Questions and Answers
About Implementing Public Health Quality Concepts
The public health system represents the complex network of organizations that work towards fulfilling the public health mission of assuring conditions for a healthy population.
The public health system includes four components:
- Structural capacity
It is assumed to be an open system with relationships that lead to interaction and mutual adjustments among the components.
Public Health Finance is a field of study that examines the acquisition, utilization, and management of resources for the delivery of public health functions and the impact of those resources on population health and the public health system1.
In 2008, the Office of the Assistant Secretary for Health convened the Public Health Quality Forum. With input from all HHS agencies, staff divisions and external stakeholders, the Quality Forum defined public health quality as, “The degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy.” This definition, along with public health quality aims, priority areas and the vision provide a comprehensive National Framework for Public Health Quality.
The definition of public health quality was developed on the basis of the recommendations in the 1998 report, President’s Commission on Consumer Protection and Quality in the Health Care Industry, that all sectors of health develop quality aims, priorities, and definitions as a means to building a systematic approach to quality. The Office of the Assistant Secretary for Health (OASH) includes quality as a primary area of focus. It is dedicated to the mission of creating better public health systems for prevention and care so that all people can reach their highest attainable standard of health. Achieving system effectiveness is, however, contingent upon mainstreaming concepts for quality throughout the entire public health system. The Public Health Quality Forum, established and led by OASH, was given the charge to develop the definition, aims for improvement of quality in public health, and priority areas for quality improvement in public health.
These are the public health quality aims:
The aims are a set of characteristics to guide public health practices. They advance population health improvements across all sectors of the public health system. The aims:
- Describe quality in relation to public health
- Forge a coordinated approach to quality improvement
- Strengthen the intersection of healthcare and public health
- Provide a consistent approach to frame and promote consistency for quality improvement across the public health system.
The aims can be used to:
- Guide goals and activities of programs that promote quality
- Identify areas that need quality improvement
- Design, coordinate, and evaluate quality improvement efforts across all levels in the public health system
- Ensure consistency when identifying and implementing activities to improve quality in the organization
- Focus attention on a particular set of program goals and activities
Use of the public health quality concepts fosters an organizational culture for quality. The aims can aid agencies in building quality management systems (such as, quality assessment, quality assurance, quality improvement) aligned with national quality goals. Applying these quality characteristics also promotes improvements in population health and aids in identifying quality weaknesses.
The vision for quality in public health is to build better systems to give all people what they need to reach their full potential for health. The ultimate goal of quality improvement in public health is to optimize population health across all populations and with a particular focus on eliminating disparities.
Since public health services are multidimensional when testing for quality, only one or a subset may apply to a single service or function when testing for quality. In other public health functions, all aims may be applicable. Routinely examining public health activities for these characteristics enables a consistent approach to quality improvement. When all functions and services of an agency are considered, all nine aims are likely to be identified. Priority Areas for Improvement of Quality in Public Health gives an example of how a state office and a Federal office are implementing the aims.
Priority areas are the primary drivers of public health quality and outcomes. The areas reflect the interactive nature of the public health system, as lack of quality in one area can potentially negatively impact quality in another. These descriptions can also help identify specific elements of the priority areas that require the greatest attention for improving quality and achieving desired results. For example, the surveillance function of public health is vital for reducing the barriers to quality when data needs to be improved.
There are six priority areas:
- Population health metrics and information technology
- Systems thinking
- Sustainability and stewardship
- Workforce and education
The priority areas help to identify specific elements of a public health program that require increased attention for improving quality and achieving desired results. For example, population health metrics and ongoing surveillance are vital for identifying and reducing any barriers to quality.
The following recommendations have been made in order to achieve optimum public health quality:
- Improve the analysis of population health and move toward achieving health equity
- Improve program effectiveness
- Improve methods to foster integration among all sectors that impact health (i.e., public health, health care, and others)
- Increase transparency and efficiencies to become better stewards of resources
- Improve surveillance and other vigilant processes to identify health risks and become proactive in advocacy and advancement of policy agendas that focus on risk reduction
- Implement processes to advance professional competence in the public health workforce
- Honore, P. A., & Amy, B. W. (2007). Public health finance: Fundamental theories, concepts and definitions. Journal of Public Health Management and Practice, 89-92.