The Use of Formal Quality Improvement Methods to Improve Programs in Local Health Departments: A Systematic Review of Published Literature
Creators: name: Steiner, Michael J.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2013

description: Background: Formal quality improvement (QI) methods were originally introduced in business management and have recently been adopted in healthcare delivery. Local health departments (LHD) have begun to use QI methods to make care in clinical services more efficient or to improve access; however, LHD use of QI methods for traditional population or other public health improvements is less well described. Objective: To systematically review the published literature on the use of formal QI methods to improve population-based health intervention or other public health programs used in LHDs. Methods: A structured search of PubMed was created to identify articles describing direct experience using formal QI methods to improve a population-based public health intervention, public health administrative structures or processes in LHDs. Solely clinic-based interventions were excluded because of extensive literature for clinic-based interventions in similar fields. Titles and abstracts were reviewed and articles that met inclusion criteria were then selected for full text review. In order to expand the pool of literature, published story boards from the National Network of Public Health Institutes clearinghouse site were also extracted. Articles that met inclusion after full text review had recommended QI implementation strategies and measured outcomes extracted. Quantitative reporting of outcomes was planned in addition to qualitative reporting of ‘best practices’ for effective use of QI in LHDs. Results: Full text review was completed for 37 out of 395 titles initially identified, and eight final articles were included. Published studies included descriptions of individual health departments (HD) programs, QI collaboratives among HDs, and state division of health supported QI processes. There were no randomized or controlled trials of QI interventions. All published studies were case reports listing areas of success and lessons learned. The lessons through the publications were that LHDs should clarify processes early in the improvement process, involve staff in process and change, and measure outcomes. Additionally, QI was found to spread quickly within organizations, and related, having QI expertise either locally or from the outside helped move programs forward. Individual QI Storyboards were identified from the website of the National Network of Public Health Institutes and 138 met inclusion criteria. Abstracts described programs that generally used the PDSA method but reported on a wide variety of public health programs. Discussion: The use of QI methods in population-based health interventions and other nonclinical public health programs by local health departments is limited. QI approaches such as elimination of waste, reduction of defects, and small trials of change could successfully improve public health interventions, and should be more broadly implemented both under real-world and experimental conditions.