Taking improvement action based on performance results: Washington State's experience.

Washington state used the Multistate Learning Collaborative grants to address improvement opportunities identified through the results of the Standards Performance Review cycles and county-specific local public health indicators. State and local health departments initiated statewide collaboratives to address the high priorities for system and individual health department improvements. Two individual agency quality improvement efforts are highlighted, one in a large local health department and the other in the State Department of Health, with emphasis on the results in establishing an agency quality improvement infrastructure and Rapid Cycle Improvement teams.

Transforming the Cross Cultural Collaborative of Pierce County through assessment capacity building.

BACKGROUND: Underserved populations are underrepresented in public health initiatives such as tobacco control and in cancer clinical trials. Community involvement is crucial to interventions aimed at reducing health disparities, and local health departments increasingly are called upon to provide both leadership and funding. The Tacoma Pierce County Health Department (TPCHD), in conjunction with 13 key community-based organizations and healthcare systems, formed the Cross Cultural Collaborative of Pierce County (CCC) that successfully employs needs-assessment and evaluation techniques to identify community health initiatives. METHODS: Community leaders from six underserved populations of the CCC were trained in needs-assessments techniques. Assessments measured effectiveness of the collaborative process and community health initiatives by using key informant (n = 18) and group interviews (n = 3). RESULTS: The CCC, facilitated by its partnership with the TPCHD, built capacity and competence across community groups to successfully obtain two funded public health initiatives for six priority populations. Members expressed overall satisfaction with the training, organizational structure, and leadership. The CCC's diversity, cultural competency, and sharing of resources were viewed both as a strength and a decision-making challenge. CONCLUSION: Public health department leadership, collaboration, and evidence-based assessment and evaluation were key to demonstrating effectiveness of the interventions, ensuring the CCC's sustainability.

The use of assessment in promoting secondhand smoke policy in a local health jurisdiction.

BACKGROUND: Clean indoor air regulations reduce both exposure to secondhand smoke and use of tobacco, two significant causes of death in the United States. In 2003, the Board of Health in Pierce County, Washington State, adopted a resolution prohibiting indoor smoking in all public places. Assessment activities were used in three key steps during the secondhand smoke policy development process: (1) setting prevention priorities, (2) monitoring and evaluating interventions, and (3) adopting local policy change. METHODS: Step 1 included calculating attributable risks for morbidity and mortality caused by preventable health behaviors. Step 2 involved designing logic models and outcomes-based evaluations to collect and analyze data from prevention efforts. Surveillance of restaurants documented voluntary adoption of smoke-free policies. Step 3 included conducting telephone surveys to track public support for tobacco policy approaches. FINDINGS: Results demonstrated tobacco's high impact on morbidity and mortality, illustrated a plateau of restaurants' voluntary smoke-free policies, and identified growing public support for secondhand smoke policy. Assessment results were included in multiple policy and support documents and cited by Board of Health members during policy adoption. CONCLUSIONS: Assessment data contributed critical support to local public health decision makers during key steps of a lengthy secondhand smoke policy development process.