The Power of Community in Addressing Infant Mortality Inequities.

On opposite ends of North Carolina, collaborations in Buncombe and Chatham counties are tackling infant mortality inequities with innovative strategies. While their strategies differ, both groups use an approach that is driven by authentic community voice and directly contributes to dismantling structural racism. The Mountain Area Health Education Center in Asheville is transitioning their leadership of the Mothering Asheville Coalition to SistasCaring4Sistas, a group of Black doulas with lived experience, and is supporting the doulas' work to become a nonprofit organization that will serve the entire state. Chatham County Health Department leads the Equity for Moms and Babies Realized Across Chatham Coalition, a group that relies on recommendations from birthing individuals with lived experience to continually assess and revise hospital policies and practices to improve birth experiences in addition to birth outcomes. The work of these communities highlights several implications for advancing health equity, including the need to establish and maintain trust with the community served, include those with lived experience and expertise in decision making, guide strategies, take risks, and facilitate organizational culture change.

Performance management models for public health: Public Health Accreditation Board/Baldrige connections, alignment, and distinctions.

CONTEXT: The nationally known Malcolm Baldrige Award for Excellence ("Baldrige program") recognizes outstanding performance management and is specifically cited by the Public Health Accreditation Board (PHAB) as a potential framework for PHAB's requisite performance management system. The authors developed a crosswalk that identifies alignments between the 2 programs and is a highlight of the Quest for Exceptional Performance tool that is intended to help health departments capitalize on the connections between the 2 programs. OBJECTIVE: To provide deeper insight into the most robust connections between the 2 programs. DESIGN: The authors developed a crosswalk by listing the PHAB measures, identifying corresponding Baldrige areas to address, and assigning a rating regarding the strength of the alignment. Subsequently, they generated a matrix with numerical scores reflecting the strength of the PHAB-Baldrige alignments that were then analyzed for frequency and strength of alignment by PHAB domain and by Baldrige category. PARTICIPANTS: The tool developers and 3 public health leaders with experience in the Baldrige program contributed to both the design and the analyses. MAIN OUTCOME MEASURES: The measures used reflected both the frequency and strength of alignments. RESULTS: Of the 123 alignments identified in the crosswalk, 39 were rated as high, 40 as medium, and 44 as low. The strongest connections were in the areas of performance management, quality improvement, strategic planning, workforce development, assessment and analysis, and customer service. CONCLUSIONS: While the areas with the most frequent and strongest connections provide the most useful basis for health departments pursuing Baldrige recognition or using Baldrige criteria as a framework for performance management, all alignments could be considered for both purposes.

Driving quality improvement in local public health practice.

OBJECTIVES: To understand what tools, resources, and assistance are needed for local health departments (LHDs) to successfully engage in quality improvement (QI) and to generate examples of successful QI efforts. METHODS: With funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, the National Association of County & City Health Officials supported 66 LHD demonstration sites between 2007 and 2009. The sites measured themselves against national standards and addressed priority areas for improvement through the application of QI techniques. We used on-line surveys, interviews, and informal collection of participant feedback to determine the usefulness of resources that were provided for QI efforts. RESULTS: Participating LHDs lack a common understanding of formal QI. Several existing QI resources specifically geared to public health are very useful, and in-person assistance is highly valued. DISCUSSION: The value of Web-based sessions is uncertain, and state and national meetings could provide accessible forums for in-person training. Dedicated time to training and implementation, coupled with widespread sharing of best practices and success stories, could enhance the uptake of QI efforts in LHDs. Additional studies regarding sustainability are needed to understand how to institutionalize QI.

Achieving a culture of quality improvement.

The National Association of County and City Health Officials (NACCHO) is the national organization representing local health departments. It supports efforts that protect and improve the health of all people and all communities by promoting national policy, developing resources and programs, seeking health equity, and supporting effective local public health practice and systems.

Quality improvement in local health departments: progress, pitfalls, and potential.

OBJECTIVES: To assess the current deployment of quality improvement (QI) approaches within local health departments (LHDs) and gain a better understanding of the depth and intensity of QI activities. METHODS: A mixed quantitative and qualitative approach was employed to determine the current status of QI utilization within LHDs. All respondents from the 2005 NACCHO Profile QI module questionnaire who indicated that their LHD was involved in some kind of QI activity received a follow-up Web-based survey in 2007. A smaller convenience sample of 30 LHDs representing all groups of respondents was selected for the follow-up interview to validate and expound upon survey data. RESULTS: Survey response rate was 62 percent (181/292). Eighty-one percent of LHDs reported QI programmatic activities, with 39 percent occurring agency-wide. Seventy-four percent of health departments had staff trained in QI methods. External funding sources for QI were infrequent (28%). LHDs that were serving large jurisdictions and LHDs that were subunits of state health agencies (centralized states) were more likely to engage in most QI activities. However, interview responses did not consistently corroborate survey results and noted a need for shared definitions. CONCLUSION: Multiple factors, including funders and accreditation, may be driving the increase of QI for public health. Additional research to confirm and validate these findings is necessary. A common QI vocabulary is also recommended.

Final recommendations for a voluntary national accreditation program for state and local health departments: steering committee report.

A recently released report of the Exploring Accreditation Project affirmatively answered the questions regarding the desirability and feasibility of establishing a national voluntary public health accreditation program. The report's recommendations were made after 10 months of inquiry from public health experts, elected officials, the general public health workforce, academicians, and other interested parties, more than 650 public health professionals in all. Recommendations regarding how such a program might be implemented insofar as its governance, principles for standards development, financing and incentives, and evaluation were included. The report provides a blueprint for establishing a national voluntary public health accreditation program. This article describes key aspects of the Steering Committee recommendations, with limited linkage to implementation strategies where relevant, in the four areas in which the project was designed. Details are provided in the final reports of the Steering Committee (www.exploringaccreditation.org) and in other articles in this issue.

The operational definition of a functional local public health agency: the next strategic step in the quest for identity and relevance.

In 2002, the National Association of County and City Health Officials embarked on a quest to clarify, in a uniform way, the functions of governmental local public health agencies. Over the next 3 years, a diverse group of local health department officials and their partners developed an Operational Definition of a Functional Local Health Department, which included 45 standards matched to the 10 Essential Services. These standards serve as the first comprehensive and uniform articulation of local health department activities for which 250 prototype metrics have subsequently been developed. This article articulates the historical and policy significance of the Operational Definition, the methodological development of the recently published prototype metrics, and presents ideas for use of the metric tool especially in light of current accreditation and quality improvement initiatives.