Quality improvement in local health departments: results of the NACCHO 2008 survey.

OBJECTIVES: To assess the current status of quality improvement (QI) within local health departments (LHDs) and examine the characteristics associated with such QI efforts. METHODS: A QI module was administered to a representative sample of 545 LHDs along with the core instrument in the 2008 NACCHO Profile survey of all LHDs nationally. Using the Profile survey data set, a quantitative approach was employed to determine the current status of QI within LHDs. Statistical analysis was performed to identify characteristics of LHDs associated with QI. The response rate to the QI module was 82 percent. RESULTS: Of the 448 LHDs that responded to the QI Module, 55 percent reported conducting formal QI efforts during the previous 2 years. Forty-four percent of these LHDs used a specific framework for QI, 56 percent used at least one of four commonly employed QI tools or techniques, and customer focus and satisfaction was the most frequently reported area (76%) of QI efforts. LHDs with large size of jurisdiction population and those with centralized governance were more likely to have engaged in quality or performance improvement, have managers who received formal QI training, and have provided QI training to staff. CONCLUSION: The 2008 NACCHO Profile QI module furnishes an excellent baseline for measuring progress of health department QI activities as accreditation and other related activities intensify. A clear definition of QI in public health that is understood by practitioners will greatly increase our ability to measure the adoption of QI by LHDs. Further research is necessary to identify and explore some of the predictors and possible barriers to increasing the application of QI by LHDs.

Why just prepare for emergencies when full use is possible?

Emergency preparedness, fits within the larger context of governmental public health preparedness. Full use of current, appropriations for learning management, education, and training systems designed for emergency preparedness can prepare and retain the current workforce to promote health and prevent disease, while recruiting the next generation to the governmental public health workforce.

Flint Photovoice: community building among youths, adults, and policymakers.

Flint Photovoice represents the work of 41 youths and adults recruited to use a participatory-action research approach to photographically document community assets and concerns, critically discuss the resulting images, and communicate with policymakers. At the suggestion of grassroots community leaders, we included policymakers among those asked to take photographs. In accordance with previously established photovoice methodology, we also recruited at the project's outset another group of policymakers and community leaders to provide political will and support for implementing photovoice participants' policy and program recommendations. Flint Photovoice enabled youths to express their concerns about neighborhood violence to policymakers and was instrumental in acquiring funding for local violence prevention. We note salutary outcomes produced by the inclusion of policymakers among adults who took photographs.

A partnership to reduce African American infant mortality in Genesee County, Michigan.

A partnership in Genesee County, Michigan, has been working to reduce African American infant mortality. A plan was developed utilizing "bench" science and community residents' "trench" knowledge. Its theoretical foundation is ecological, grounded in a philosophy of public health as social justice, and based on the understanding that cultural beliefs and practices can be both protective and harmful. Partners agree that no single intervention will eliminate racial disparities and that interventions must precede, include, and follow the period of pregnancy. Core themes for the work include: reducing racism, enhancing the medical care and social services systems, and fostering community mobilization. Strategies include community dialogue and raising awareness, education and training, outreach and advocacy, and mentoring and support. The evaluation has several components: scrutinizing the effect of partnership activities on direct measures of infant health; analyzing changes in knowledge, attitudes, behaviors and other mediating variables thought to influence maternal and infant health; and effecting changes in personal and organizational policy and practice.

Protecting our vulnerable food supply.

From farmyard to dinner table, our food supply presents ample opportunity for dangerous microorganisms or their products to thrive and infect or intoxicate human beings, often with harmful and sometimes fatal results. Traditional controls to protect the food supply include, but are not limited to, law and regulation. But law and regulation are only enablers, an underpinning. Most important to protection of the food supply is organizational leadership and commitment at federal, state, and local levels of government to protect the public's health. This article provides examples of such leadership in locales as diverse as Australia, New Zealand, and Genesee County, Michigan. Even when a supportive law is in place and the will and resources to make the law work exist, competing political and economic world-views are constantly at work to amend the law and thus adversely affect the public's health.