Monitoring QI Maturity of Public Health Organizations and Systems in Minnesota: Promising Early Findings and Suggested Next Steps

This paper presents methods used by the MN PBRN to identify a select number of items from the QI Maturity Tool as the basis for calculating organizational and system-level QI maturity scores. The findings suggest that the abbreviated tool measures variation in QI maturity across LHDs, and differences in scores among divisions within the larger state health department. The results have several implications. This modified tool shows promise and may accelerate measurement of QI in practice settings. Future additional testing may help refine the score and assure that it reflects emerging research related to QI maturity

Quality Improvement Learning Collaboratives in Public Health: Findings from a Multisite Case Study

OBJECTIVES: This study was designed to (1) test a theory on the key drivers of a successful mini-collaborative, (2) describe the application of quality improvement (QI) approaches and techniques among mini-collaborative participants, and (3) identify key attributes that affect the spread and sustainability of QI efforts within a local public health agency. METHODS: A multisite case study methodology was used to evaluate a subset of mini-collaboratives and their participating local health departments that were working in specific target areas. Data were collected during semistructured interviews and while observing mini-collaborative meetings. Documentation reviews were also conducted. We used standard techniques to code the data on the basis of themes and connections between themes. RESULTS: The findings provide early evidence that support our case study theory on the drivers of a successful mini-collaborative including advanced planning, the selection of faculty, timely training and technical assistance, the role of senior leaders, the application of evidence-based practices, the use of an improvement model, evaluation efforts, communication, the availability of resources, target selection, and prior experience with and application of QI. While the case studies provided limited evidence of sustainability and broad spread of QI within participating states, mini-collaboratives appear to have had a major impact and will likely influence the work of participating local health departments going forward. CONCLUSIONS: Our findings suggest that the mini-collaboratives served as a catalyst for engaging local health departments in the theory and practice of QI

Introduction to Case Reports: One Goal - Many Journeys

This article describes case reports that highlight the journey of accreditation through the lens of 11 health departments at various stages in the process. These case reports call attention to the link between accreditation and quality improvement

Children\u27s Bicycle Helmet Use and Injuries in Hillsborough County, Florida Before and After Helmet Legislation.

The purpose of this research was to explore the changes in children\u27s bicycle helmet use and motor vehicle bicycle related injuries in Hillsborough County, Florida before and after passage of the Florida\u27s bicycle helmet law for children under the age of 16. The results show a significant increase in bicycle helmet use among children, ages 5-13, in the post-law years compared with the pre-law years. Also, there has been a significant decline in the rates of bicycle related motor vehicle injuries among children in the post-law years compared with the pre-law years. Although there have been complementary educational and outreach activities in the county to support helmet use, it appears that the greatest increase in use occurred after the passage of the helmet law. It is recommended that educational efforts continue to sustain helmet use rates and decreases in injuries

Measuring Quality Improvement in Public Health: The Development and Psychometric Testing of a QI Maturity Tool

There is growing interest and investment in improving the quality of public health services and outcomes. Following the lead of other sectors, efforts are underway to introduce systematic quality improvement (QI) tools and approaches to state and local public health agencies. Little is known, however, about how to describe and reliably measure the level of QI maturity within a public health agency. The authors describe the development of a QI Maturity Tool using research from the fields of organizational design, psychology, health care, and complexity theory. The 37-item assessment tool is based on four quality domains derived from the literature: (a) organizational culture, (b) capacity and competency, (c) practice, and (d) alignment and spread. The tool was designed to identify features of an organization that may be enhancing or impeding QI; monitor the impact of efforts to create a more favorable environment for QI; and define potential cohorts of public health agencies for evaluation purposes. The article presents initial steps in testing and validating the QI Maturity Tool including: (a) developing a theoretical framework, (b) assuring face and content validity, (c) determining the tool\u27s reliability based on estimates of internal consistency, (d) assessing the dimensionality, and (f) determining the construct validity of the instrument. The authors conclude that there is preliminary evidence that the QI Maturity Tool is a promising instrument. Further work is underway to explore whether self-reported survey results align with an agency\u27s actions and the products of their QI efforts

Driving a Public Health Culture of Quality: How Far Down the Highway Have Local Health Departments Traveled?

