Developing a Taxonomy for the Science of Improvement in Public Health

Abstract

Quality improvement (QI) methods have been used for almost a decade in public health departments to increase effectiveness and efficiency. Although results are rapidly accumulating, the evidence for the science of improvement is shallow and limited. To advance the use and effectiveness of QI in public health, it is important to develop a science of improvement using practice-based research to build an evidence base for QI projects. This purpose of this study is to advance the science of improvement in public health departments with 3 objectives: (1) establish a taxonomy of QI projects in public health, (2) categorize QI projects undertaken in health departments using the taxonomy, and (3) create an opportunity modes and effects analysis. This study is a qualitative analysis of archival data from 2 separate large databases consisting of 51 QI projects undertaken in public health departments over the last 5 years. The study involves 2 separate QI collaboratives. One includes Minnesota health departments; the other is a national collaborative. We propose a standardized case definition, common metrics, and a taxonomy of QI projects to begin building the evidence base for QI in public health and to advance the science of continuous quality improvement. All projects created an aim statement and used metrics while 53% used a specific QI model with an average of 3.25 QI techniques per project. Approximately 40% of the projects incorporated a process control methodology, and 60% of the projects identified the process from beginning to end, while 11 of 12 PHAB (Public Health Accreditation Board) domains were included. The findings provide a baseline for QI taxonomy to operationalize a science of improvement for public health departments.