Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture

Abstract

BackgroundPublic health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA.MethodsAn online survey of key informants in Georgia’s districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting.ResultsIncreases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments.ConclusionsAgency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.

Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia

“…They include a QI immunization evaluation project in a large urban area of Northeast Florida, evaluation of QI efforts within Georgia public health agencies, evaluation of community asthma projects utilizing QI in Georgia, and sexually transmitted disease (STD) quality and cost effectiveness efforts in Florida county health departments (CHD). [26][27][28][29][30][31][32][33][34][35] Data that were analyzed came from both structure inquiries as well as direct observation and input provided without structured prompts.…”

Implementation Research as Applied Science: Bridging the Research to Practice Gap

“…A QI postintervention survey was also conducted with participating CHD staff to assess staff perceptions of using QI to support organization change (adoption of an option for client enrollment for texting STI results). The survey included 10 Likert-type ordinally scaled QI items developed from previous QI research (Livingood et al, 2012; Livingood et al, 2013; Livingood et al, 2015) and open-ended items to obtain staff perspectives of the QI efforts and texting project. The scaled 10 items were aggregated under 3 major constructs; Management/Unit support (3 items), Measurement and Tracking (3 items), and QI Team Engagement (4 items).…”

Developing and Evaluating a Quality Improvement Intervention to Facilitate Patient Navigation in the Accountable Health Communities Model

“…To date there is no standard agreement on the definition or essential elements of what comprises a TA intervention (9,10). A content analysis of working definitions found three overarching common elements: (1) capacity building (11)(12)(13), (2) quality implementation (14), and 3) quality improvement (QI) (15). However, the field lacks consensus on how to effectively implement TA interventions (16).…”