Statement from Dr. Howard Koh, Assistant Secretary for Health, on Quality in the Public Health System
A fundamental function of the public health system is to safeguard and improve the quality of health in America. Compared to the medical care system which focuses primarily on delivery of care to individuals, public health focuses more on population-based activities. There must be synergy between the two sectors in order to improve the health and quality of care for all Americans.
Public health can advance national quality improvement efforts. The landmark 1998 report Quality First: Better Health Care for All Americans(Quality First), issued by the President’s Advisory Committee on Consumer Protection and Quality in the Healthcare Industry, noted the need for quality measurement for public health initiatives and policymaking.1 Also, in Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) recognized the relevance of public health to system-wide improvements in health.2 However, while that 2001 IOM Committee issued a framework for quality improvement in patient care, they acknowledged that identifying a role for public health in quality improvement was outside of the scope of that work.2 Recognizing this gap, in 2008 the U. S. Department of Health and Human Services developed and widely disseminated a framework for quality in the public health system through the Public Health System, Finance, and Quality Program.3 The framework and aims for public health quality improvement were based on recommendations included in the 1998 Quality First report.
The Assistant Secretary for Health (ASH) serves as the principal advisor to the U.S. Department of Health and Human Services for the nation’s public health system. Resting within the responsibilities of the ASH are goals for protecting, promoting, and advancing the health and safety of the nation. Fulfilling these goals requires embracing public health’s role in national quality improvement initiatives.
To build capacity in public health to improve quality, we can employ methods that could:
- Facilitate partnerships between public and private entities focused on quality to stimulate and promote the engagement of national leaders;
- Promote dialogue between public health and health care organizations on improving quality as a means of developing unifying strategies to build synergy and reduce fragmentation of quality improvement efforts; and
- Enhance the knowledge of the public health workforce to ensure that concepts of quality and quality improvement are mainstreamed into public health practice.
As Assistant Secretary for Health, I fully acknowledge and embrace the necessity for advancing quality concepts in the public health system. This Statement serves as evidence and a measure of that commitment. A strategic partnership has been established with the American Public Health Association (APHA) to ensure that the public health leadership is actively engaged in quality improvement. In this role, APHA will promote and provide venues for dialogue between key public health and national quality organizations. An anticipated outcome from this dialogue should be establishing methods for identifying and clearly articulating public health quality improvement priorities. Additional strategic alliances with other entities will be established over time. Providing the public health workforce with tools to institutionalize quality concepts can then help us achieve desired quality improvement outcomes. Publications for wide dissemination that describe the national framework for quality in the public health system are being developed to promote these concepts in practice and academia. Participants from across all sectors of health and public health will share in the development of these publications. The Public Health System, Finance, and Quality Program will continue to provide leadership and direction over these activities.
Public health is on the front line of protecting and promoting the quality of health in the nation. Public health’s role in quality improvement is essential to achieving those goals. I am honored to have the Office of the ASH assume a leadership position in supporting quality improvement initiatives that advance successful fulfillment of this role.
1. President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. (1998, March). Quality first: Better health care for all Americans. Retrieved May 24, 2008, from http://www.hcqualitycommission.gov/.
2. Committee on Quality of Health Care in America, Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academy Press.
3. U.S. Department of Health and Human Services. (2008, August). Consensus statement on quality in the public health system. Retrieved August 14, 2009, from http://www.hhs.gov/ophs/initiatives/quality/quality/phqf-consensus-statement.pdf.