likely to see evaluation as important, and use that evaluation to adapt or adopt new programs, whereas low-capacity LHDs were more likely to report lacking established methods of evaluation, and reported a lack of appropriate programs or funding as a significant barrier.…”

Section: Discussionmentioning

confidence: 99%

“…Factors needed to facilitate a QI culture include having agency leaders and staff who are committed to using QI processes, aligning QI practices with strategic goals, having experience in QI or EBDM in the past, having leaders, partners, and boards that hold them accountable for their service quality, and having a supportive infrastructure with sufficient resources to maintain a QI culture. 27–29 For many high-capacity LHDs, program evaluation has involved creating a culture of improvement within their agency that makes it an expectation—if they do face barriers, most of the time it is in formalizing the process. While some of the challenges faced by low-capacity LHDs are not modifiable, it might be feasible to begin to shift the culture of the organization toward one more supportive of QI.…”

Section: Discussionmentioning

confidence: 99%

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Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments

Tabak

Duggan

Smith

et al. 2016

Journal of Public Health Management and Practice

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Context Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health and is important in local health departments (LHDs) to retain the benefits of effective programs. Objective Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards. Design Case study interviews from June-July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively. Setting Six geographically diverse LHD’s (selected from three high- and three low-capacity) Participants 35 LHD practitioners Main Outcome Measures Thematic reports explored the eight domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework. Results High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training compared to low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High- and low-capacity LHDs described strategic planning, but high-capacity LHDs reported efforts to integrate evidence-based public health. Conclusions Investments in leadership support for improving organizational capacity, improvements in communication from the top of the organization, integrating program evaluation into implementation, and greater funding flexibility may enhance sustainability of evidence-based public health in LHDs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments

Tabak

Duggan

Smith

et al. 2016

Journal of Public Health Management and Practice

View full text Add to dashboard Cite

show abstract

“…Information infrastructure, performance measurement, oversight and accountability (14); incentives to cross-unit collaboration (15). QI strategic priority (16) Davis et al 47 Barriers to QI: lack of time, resources, perceived low relevance, poor leadership and teamwork commitment to QI, and insufficient QI training and experience (11). Mandatory QI for accreditation may be a QI driver (10) Leadership support (12).…”

Section: Evaluations Of Roi In Qi Initiativesmentioning

confidence: 99%

Evaluating investment in quality improvement capacity building: a systematic review

et al. 2017

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PurposeLeading health systems have invested in substantial quality improvement (QI) capacity building, but little is known about the aggregate effect of these investments at the health system level. We conducted a systematic review to identify key steps and elements that should be considered for system-level evaluations of investment in QI capacity building.MethodsWe searched for evaluations of QI capacity building and evaluations of QI training programmes. We included the most relevant indexed databases in the field and a strategic search of the grey literature. The latter included direct electronic scanning of 85 relevant government and institutional websites internationally. Data were extracted regarding evaluation design and common assessment themes and components.Results48 articles met the inclusion criteria. 46 articles described initiative-level non-economic evaluations of QI capacity building/training, while 2 studies included economic evaluations of QI capacity building/training, also at the initiative level. No system-level QI capacity building/training evaluations were found. We identified 17 evaluation components that fit within 5 overarching dimensions (characteristics of QI training; characteristics of QI activity; individual capacity; organisational capacity and impact) that should be considered in evaluations of QI capacity building. 8 key steps in return-on-investment (ROI) assessments in QI capacity building were identified: (1) planning—stakeholder perspective; (2) planning—temporal perspective; (3) identifying costs; (4) identifying benefits; (5) identifying intangible benefits that will not be included in the ROI estimation; (6) discerning attribution; (7) ROI calculations; (8) sensitivity analysis.ConclusionsThe literature on QI capacity building evaluation is limited in the number and scope of studies. Our findings, summarised in a Framework to Guide Evaluations of QI Capacity Building, can be used to start closing this knowledge gap.

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“…Previous research indicates that LHDs that participate in at least performance improvement efforts can enhance performance throughout the LHD. 29 We accounted for this potential effect by identifying performance improvement efforts that could affect preparedness capacities in the comparison group where program records were available at the LHD level. These efforts included the PHAB beta-test, the NPHPSP, and PPHR.…”

Section: Methodsmentioning

confidence: 99%

“…29 Using quantiles of the estimated propensity score, LHDs were stratified into four dummy variables for each group. LHDs assigned to the upper fourth quantile (n582) represented those health departments whose characteristics were most similar to those in NC.…”

Section: Variablesmentioning

confidence: 99%

Effects of Performance Improvement Programs on Preparedness Capacities

2014

Self Cite

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Objective. In response to public health systems and services research priorities, we examined the extent to which participation in accreditation and performance improvement programs can be expected to enhance preparedness capacities.Methods. Using data collected by the Local Health Department Preparedness Capacities Assessment Survey, we applied a series of weighted least-squares models to examine the effect of program participation on each of the eight preparedness domain scores. Participation was differentiated across four groups: North Carolina (NC) accredited local health departments (LHDs), NC non-accredited LHDs, national comparison LHDs that participated in performance or preparedness programs, and national comparison LHDs that did not participate in any program.Results. Domain scores varied among the four groups. Statistically significant positive participation effects were observed on six of eight preparedness domains for NC accreditation programs, on seven domains for national comparison group LHDs that participated in performance programs, and on four domains for NC non-accredited LHDs.Conclusions. Overall, accreditation and other performance improvement programs have a significant and positive effect on preparedness capacities. While we found no differences among accredited and non-accredited NC LHDs, this lack of significant difference in preparedness scores among NC LHDs is attributed to NC's robust statewide preparedness program, as well as a likely exposure effect among non-accredited NC LHDs to the accreditation program.

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Creating Quality Improvement Culture in Public Health Agencies

Abstract: Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

Cited by 24 publications

References 18 publications

Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments

Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments

Evaluating investment in quality improvement capacity building: a systematic review

Effects of Performance Improvement Programs on Preparedness Capacities

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