Quality Improvement in Public Health

Public health agencies in Minnesota are embracing quality improvement as they prepare for the voluntary national accreditation program for public health departments, to launch in 2011. The goal of accreditation is to improve and protect the health of every community by advancing the quality and performance of public health departments.

"Improving health department performance may be the best way to improve the health of the population," said William Riley, chair of the Public Health Accreditation Board and associate dean of the University of Minnesota School of Public Health. "We have this tremendous opportunity with accreditation right now."

Accreditation is bringing a focus to standards of practice, starting with performance and capacity measures that will provide greater consistency across public health agencies. The process measures ensure that the key components are in place to impact health outcomes. Before agencies can register to apply for accreditation, they need to have a:

• Comprehensive health assessment
• Strategic plan
• Comprehensive health improvement plan
  

Readiness for accreditation across the country varies. According to Riley, "Some agencies have processes in place and are ready to go. Others have some of the pieces, and others have a long way to go."

"As more agencies are able to meet the standards and measures, I think they'll bump up the measures so that all are improving," said Kim McCoy, Minnesota Department of Health (MDH), Office of Performance Improvement.

Public health agencies in Minnesota are well ahead of other states. The state already requires local health departments to complete a community health assessment every five years. Minnesota agencies have been evaluating their accreditation readiness and receiving guidance from MDH.

Having national standards and measures will allow public health agencies to stay focused on priority issues and not need to change priorities with each newly appointed commissioner. They can reduce the likelihood that priorities will fluctuate on the essential health services, like surveillance and health promotion.

Quality Improvement

Unlike for some accreditation programs, quality improvement is an integral part of the public health accreditation process.
"Many accreditation processes are basically about dotting the "i's" and crossing the "t's", mostly focused on record keeping," said Riley. Public health accreditation is based on a philosophy of comparing performance against standards. In areas where agencies are not meeting standards, accreditation requires that they use continuous quality improvement practices.

Minnesota is one of 16 states participating in a multi-state collaborative, funded by the Robert Wood Johnson Foundation, to build quality improvement capacity in public health agencies across the country and prepare state and local health departments for accreditation. In Minnesota, MDH has been providing resources, tools, technical assistance, and training on quality improvement techniques to the state and local public health departments. Stratis Health has shared with this group its knowledge and experience in building a culture of quality improvement.

Although formal quality improvement techniques are new to public health, continuous quality improvement is proven from decades of application in other industries. It's well recognized as a means to improve quality and decrease deficiencies.

Local public health directors are supportive of performance improvement. "It's an expectation of our elected officials, and an expectation of our residents that we will be improving our performance," said Karen Zeleznak, public health administrator for the City of Bloomington.

Collaboration is Central to Public Health

Public health has to work with other organizations to successfully carry out its work. Collaborating and engaging with the community to identify and solve health problems is a theme in the accreditation standards.

Public health works with school partners, faith organizations, and other community organizations. Data from hospitals and clinics, such as rates for immunizations and health conditions, provide the basis for public health to develop community health assessments and improvement plans. And, the medical community refers patients to public health services, such as high risk new moms and babies, and children with developmental delays, asthma, or autism.

"We work together to build synergy around health issues," said Zeleznak.

Plans in Actions

Using their community assessments and data, public health agencies execute plans in support of short term and long term goals. But, funding for the work remains a challenge and agencies rely heavily on grant funding to carry out their work.

"About 70 percent of our budget is grant funded and those dollars are usually very targeted," Zeleznak noted.

Among other sources, Bloomington Public Health tapped into Statewide Health Improvement Program funding to foster and promote two new farmers markets, working to eliminate access barriers for minority populations and people with disabilities. SHIP is part of a larger statewide health care reform effort intended to improve the overall function of the health care system and reduce health care costs.

It also participated in Stratis Health's cultural competence initiative, funded by UCare. Completing the Culturally and Linguistically Appropriate Services assessment and following up on the gap analysis developed by Stratis Health, the agency developed a strategic plan to improve its staff's cultural competence.

No one is losing sight of the purpose for the standards and measures, assessments, and plans. Zeleznak noted, "The ultimate goal is improving community health."