This post was submitted by Michael Stoto, Ph.D., the chair of the PHSR IG and Professor of Health Systems Administration and Population Health at Georgetown University School of Nursing & Health Studies. Dr. Stoto will join AcademyHealth as its first Senior Scholar in Residence in August.
When I became the chair of the Public Health Systems Research Interest Group’s advisory committee last year, my aim was to ensure that our research was relevant to public health practice while maintaining the rigor we, as health services researchers, bring to it. I was delighted to see that all of the research panels at this year’s IG meeting demonstrated this dual focus. The first panel, New Strategies for Public Health Practice, addressed accreditation and preparedness capacities, the use of social media, and local health departments’ update of evidence-based practices. The public health funding panel used quantitative as well as qualitative research methods to learn from health departments’ response to the recent financial crisis. The two methods panels and the poster sessions also demonstrated a good balance between rigor and relevance.
The importance of using rigorous research methods to address important topics in public health practice, however, might have been best demonstrated in the panel on quality improvement (QI) and public health agency performance. The three presentations on quality improvement per se, by Hilary Kirk (University of Illinois, Chicago), Brenda Joly (University of Southern Maine), and Mary Davis (North Carolina Institute for Public Health) employed an interesting array of rigorous qualitative methods: comparative case studies, enhanced with participant surveys, logic modeling, and other formal qualitative methods.
These presentations stressed Public Health Accreditation Board (PHAB) accreditation as a motivator for local health departments (LHDs) to adopt QI practices. The exception to this was the LHDs that were the most intensive QI users, which tend to have a history of evidence-based decision making and using QI to address emerging issues such as H1N1. The presentations also stressed the importance of LHD staff having basic QI skills, especially data management and utilization, and QI teams that meet on a regular basis.
The presenters also noted the importance of leadership buy-in and support for QI initiatives, including authority to make changes to existing public health delivery systems. I found it interesting in Joly’s presentation that leaders report being generally receptive to new ideas for improving quality, but many "don’t know" whether they are trained in basic QI skills. Similarly, many health department staff members don’t know whether they are trained in basic QI skills, and many leaders and staff also don’t know whether their agency has a QI plan. It makes you wonder just how receptive the health departments are to QI.
Indeed, these results suggest that many LHDs are adopting QI practices and initiatives because of outside pressures such as accreditation and state mandates, without having the leadership buy-in and staff skills needed to make QI work. My own research in applying QI in public health emergency preparedness is finding similar patterns. Is change harder in health departments than in other healthcare delivery organizations or government agencies? In today’s challenging environment, LHDs need to show they can perform effectively and improve, and figuring out how to use QI methods to help them will surely be an important topic for public health systems researchers in the upcoming years.
Although "QI" wasn’t in the title of Paige Bowen’s (University of Minnesota) paper, her presentation addressed an important aspect of high performing organizations – teamwork – and used an innovative qualitative method out of the QI toolbox –videotaping, watching, and analyzing emergency preparedness exercises. Substantively, the results of her team’s research indicate that exercising more often (more than twice per year), coupled with recording and analyzing the results, can improve team performance in short order. While exercises are common in public health emergency preparedness, they are rarely studied to improve performance in any way, so this research has important implications for public health practice. As important as this seems to be though, the work of my colleagues at Harvard School of Public Health has demonstrated the costs and difficulties of frequent exercises, especially if they involved non-public health participants. Figuring out a way to translate the Minnesota team’s research to practice is another challenge to the field.