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Planning for a quality public health department 

Creating and maintaining health in our Native communities requires efforts that span a wide range of activities.  These activities include ensuring safe food and water supplies, providing education about healthy food and lifestyles, regulating to reduce accident and injury, and taking measures to prevent or contain disease, to name but a few.  Actors engaged in this work are also diverse. Safety inspectors, health educators, health agency staff, first responders, and many others all play a role in the delivery of a community’s public health services. 
What is common throughout a successful public health system is a continual process of identifying community needs, creating strategies, implementing plans, and making adjustments to ensure the best outcomes. As conditions change and new information comes to light, public health systems must look toward new and improved strategies to ensure the health of their communities.  To support this goal, health departments should consider adopting a quality improvement process.

What is Quality Improvement (QI)?

The Public Health Accreditation Board’s (PHAB) voluntary accreditation program emphasizes the importance of quality improvement and serves as a catalyst for health department activity in this area. The Accreditation Coalition, comprising national public health leaders, defines quality improvement in public health as the following:
 “Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing 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.” 1
1.    This definition was developed by the Accreditation Coalition Workgroup (Les Beitsch, Ron Bialek, Abby Cofsky, Liza Corso, Jack Moran, William Riley, and Pamela Russo) and approved by the Accreditation Coalition on June 2009.

What is the Plan-Do-Check-Act (PDCA) Model?

The Plan-Do-Check-Act cycle (PDCA) has been embraced as an excellent foundation for quality improvement for public health departments.  It is both simple and powerful. Its simplicity comes from the systematic, straightforward and flexible approach that it offers. Its power is derived from its reliance on the scientific method, as it involves developing, testing, and analyzing a hypothesis (an educated and logical guess). This simple foundation offers a means to engage with a host of additional quality improvement methods and techniques, and to progressively evolve into addressing more complex problems and/or migrating to system-wide approaches to QI.
The National Association of Local Boards of Health (NALBOH) explains the Core Concepts of the PDCA Model as:
PLAN: Investigate the current situation, identify and prioritize quality improvement opportunities, and develop an action plan with potential solutions.
DO: Carry out the action plan.
CHECK: Look at the results and reflect. What did you find out? Remember to document lessons learned, knowledge gained, and any surprises.
(This step is sometimes referred to as STUDY)
ACT: Decide what actions should be taken to improve. You can Adopt, Adapt, or Abandon the changes made.
NALBOH also gives more information and examples of the PDCA process on their Quality Improvement Website.

Other PDCA and Quality Improvement Resources:

Association of State and Territorial Health Officials ( ASTHO)
910 Pennsylvania Avenue, SE . Washington, DC 20003    Phone: 202.507.4070   Fax: 202.507.4071
WWW.NIHB.ORG • © Copyright 2013, National Indian Health Board All Rights Reserved.
What is Quality Improvement?