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

Li-Wu Chen; Abbey Gregg; David Palm

doi:10.1177/0033354918754542

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

Public Health Rep. 2018 May/Jun;133(3):250-256. doi: 10.1177/0033354918754542. Epub 2018 Apr 13.

Authors

Li-Wu Chen^{1

2

3}, Abbey Gregg⁴, David Palm^{1

3}

Affiliations

¹ 1 Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
² 2 Center for Health Policy Analysis and Rural Health Research, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
³ 3 Nebraska Public Health Practice-Based Research Network, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
⁴ 4 Department of Community Medicine and Population Health, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA.

Abstract

Objectives: Public health accreditation is intended to improve the performance of public health departments, and quality improvement (QI) is an important component of the Public Health Accreditation Board process. The objective of this study was to evaluate the QI maturity and accreditation readiness of local health departments (LHDs) in Nebraska during a 6-year period that included several statewide initiatives to progress readiness, including funding and technical assistance.

Methods: We used a mixed-methods approach that consisted of both online surveys and key informant interviews to assess QI maturity and accreditation readiness. Nineteen of Nebraska's 21 LHDs completed the survey in 2011 and 2013, 20 of 20 LHDs completed the survey in 2015, and 19 of 20 LHDs completed the survey in 2016. We facilitated a large group discussion with staff members from 16 LHDs in 2011, and we conducted key informant interviews with staff members from 4 LHDs in 2015.

Results: Both QI maturity and accreditation readiness improved from 2011 to 2016. In 2011, of 19 LHDs, only 6 LHD directors agreed that their LHD had a culture that focused on QI, but this number increased every year up to 12 in 2016. The number of LHDs that had a high capacity to engage in QI efforts improved from 3 in 2011 to 8 in 2016. The number of LHDs with a QI plan increased from 3 in 2011 to 10 in 2016. The number of LHDs that were confident in their ability to obtain Public Health Accreditation Board accreditation improved from 6 in 2011 to 13 in 2016. Although their QI maturity generally increased over time, LHDs interviewed in 2015 still faced challenges adopting a formal QI system. External financial and technical support helped LHDs build their QI maturity and accreditation readiness.

Conclusion: Funding and technical assistance can improve LHDs' QI maturity and accreditation readiness. Improvement takes time and sustained efforts by LHDs, and support from external partners (eg, state health departments) helps build LHDs' QI maturity and accreditation readiness.

Keywords: accreditation; local health departments analysis; public health practice; quality improvement.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Accreditation / standards*
Humans
Local Government*
Longitudinal Studies
Nebraska
Public Health / standards*
Quality Improvement / standards*
Surveys and Questionnaires