Quality Improvement
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MyNACCHO LoginThe public health field is a dynamic environment with health departments having to navigate emerging public health threats while dealing with budget cuts and increasing political pressures. Quality improvement (QI) has been introduced to, and embraced by, the field of public health as a means to achieve efficiencies and improve quality of services to improve overall community health.
QI in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act (PDSA),1 which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes that achieve equity and improve the health of the community.2
Organizational culture is the embodiment of the values, principles, norms, and attitudes that collectively contribute to its daily operations. It is the essence of how work is accomplished and matures over several years. Transforming culture to embrace QI when minimal knowledge or experience exists requires strong commitment and deliberate management of change over time. The following resources will assist in assessing and growing a QI culture and integrating QI into local public health practice.
An agency QI plan provides and establishes accountability around formalizing the QI program. It outlines the agency QI vision, establishes the QI program governance structure, specifies QI processes and methods for selecting and implementing projects, and provides an action plan for how to grow the QI culture. QI assessment results should be used to select the priorities in the QI plan. An adopted QI plan should be monitored for progress, evaluated at least annually, and should align with other agency plans to maintain focus on overall strategy and performance.
QI Plan Guides
- The Ohio State University Center for Public Health QI Plan User’s Guide and template
- ASTHO guide to QI plans
Example QI Plans
The following are examples of high-quality Quality Improvement Plans that you can reference when planning for your local health department. They are from accredited health departments and were selected by NACCHO due to their: structure and clarity, alignment with additional organizational plans (for performance management, strategic planning, community health improvement, and workforce development), description of the organization’s quality improvement infrastructure, replicability, and inclusion of equity.
All staff, from executive leaders to frontline staff, should continuously improve their work. Empowering employees to engage in QI requires access to QI training and resources. NACCHO has developed some presentations and compiled other resources for LHDs to use when the need for training arises. Listed below are a collection of QI trainings available for different levels of health department staff.
- NACCHO Compendium of QI Training Resources – Gathered from national, state, and local level agencies, this resource includes a listing of free, online, QI trainings including webinars, self-paced courses, and training tools.
- QI Culture Staff Orientation Slides – This PowerPoint presentation can be tailored to orient staff to concepts related to building a culture of quality. It includes slides, talking points, and facilitator instructions.
- Introduction to QI Slide Deck – This PowerPoint can be used to introduce basic QI concepts to staff and provide an overview of each phase of the Plan-Do-Study-Act (PDSA) cycle, a QI method for continuous improvement.
For more resources around QI trainings, visit the QI Roadmap Resources section and sort by the foundational element, “Employee Empowerment.”
As an agency gains more expertise and experience with QI projects, QI should spread to all departments, programs, and services. The following resources provide guidance on selecting and implementing QI projects.
QI Project Prioritization and Selection
The agency QI Committee or QI leaders should create criteria and processes for selecting a QI project to ensure selection of projects with the greatest potential for impact. Potential projects should also be screened to determine whether they are appropriate for a formal QI process. The following resources provide guidance implementing these processes:
- QI Project Prioritization and Selection Process – This resource offers recommended sources for identifying QI projects and screening and prioritization criteria for project selection.
- Guide to Prioritization Techniques – This guide offers five commonly used prioritization techniques including instructions, templates, and examples from the field.
- Worksheet 6 QI Project Nomination Form - A worksheet from NACCHO's Guide to Performance Management, agencies can use this worksheet to allow staff to nominate a QI project.
There are a variety of QI processes and tools that can be used to implement QI projects. It is important to define for staff the QI processes that will be used and to cultivate expertise around selecting and implementing the most appropriate methods. Some common QI methods include Plan-Do-Study-Act (PDSA), Kaizen, Lean, and Six Sigma. There are also several QI tools and templates that can be used to implement different phases of these QI methods (e.g. flowcharts, cause-and-effect diagram, control charts). The following resources may assist with implementing QI projects:
- ABCs of PDSA Article – Provides a simple overview of each phase of a PDSA cycle.
- American Society for Quality: Quality Tools A to Z – This webpage offers a listing of a variety of QI tools and methods including instructions for use and downloadable templates.
- Public Health Memory Jogger - This QI pocket-guide provides step-by-step instructions on using 22 of the most common QI tools and techniques
- QI Storyboard Template – One page template for summarizing and documenting QI projects and displaying results.
- QI Project Step-by-step guide - These videos and tools walk you through each phase of a QI project and provide you with examples and templates to successfully carry out a QI project.
For more resources around QI trainings, visit the QI Roadmap Resources section and sort by the foundational element, “Continuous Quality Improvement.”
References
1. Plan-Do-Study-Act (PDSA) is an iterative, four-stage problem solving model used for gaining learning and knowledge for the continual improvement of a product, service, or process.
2. Riley, W., Moran, J., Corso, L., Beitsch, L., Bialek, R., and Cofsky, A. Defining Quality Improvement in Public Health. J Public Health Management Practice 2010; 16(1)5-7.