Accreditation and Quality Improvement for Public Health Departments Patrick Libbey

“Quality Improvement…is…deliberate and defined improvement…focused on activities that are responsive to community needs and improving population health. It [is] a continuous…effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality in services or processes which achieve equity and improve the health of the community.” The Accreditation Coalition July 14, 2009

Poll Question Do you have a formal quality improvement process in place? A. Only some programs B. All programs C. Organization-wide D. None at all Click on the down arrow if you can’t see the response choices.

Quality Improvement or Evaluation? Incentives and disincentives Consequences What gets measured gets done

Plan-Do-Study-Act: The Quality Improvement Cycle Prioritization: will accreditation standards help guide us? Reinvention or replication: how do we use others’ work? Principle of small scale implementation: does trialability apply?

Preparing for the Test or Putting into Practice? 11 domains capacity 109 measures process 31 standards outcome documen-tation

Other Qualitative and Operational Implications Increased visibility: improving public and partner understanding Clarification of expectations by policy makers and funders Changes to system, structure, and service delivery Other Qualitative and Operational Implications

We don’t know what public health is supposed to do We don’t know what public health is supposed to do. And we don’t know if you’re doing it. The Joint Commission

Accreditation: Internal or External? Having partner and public involvement in preparation and review Sharing the results Creating buy-in and building expectations Keeping it understandable Create buy-in & build expectations

“I don’t know how he lost the election; everybody I talked to voted for him.” Patrick Libbey about the outcome of the 1972 Nixon-McGovern presidential race

Policy Makers and Funders Over 50% of local public health costs are funded by local and state government (exclusive of federal pass-through) State legislatures and local government elected officials establish public health policy, priorities and operating frameworks. Do we know what they want public health departments to be able to do? This is an opportunity to shape expectations.

Poll Question In moving forward with accreditation, you envision involving your policy makers. A. Strongly agree B. Agree C. Disagree D. Strongly disagree Click on the down arrow if you can’t see the response choices.

“Insanity: doing the same thing over and over again and expecting different results.” Albert Einstein

Regionalization Shared capacities and resources among health departments Cross jurisdiction services or issue focus, e.g., preparedness Consolidation of jurisdictions Changes in local / state roles, relationships, and services

“I won't belong to any organization that would have me as a member.” Groucho Marx