CONTEXT: There has been an extensive investment in building public health organizational capacity to improve performance and prepare for accreditation. An evolving perspective has focused not only on the practice of quality improvement (QI) within the health department but also upon the extent the culture of QI is embraced within the agency. OBJECTIVE: No studies have examined the current national baseline of QI culture implementation, nor estimated the degree of QI sophistication local health departments (LHDs) have attained. We attempt to fill this void by aligning the findings from the QI module of the National Association of County & City Health Officials (NACCHO) 2010 Profile of LHDs against the constructs defined by the QI Maturity Tool and the NACCHO QI Roadmap (Roadmap to a Culture of Quality Improvement). DESIGN: Specific questions regarding QI activities from the 2010 Profile Study QI module were used to assign responding LHDs to stages within the Roadmap. We also used data from the QI Maturity Tool administered to all LHDs in the 16 participating Multi-State Learning Collaborative states in 2010 and 2011. On the basis of this matched set, we applied the summative domain scores algorithm, classified agencies into 1 of 5 groups, compared our findings with those of the NACCHO survey, and aligned our categories to those of the Roadmap. RESULTS: Nearly 80% of LHDs classified using the NACCHO Profile data were assigned to group 3 or 4 versus 48% using the QI Maturity Tool. Results from the cross-tabulations of the matched data set between the QI Maturity Tool classifications and the NACCHO Profile classifications revealed exact alignment 30% of the time. Forty-nine of 163 agencies were classified in the same grouping in both schemata. In addition, 84% of the agencies were classified within 1 neighboring category. CONCLUSIONS: The results revealed that half, if not most, LHDs fall within the middle categories of QI maturity and sophistication, regardless of which classification system was deployed

Assessing Quality Improvement in Local Health Departments: Results from the Multi-State Learning Collaborative.

OBJECTIVE: This study examined changes in quality improvement: (1) over a 3-year period, (2) among mini-collaborative participants, and (3) among agencies that were classified in the lowest QI performance quartile. METHODS: : A QI Maturity Tool was administered to all local health departments in the Multi-State Learning Collaborative states. Factorial ANOVA was performed to determine differences in composite factor scores and interaction effects were explored. RESULTS: : The results revealed a significant increase in the percent of agencies that reported ever implementing a formal QI process from 2009 to 2011 and agencies that participated in a mini-collaborative were more likely than their non-mini-collaborative counterparts to report QI implementation. The findings also suggested significant changes in QI capacity and competency as well as alignment and spread over the course of the grant, among mini-collaborative participants, and among agencies that were originally identified in the lowest QI maturity quartile. No significant changes in organizational culture were revealed by year or among mini-collaborative participants. However, agencies in the lowest quartile saw significant changes in organizational culture during the project period. CONCLUSIONS: Significant changes in specific QI domains are possible to detect during a 3-year period. Our research gives us confidence that the QI Maturity Tool measures the right domains and is an important contribution to quantifying the adoption and spread of QI in public health. However, further refinement is needed to better standardize language and definitions of the component parts of a QI system

Early Detection and Intervention for the Prevention of Psychosis. Outreach Evaluation Report: Year 1 Annual Report

Under contract with the Robert Wood Johnson Foundation, researchers at the Muskie School of Public Service are evaluating the community outreach and training efforts of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). This Year One report (8/15/2007 - 8/15/2008) provides an overview of the initiative and the five demonstration sites; a description of the evaluation framework and design; the evaluation questions and methods; preliminary evaluation results; and a summary of preliminary findings and next steps. Preliminary Findings: Outreach and training efforts are reaching the intended audiences; Trainings are a critical component of the outreach model; EDIPPP is perceived as a credible program; Most referrals are appropriate and given by a professional; Several factors are associated with intentions to refer; EDIPPP operates in different community and policy contexts

Evaluation as a Critical Factor of Success in Local Public Health Accreditation Programs

This article presents the variety of approaches used to conduct evaluations of performance improvement or accreditation systems, while illustrating the complexity of conducting evaluations to inform local public health practice. We, in addition, hope to inform the Exploring Accreditation Program about relevant experiences involving accreditation and performance assessment processes, specifically evaluation, as it debates and discusses a national voluntary model. A background of each state is given. To further explore these issues, interviews were conducted with each state\u27s evaluator to gain more in-depth information on the many different evaluation strategies and approaches used. On the basis of the interviews, the authors provide several overall themes, which suggest that evaluation is a critical tool and success factor for performance assessment or accreditation programs

Promoting Early Detection of Psychosis: The Role of Community Outreach

The purpose of this paper is to determine the effectiveness of community outreach efforts in promoting public education on the early warning signs of psychosis and in generating referrals for treatment during the prodromal stage of illness