Factors Driving the Adoption of Quality Improvement Initiatives in Local Health Departments

Abstract

Background Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives. Objectives (1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs’ decision to implement QI initiatives. Methods In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs’ QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration’s Area Resource Files and the Association of State and Territorial Health Officials’ 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design. Results The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives. Conclusion According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed.

Longitudinal Evaluation of Quality Improvement and Public Health Accreditation Readiness in Nebraska Local Health Departments, 2011-2016

“…5 These 4 domains of QI maturity formed the basis for evaluating progress in Nebraska LHDs: the first 3 domains evaluated the LHDs’ culture and competency, and the fourth domain evaluated QI practice. Both QI and accreditation readiness are processes that require an investment of resources, 6 leadership support, 7 and time 8 to shape the LHD’s culture to one that is receptive to and capable of continuous improvement and performance measurement. 9…”

The Relationship Between Health Department Accreditation and Workforce Satisfaction, Retention, and Training Needs

“…One hypothesis that should be explored is whether, as employees become more involved in community health improvement work, they become more aware of its complexities and therefore are more aware of how much additional opportunity exists to build their skills. This has been seen in QI: as greater understanding was acquired, greater deficits in training were acknowledged 5,21. A similar hypothesis could also explain some differences in having “a lot” of awareness about some public health concepts.…”

Local Boards of Health Characteristics Influencing Support for Health Department Accreditation

“…Although previous studies have not specifically focused on the level of LBoH members’ support of LHD accreditation, some studies examining correlations between the presence of LBoHs and actual level of engagement of LHDs in PHAB accreditation show similar positive associations. 15,17–19 …”

“…Research has shown mixed results concerning the influence of LBoHs on LHDs’ accreditation engagement and future inclinations. Presence of an LBoH in a jurisdiction was found to have a significant positive influence on accreditation engagement of LHDs by some studies, 17–19 whereas negative impacts or no impact was reported by other studies. 2,20,21 The studies’ lack of clarity about the nature of LBoH influence may result from the studies’ treating the question as a dichotomy—simply capturing the presence or absence of LBoHs.…”