Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.

William C Livingood,Lynn D Woodhouse,Alesha R Wright,Angela H Peden,Russell B Toal,Nandi A Marshall,Dayna S Alexander,Ketty M Gonzalez,Gulzar H Shah

doi:10.1186/s12913-015-0956-3

Abstract

BackgroundPublic health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA.MethodsAn online survey of key informants in Georgia’s districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting.ResultsIncreases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments.ConclusionsAgency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.

Highlights

Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance
The overall participation rate of invited key informants was 75 %. This comparison of perceptions of QI culture showed that the odds of improved QI cultural characteristics were significantly greater (OR ranging from 1.97 to 10.14) for health districts that participated in the Georgia PBRNQI activities, reflecting a .05 level or better significant increase in support for five of the 10 QI domains and a .10 level of significant increase for eight of the 10 domains
QI is an underlying foundation for public health agency accreditation, accreditation processes do tend to focus on documentation of specific use of QI methods, this is one of several recently emerging attempts to assess changes in QI culture within local public health agencies

Summary

Introduction

Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. QI work with Florida and Georgia local public health systems have revealed other common, more functional challenges to public health agency use of QI principles [7,8,9], including: traditional administration and management practices based on hierarchical decision making, emphasis on rigidly following rules rather than outcomes, narrowly defined and siloed (not my job) work responsibilities, and “once and done” approach to problems rather than continuous improvement [10, 11]. Public health’s success in adopting QI is not well established [17], and with few exceptions, the impact on changing organizational culture to reflect QI principles and practices is even less reported

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