What Is Public Health Quality?
Quality in public health is the degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy. The HHS vision for public health quality, as defined by the Assistant Secretary for Health, is to build better systems to give all people what they need to reach their full potential for health
Priority Areas (Primary Drivers of Quality)
Key Public Health Quality Reports
Public Health Aims
The nine aims help guide public health practices across the entire system to ensure quality for increasing positive population health outcomes.
- Population-centered: Protecting and promoting healthy conditions and the health for the entire population
- Equitable: Working to achieve health equity
- Proactive: Formulating policies and sustainable practices in a timely manner, while mobilizing rapidly to address new and emerging threats and vulnerabilities
- Health promoting: Ensuring policies and strategies that advance safe practices by providers and the population and increase the probability of positive health behaviors and outcomes
- Risk reducing: Diminishing adverse environmental and social events by implementing policies and strategies to reduce the probability of preventable injuries and illness or negative outcomes
- Vigilant: Intensifying practices and enacting policies to support enhancements to surveillance activities
- Transparency: Ensuring openness in the delivery of services and practices with particular emphasis on valid, reliable, accessible, timely and meaningful data that is readily available to stakeholders, including the public
- Effective: Justifying investments by using evidence, science and best practices to achieve optimal results is areas of greatest need
- Efficient: Understanding costs and benefits of public health interventions and to facilitate the optimal use of resources to achieve desired outcomes
Priority Areas (Primary Drivers of Quality)
The six priority areas represent areas of greatest need where the public health system should improve quality to achieve improved population health outcomes. The following three criteria guided the selection of the priority areas:
Impact – the extent of significant improvements in population health, health equity, quality, and safety that could result from changes in this area.
Improvability – the potential for changes that could lead to desired health, process, or given changes in system outcomes.
Practice Variability – the potential for standardizing areas where wide variability in practices exist and where gaps between current practices and knowledge, evidence, or best practices can be closed without hindering innovation.
Based on concepts developed at the Institute of Healthcare Improvement1, the priority areas are actually considered as primary drivers of quality. The six priority areas reflect the complex interactive nature of the public health system as lack of quality in one area can potentially negatively impact quality in another. They function interactively as system-level drivers that have an impact across the entire public health system.
The six priority areas (primary drivers):
- Population Health Metrics and Information Technology
- Evidenced-based Practices, Research and Evaluation
- Systems Thinking
- Sustainability and Stewardship
- Policy
- Public Health Workforce and Education
1. Population Health Metrics and Information Technology
Improve methods and analytical capacity to collect, evaluate and disseminate data that can be translated into actionable information and outcomes in population health the local, state and national level. Make the improvement of data collection for population subgroups a core value of public health. The informed use of health care quality data can serve as a catalyst to build population-based public health programs as a strategy to improve population health, eliminate health inequities, and bridge gaps between health care and public health.
2. Evidence-based Practices, Research and Evaluation
Bridge research and practice and institutionalize evidence-based approaches to achieve results-based accountability. Support effective and safe practices that can be used by practitioners.
Advance systems thinking in public health. Foster systems integration strategies by analyzing problems using systems science methodologies (network analysis) while taking into account the complex adaptive nature of the public health system. Complex adaptive systems are described as those based on relationships of diverse and interconnected agents that have the capacity to learn, change, and evolve (hospitals, emergency medical services systems, educational systems, emergency preparedness and response systems).
4. Sustainability and Stewardship
Strengthen system sustainability and stewardship through valid measures and reporting of performance and quality. Ensure efficient funding methodologies that align resources with goals, demonstrated need, responsibilities, measurable results, and ethical practices.
Strengthen policy development and analysis processes and advocacy to ensure that evidence is integrated into policymaking to improve population health.
6. Public Health Workforce and Education
Develop and sustain a competent workforce by ensuring that educational and skills content are appropriately aligned with core and discipline-specific competencies. Assure that public health education is accessible at all academic levels, and that life-long learning is encouraged and valued.
Institute for Healthcare Improvement’s Applied Concept of Primary and Secondary Drivers
| Outcome | Public Health Primary Drivers of Quality | Public Health Secondary Drivers of Quality | |||||||
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National Goals for |
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Secondary Drivers of Quality
Consistent with the Institute for Healthcare Improvement
model, secondary drivers play an important role in supporting the priority areas (primary drivers) to drive improvements. The secondary drivers help support critical elements of the primary drivers, increase the likelihood of achieving improved outcomes and also strengthen the public health infrastructure. Aligning secondary driver activities with the public health quality aims is the suggested tactic for achieving strategic improvements.
Interactive Models Demonstrating Use of Priority Areas:
References:
- Nolan, T. (2007). Executing for system-level results: Part 2. Retrieved July 30, 2010, from http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/ ImprovementStories/ExecutingforSystemLevelResultsPart2.htm
Key Public Health Quality Reports
Consensus Statement on Quality in the Public Health System [PDF 82 KB] [En Español]
The Consensus Statement provides an in-depth discussion on incorporating quality in the public health system, including a definition of quality in public health and its nine aims. It is intended to enhance and guide the goals of existing and future programs that promote quality.
Priority Areas for Improvement of Quality in Public Health
Building on the development of the nine public health quality aims, ‘Priority Areas for Improvement of Quality in Public Health’ unveiled the six priority areas. These areas are expected to improve quality in the field of public health and are based on the following selection criteria – impact, improvability and practice variability.
Creating a Framework for Getting Quality into the Public Health System
This paper, published in Health Affairs, presents real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a state office of minority health.