Welcome to the fourth installment of Quality Improvement Corner. Here, PHAB Accreditation Specialist April Harris, MPH, CHES, talks about the importance of a quality improvement culture.

In the public health world, we hear the term “assessment” used quite frequently. Assessment is not only one of the three core functions of public health, but is also consistently used throughout PHAB’s Standards and Measures. It is the foundation for many public health activities, including quality improvement (QI). Whether your health department is just beginning its journey to foster a culture of quality improvement or working to sustain progress for an active continuous quality improvement culture, a QI culture assessment is an important step. A Quality Improvement (QI) Culture is defined as shared beliefs, perceptions, norms, values, and expectations of individuals and the organization regarding QI and customer satisfaction.[i]

At times, it may feel as though the QI plan is the first step to establishing a culture of QI, however, an assessment is often needed to collect baseline data, track progress and determine how best to proceed with planning efforts. A QI culture assessment is a natural starting point when drafting or revising your health department’s QI plan, so that areas for improvement are clearly identified and incorporated into formal planning. A QI culture assessment can support the ongoing need to advance QI efforts in a health department by providing data on key themes, such as training, which is instrumental in building a culture of QI. Assessments may also reveal strengths amongst the health department’s QI culture, which is a great way to engage and motivate staff to continue improvement work.

At Cobb & Douglas Public Health (Georgia), accredited in 2015, the health department reports utilizing a QI culture assessment every two years to help assist their QI efforts. Gurleen Roberts, Accreditation Coordinator, said, “First, the NACCHO culture of quality assessment is completed by the health department’s Quality Council. The full assessment results serve as a needs assessment for the QI plan revision. Secondly, two questions are added to the Annual Employee Satisfaction Survey to specifically address QI project participation rates and staff’s assessment of the phases of culture of quality. The all-staff response to the phase question is comparab-Ale to the Quality Council’s full assessment results. The results of the assessment and progress on goals are compared to evaluate necessary revisions.”

There are several well-known QI culture assessments that health departments can use, such as NACCHO’s Self-Assessment Tool and the QI Maturity Tool. Facilitator guides, presentations, and discussion questions are also available to assist health departments. The Public Health Foundation’s Performance Management Self-Assessment Tool incorporates a quality improvement section as well. The phPIN network is also an excellent way to consult with public health peers across the country for suggestions and advice on tools such as QI culture assessments.

[1] Ward D, Moran J. Visualizing your organization’s QI culture growth: a QI culture map. http://www.phf.org/resourcestools/Documents/QI%20Culture%20Growth%20Final.pdf. Public Health Foundation. Published 2013. Accessed September 19, 2019.