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Lessons Learned From Measuring Return on Investment in Public Health Quality Improvement Initiatives

Crawley-Stout, Lou Anne MBA, CLSSBB, PMP; Ward, Kerri Ann BS; See, Claire Herring MHA; Randolph, Greg MD, MPH

Journal of Public Health Management and Practice: March/April 2016 - Volume 22 - Issue 2 - p E28–E37
doi: 10.1097/PHH.0000000000000229
Original Articles

Context: The Center for Public Health Quality and its partner, North Carolina State University Industrial Extension Service, used 2 existing, yet similar quality improvement (QI) programs to provide technical assistance to conduct return on investment (ROI) and economic impact (EI) analyses so that they could estimate their QI projects' financial impacts.

Objectives: The objectives of this article are to describe the approach and ongoing learning from applying ROI and EI analyses to public health QI projects and analyze the results in order to illustrate ROI potential in public health.

Design: We used a before-after study design for all ROI and EI analyses, spanning a 3-year time period.

Setting: The study was conducted as part of 2 existing public health QI training programs that included webinars, face-to-face workshops, on-site facilitation, and longitudinal coaching and mentoring.

Participants: The QI training programs included multidisciplinary teams from local and state public health programs in North Carolina.

Main Outcome Measure: Return on investment and EI calculations.

Results: Numerous adaptations were made over the 3 years of the ROI program to enhance participant's understanding and application. Results show an average EI of $149 000, and a total EI in excess of $5 million for the 35 projects studied. The average ROI per QI project was $8.56 for every $1 invested in the project.

Conclusions: Adapting the ROI approach was important in helping teams successfully conduct their ROI analyses. This study suggests that ROI analyses can be effectively applied in public health settings, and the potential for financial return is substantial.

Supplemental Digital Content is Available in the Text.This study aims to describe the approach and ongoing learning from applying ROI and EI analyses to public health QI projects and analyze the results in order to illustrate ROI potential in public health.

North Carolina State University Industrial Extension Service and Center for Public Health Quality, Raleigh (Ms Crawley-Stout); Center for Public Health Quality, Raleigh, North Carolina (Ms Ward and See and Dr Randolph); University of North Carolina School of Medicine, Chapel Hill (Dr Randolph); and University of North Carolina Gillings School of Global Public Health, Chapel Hill (Dr Randolph).

Correspondence: Lou Anne Crawley-Stout, MBA, CLSSBB, PMP, North Carolina State University Industrial Extension Service and Center for Public Health Quality, PO Box 18763, Raleigh, NC 27619 (lacrawle@ncsu.edu).

This article was supported by grants from the Duke Endowment, Blue Cross Blue Shield of North Carolina Foundation, and by funds made available from the Centers for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support under grant number 5U58CD001291-03. The content of this article are those of the authors and do not necessarily represent the official position of or endorsement by the Centers for Disease Control and Prevention.

The devoted time, effort, and follow-through from the local and state teams that participated in the QI 101 program made this article possible. Their commitment to improve processes and calculate the project economic impact and return on investment is worthwhile and greatly appreciated. In particular, the authors are grateful to the DPH Tobacco Prevention and Control Branch in supporting their ongoing EI/ROI training through the use of their team's actual ROI calculation and results.

Finally, the NC State IES Lean Healthcare expertise contributed greatly to the initiation and continuance of our ROI/EI work. The authors are especially grateful to Gene Smith and Jim Kurian for improvement changes to their approach and form formatting and for their ROI guidance and support to the QI teams.

No conflicts of interest exist for the authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

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