Performance Management and Quality Improvement

The Public Health Journey

Throughout the years, numerous drivers and catalysts have advanced the awareness and use of performance management and quality improvement in public health. The below list, while not exhaustive, highlights key milestones and initiatives:

• Institute of Medicine (IOM) Reports and Recommendations – the IOM has provided leadership and national guidance throughout the decades including the 1988 report that established the core functions of public health, the 1996 report about community health improvement, the 2003 report that included recommendations for catalyzing accreditation and increasing system partnerships and the most recent 2010 IOM report providing recommendations on performance measurement.
• Assessment Protocol for Excellence in Public Health (APEX/PH)– released in 1991, this workbook provides local health departments with guidance for conducting an organizational capacity assessment and a community health assessment.
• Essential Public Health Services – established in 1994 and outlining essential areas of public health responsibility. This framework has set the stage for much of the subsequent work in standards and performance management.
• National Public Health Performance Standards Program – begun in 1998, this long-standing CDC and partnership effort is intended to advance the quality and performance of public health systems through the use of public health system standards and performance improvement processes. The national performance standards for public health systems and governing bodies – which are based upon the Essential Public Health Services framework – have been used in more 1000 local jurisdictions and 30 states.
• Turning Point Performance Management model and resources - the Turning Point Performance Management Collaborative provides tools and framework for implementing performance management in public health. The performance management model – released in 2003 – is widely used, including within the NPHPSP performance improvement guidance and by many states active within performance management.
• Accreditation – for the past 6 years and with an exciting launch coming up in September 2011, there has been groundbreaking work occurring in establishing a national accreditation program for state, tribal local and territorial health departments. The goal of the program is anchored around quality improvement. This work draws heavily from the National Public health Performance Standards as well as the activities of several states that undertook pioneering work in developing their own accreditation or state-based standards programs.
• Multi-State Learning Collaborative – this Robert Wood Johnson Foundation funded initiative has been in place since 2005. This effort parallels the development of a national accreditation program and brings together innovative states implementing agency performance and capacity assessment, accreditation programs, and quality improvement initiatives to further current efforts and add to the public health knowledge base. The MLC is now a community of practice consisting of 16 lead states in public health quality improvement.

• Quality in Public Health– the U.S. Department of Health and Human Services has led a series of efforts focused on improving quality in public health and health care. Through this effort, a Consensus Statement on Quality in the Public Health System and a report describing Priority Areas for Improvement of Quality in Public Health have been developed.
• National Public Health Improvement Initiative– initiated in 2010 with Affordable Care Act funding, this CDC initiative provides US state, tribal, local and territorial health departments with resources to adopt and institutionalize cross cutting performance management and quality improvement methods and approaches to improve accountability, efficiency, and effectiveness of public health programs and services.

Other efforts and activities in PM / QI – In addition to the initiatives noted above, there has been considerable work focused on disciplinary or programmatic areas. The Laboratory System Improvement Program, the Environmental Public Health Performance Standards are just a few examples of how we can to link with and learn from more focused efforts.

Finally, throughout the above timeline, the experiences and resources from those outside of public health were heavily utilized. Sectors such as industry, business, healthcare, and education have provided a foundation for many of these initiatives. Links to sites featuring some of this work can be found on the Resources page.