Quality improvement in public health is a key element in the movement toward accreditation. Multiple national, state, and local initiatives are under way to define quality in a public health context and to develop tools and promising practices to support quality-improvement efforts in local health departments. Until recently, efforts to improve quality at the local level have largely focused on performance measurement to assess the relationship between inputs, outputs, and outcomes. The Los Angeles County Department of Public Health has developed its own unique approach to quality improvement. This approach includes focusing on three overlapping areas (professional practice, performance improvement, and public health science) that align closely with essential public health services 8 (competent worker), 9 (evaluation), and 10 (research). Broadening the focus of quality-improvement efforts to include these three areas (rather than performance improvement alone) provides additional opportunities to address key infrastructure issues that may affect the quality of services that are provided to the public and, thus, health outcomes. While the experience in Los Angeles County parallels other efforts, it includes unique elements that will be of use to public health professionals in other agencies.
This study described an integrated, comprehensive public health quality-improvement program in Los Angeles County.
Jeffrey D. Gunzenhauser, MD, MPH, is Medical Director and Director of the Quality Improvement Division, Los Angeles County Department of Public Health, California.
Zuzka P. Eggena, MD, MPH, is Staff Physician, Office of the Medical Director, Los Angeles County Department of Public Health, California.
Jonathan E. Fielding, MD, MPH, is Director and Health Officer, Los Angeles County Department of Public Health, and Professor, Health Services and Pediatrics, Schools of Public Health and Medicine, University of California, Los Angeles.
Kathleen N. Smith, MSN, RN, MPH, is Public Health Nurse and a graduate, University of Maryland, School of Nursing. She currently serves as the Assistant Nursing Director, Office of the Medical Director, Los Angeles County Department of Public Health, California.
Dawn Marie Jacobson, MD, MPH, is Physician Specialist, Office of the Medical Director, Los Angeles County Department of Public Health, California.
Noel Bazini-Barakat, MSN, RN, MPH, is Public Health Nurse and a graduate, University of California, Los Angeles School of Nursing. She currently serves as Clinical Nursing Director, Office of Organizational Development and Training, Los Angeles County Department of Public Health, California.
Corresponding Author: Jeffrey D. Gunzenhauser, MD, MPH, Los Angeles County Department of Public Health, 313 N Figueroa St, Ste 804, Los Angeles, CA 90041.
