Standards set by the Public Health Accreditation Board focus on cultivating a culture of quality improvement in health departments. One pf these standards is to have a quality improvement plan. The plan should document the infrastructure and support that is needed for supporting staff in moving toward a culture of quality improvement.
- The Public Health Quality Improvement Exchange lists information about public health quality improvement projects and example quality improvement plans.
- Public Health Accreditation Board Standards and Measures: Domain 9 lists the criteria for quality improvement in a department, including a detailed description of what is needed in the quality improvement plan.
The following are characteristics typically seen when using QI methods to solve problems:
- Examination of current performance
- Examination of current process (not people)
- Information based problem solving
- Small scale testing
- Measurable, incremental improvement
There is a natural evolution of changes that occurs as a health department engages in QI. Because of this, public health agencies vary in the QI maturity and culture present in their organizations. The National Association of County and City Health Officials (NACCHO) developed the QI Roadmap to a Culture of Quality Improvement to help departments assess their QI maturity. This roadmap also includes tools and resources to evolve your agency's QI culture.
Phases of quality improvement
According to NACCHO's Roadmap to a Culture of Quality Improvement, in Phase 1:
- Leaders and staff lack understanding of QI and do not see the value it adds to the public health practice.
- No QI trainings or resources are available to staff, and no staff are responsible for overseeing QI efforts/initiatives.
- Resources have not been allocated for QI and current agency plans do not address QI.
- Leaders are satisfied with the status quo and may be resistant to change.
- Processes may be unnecessarily complex or undefined.
- Leaders do not practice data-driven decision-making when developing the agency's strategies.
Roadmap to a Culture of Quality Improvement
Additional Roadmap Characteristics and strategies of Phase 1
According to NACCHO's Roadmap to a culture of Quality Improvement, in Phase 2:
- Leaders and some staff begin to have a high-level understanding of QI.
- A select number of leaders and staff have received QI training, however they lack the knowledge, skills, and ability to implement QI.
- A QI council may exist but is still not fully functional.
- Staff are resistant to QI out of fear of punishment and their lack of QI skills.
- Performance data may not be collected or utilized.
- Teams are rarely or never formed for the purposes of problem-solving or innovation and issues remain unaddressed.
Roadmap to a Culture of Quality Improvement
Additional Roadmap characteristics and strategies of Phase 2
According to NACCHO's Roadmap to a Culture of Quality Improvement, in Phase 3:
- Executive leaders value QI but expectations are not consistently communicated to staff .
- Basic QI trainings/resources are available and QI champions exist but opportunities for QI are limited.
- A limited number of staff are performing QI and there is a QI council but a QI plan may not be adopted.
- Data is collected and monitored but not routinely applied in decision-making processes.
- A small number of processes are being improved through discrete QI projects but may take excessive time to complete.
Roadmap to a Culture of Quality Improvement
Additional Roadmap characteristics and strategies of Phase 3
According to NACCHO's Roadmap to a Culture of Quality Improvement, in Phase 4:
- Agency QI plan has been created and is being implemented.
- Leaders encourage staff to engage in QI and formal QI project teams are frequently formed.
- Leaders actively seek out additional QI resources and communicate about QI to staff to create buy-in.
- Staff in certain areas have knowledge, skills, and abilities to complete formal QI projects.
- Data-driven decision-making is more common and internal customers are engaged in improvement processes.
Roadmap to a Culture of Quality Improvement
Additional Roadmap characteristics and strategies of Phase 4
According to NACCHO's Roadmap to a Culture of Quality Improvement in Phase 5:
- Leaders are knowledgeable about QI and support staff around QI initiatives.
- Most employees embrace QI and some staff with necessary skills to complete QI projects exists in all areas of the agency.
- Decisions are data-driven and performance data is used to identify QI projects.
- Formal methods for peer sharing and learning about QI exist and best practices are applied.
- Customer satisfaction measures are standard throughout the agency.
Roadmap to a culture of Quality Improvement
Additional Roadmap characteristics and strategies of Phase 5
According to NACCHO's Roadmap to a Culture of Quality Improvement in Phase 6:
- Staff have the appropriate knowledge, skills, and abilities to perform QI roles and QI is incorporated into job descriptions.
- Executive leaders and middle managers fully embrace QI and hold staff accountable for incorporating QI into their work.
- Customer needs are the center in decision-making and daily operations.
- Performance data drives decision-making and improvement efforts, and QI plans and goals are consistently met.
- A strong governance structure for QI exists and agency processes are standardized, efficient, and yield high-quality products/services.
Roadmap to a Culture of Quality Improvement
Additional Roadmap characteristics and strategies of Phase 6