Fostering More-Effective Public Health by Identifying Administrative Evidence-Based Practices

Abstract

Context The aim of evidence-based decision-making in public health involves the integration of science-based interventions with community preferences to improve population health. Although considerable literature is available on the development and adoption of evidence-based guidelines and barriers to their implementation, the evidence base specific to public health administration is less developed. This article reviews the literature from public health and related disciplines to identify administrative evidence-based practices (A-EBPs; i.e., agency-level structures and activities that are positively associated with performance measures). Evidence acquisition A “review of reviews” was carried out to assess the evidence for the effectiveness of A-EBPs covering the time frame January 2000 through March 2012. The following steps were used: (1) select databases; (2) determine search parameters and conduct the search; (3) screen titles and abstracts; (4) obtain selected documents; (5) perform initial synthesis; (6) abstract data; and (7) synthesize evidence. Evidence synthesis In both the reviews and original empiric studies, the most common outcome reported was performance of the local health department or local public health system. On the basis of a synthesis of data from 20 reviews, a total of 11 high-priority A-EBPs were identified (i.e., practices that local public health systems potentially can modify within a few years). The A-EBPs covered five major domains of workforce development, leadership, organizational climate and culture, relationships and partnerships, and financial processes. Conclusions As the body of practice-based research continues to grow and the ability to measure administrative evidence-based practices improves, this initial list can be further developed and improved.

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

“…Population size ↑Productivity 11,13 • The size of the jurisdiction served by a public health agency is the strongest predictor of performance in delivering essential public health services 13 • Optimal population size for a public health jurisdiction: between 50,000 and 500,000 • Administrative evidence-based practices are associated with increased delivery of essential public health services and are identified in five major domains: workforce development, leadership, organizational climate and culture, inter-organizational relationships and partnerships, and financial processes 11 …”

“…Performance is a multifaceted concept: in Table 1, we adapt Handler and colleagues' public health performance framework 7 in order to summarize elements and dimensions of performance often reported in the PHSSR literature, notably productivity, effectiveness, efficiency and equity. 3,5,6,[8][9][10][11][12][13][14][15][16] Productivity is the relationship between structures and resulting…”

“…Increased productivity in public health systems has consistently been associated with: 1) increased financial resources; [11][12][13] 2) increased staffing per capita; [11][12][13] 3) a population size between 50,000 and 500,000; 11,13 and 4) specific administrative features with respect to workforce development, leadership, organizational climate and culture, inter-organizational relationships and partnerships, and specific financial processes.…”

“…[11][12][13] Infrastructure-related elements under study have included: population size served by a public health jurisdiction; administrative practices; presence of local boards of health; level of decentralization; and the number and scope of public health organizations within a system. Indicators of financial resources such as public health spending and funding sources, as well as workforce elements such as staffing per capita and leadership qualifications have also been studied.…”

Local Health Department Capacity for Community Engagement and Its Implications for Disaster Resilience

“…52 Theoretical and empirical studies also suggest that organizational elements such as climate, values, mission, and preferences influence performance of the public health system. 8,55 An institutional milieu that promotes shared expectations, communication and collaboration, and innovation, 55 and in which the workforce feels empowered by management, 56 has a positive effect on performance. Emerging literature also suggests that health department institutional culture plays a significant role in community health outcomes such as childhood immunization rates.…”