In local health departments across the nation, problem solving and rapid change occur every day. Often, the results of these changes or problem-solving techniques may not be studied or evaluated fully to determine whether desired results were achieved. In fact, program evaluation, research, and technical assistance at the local level may be reduced or eliminated in many states during a time of rapidly diminishing resources and increasing demand for public health services. In delivering population-level programs, quality improvement (QI) methods may provide a much-needed alternative and more efficient approach than traditional research and evaluation to help answer public health practice questions such as “How do we know when a project or program really works, and, more importantly, how can we do it better?” This article focuses on the Buncombe County Department of Health's (BCDH's) experience utilizing a QI approach called the model for improvement (MFI), incorporating plan-do-study-act cycles and small tests of change, on a specific H1N1 influenza-awareness public health preparedness communication project. In addition, results of the BCDH's participation in QI initiatives and training resulted in success implementing change in other areas of the health department including decreasing wait time and addressing a backlog of prenatal visit appointments from 54 to 15 days, and more than doubling prenatal history efficiency uptake in a 5-week period. These case studies in the BCDH present how the MFI introduced the foundation of a culture of continuous QI within the organization.
This article focuses on the Buncombe County Department of Health's experience utilizing a quality improvement approach called the model for improvement, incorporating plan-do-study-act cycles and small tests of change, on a specific H1N1 influenza-awareness public health preparedness communication project.
NC Center for Public Health Quality, Raleigh (Mss Harrison and Cornett and Dr Randolph); Buncombe County Department of Health, Asheville (Mr Shook and Ms Harris); and Department of Public Health, Brody School of Medicine, East Carolina University, Greenville (Dr Lea), North Carolina
Correspondence: Lisa Macon Harrison, MPH, Performance Improvement, NC Center for Public Health Quality, NC Division of Public Health, 5605, Six Forks Rd, 1931 Mail Service Center, Raleigh, NC 27699 (Lisa.Harrison@dhhs.nc.gov).
The authors thank the staff of the Buncombe County Department of Health (special appreciation extended to team members Chris Emory, Gaylen Ehrlichman, and Karen Smith for participating in the quality improvement training project). The NC Center for Public Health Quality is funded through grants from the Duke Endowment and Kate B Reynolds Charitable Trust and is also supported through the NC Division of Public Health and the NC Public Health Foundation.
Disclosure: The authors declare no conflicts of interest.