Can public health performance standards improve the quality of public health practice?

Recent developments suggest that a national public health performance standards program could succeed in improving the quality of public health practice. Public health standards also may be useful for enhancing accountability and strengthening the science base of public health practice. For national public health performance standards to have a substantial influence on the quality of public health practice, several important issues must be addressed. These include agreement as to the ultimate purpose and appropriate unit of measurement, delineation of the specific qualities to be measured, and expansion of strategies to promote widespread use of public health practice standards.     

美国公共卫生绩效评价工具的研究进展及借鉴意义

评价工具是公共卫生绩效评价研究的重点内容。美国公共卫生学界在公共卫生绩效评价的理论框架和工具开发两个方面取得了较大的进展,形成了以公共卫生体系的概念模型、国家公共卫生绩效标准项目等为代表的重要成果。借鉴美国公共卫生绩效评价工具研究的经验,我国的公共卫生绩效评价研究应加强公共卫生体系研究的理论基础,并推动建立国家公共卫生绩效标准。     

Assessment of validity of the national public health performance standards: the local public health performance assessment instrument

The National Public Health Performance Standards Program (NPHPSP) has developed performance standards measurement instruments, based on the 10 "Essential Services of Public Health" that are being tested in several states. This article is a report on the face and content validity of the instrument designed for local public health systems. Judgments about the face validity of the standards were obtained in a survey of local public health systems that had used the instrument in a test state. The validity of each standard was addressed along the following dimensions: the importance of the standard as a measure of the Essential Service; its completeness as a measure; and its reasonableness for achievement. All standards for each Essential Service were then judged in terms of their completeness in measuring performance of that service. Respondents judged the standards to be highly valid measures of local public health system performance. Some respondents had reservations about whether standards related to "enforcing laws and regulations" were achievable. Holding local public health systems accountable for the activities of other agencies was a factor mentioned in conjunction with those standards. The NPHPSP standards have face and content validity for measuring local public health system performance. Further testing of their validity and reliability is continuing.     

Content and criterion validity evaluation of National Public Health Performance Standards measurement instruments

OBJECTIVE: The Centers for Disease Control and Prevention's National Public Health Performance Standards Program (NPHPSP) has developed instruments to measure the performance of local and state public health departments on the 10 "Essential Services of Public Health," which have been tested in several states. This article is a report of the evaluation of the content and criterion validity of the local public health performance assessment instrument, and the content validity of the state public health performance assessment instrument. METHODS: Health department performance is measured using a set of indicators developed for the 10 Essential Services of Public Health and a model standard for each indicator. Content validity of each model standard in the local instrument was addressed by community partners along the following dimensions: the importance of each standard as a measure of the associated Essential Service, its completeness as a measure, and its reasonableness for achievement. All standards for each Essential Service were then judged in terms of their completeness in measuring performance in that service. Content validity of the state instrument was evaluated in a group interview of health department staff members from three states. Criterion validity of the local instrument was assessed for a sample of eight public health departments in Florida and six in New York by examining documentary evidence for selected responses. Criterion validity was also evaluated for a sample of Florida local public health departments and one Hawaii public health department by comparing state health department staffs' judgments of performance against the instrument score. RESULTS: Criterion validity was upheld for a summary performance score on the local instrument, but was not upheld for performance judgments on individual Essential Services. The NPHPSP standards based on the Essential Services have validity for measuring local public health system performance, according to community partners. The model standards are valid measures of state performance, according to state public health departments in three states. CONCLUSIONS: Within the scope of the validity evaluations completed, the NPHPSP state and local performance assessment instruments were found to be valid measures of public health performance.     

Local public health certification and accreditation in Illinois: blending the old and the new.

Funded by the Robert Wood Johnson Foundation through the Multi-State Learning Collaborative, the Illinois Accreditation Development Project is developing a proposal to reengineer the 15-year-old Illinois local health department certification process. The Project is addressing a variety of political, technical, and resource issues in its attempt to develop a new approach to a mature program that will incorporate more meaningful performance and capacity measures for all local public health practice standards. Both statewide strategic planning and the evolving national momentum toward local public health agency accreditation are motivating the enhancements to the Illinois program. A new proposal that blends the current mandatory certification program with a new voluntary local public health accreditation program is discussed. The proposed new structure enhances the state-operated certification program with specific performance measures and creates a three-tiered voluntary accreditation process governed by a third party accreditation board.     

Competency-based credentialing of public health administrators in Illinois.

This article describes an initiative to develop and implement a competency-based credentialing program for public health managers and administrators that is linked with practice performance standards for local public health systems. The Illinois Public Health Administration Certification Board represents an innovative model for credentialing public health workers, placing equal value on competencies secured through education and training and those demonstrated in practice. Competency-based credentialing of public health administrators may have applicability for other segments of the public health workforce.     

Essential functions of public health: emerging topic in health care reform]

In the Americas, health sector reforms are facing the challenge of strengthening the steering and leadership role of health authorities. An important part of that role consists of fulfilling the essential public health functions (EPHFs) that are incumbent on all levels of government. For that, it's crucial to improve public health practice, as well as the instruments used to assess the current state of public health practice and the areas where it needs to be strengthened. For that purpose, the Pan American Health Organization has started an initiative called "Public Health in the Americas," with the objective of defining and measuring EPHFs, as a way of improving public health practice and strengthening the leadership provided by health authorities at all levels of government. This article summarizes conceptual and methodological aspects of defining and measuring EPHFs. The article also analyzes the implications that measuring performance on these public health roles, responsibilities, and activities would have for improving public health practice in the Americas.     

Public health worker competencies for emergency response.

Emergency preparedness is an expectation of public health organizations and an expectation of individual public health practitioners. Organizational performance standards for public health agencies have been developed during the last several years, providing a foundation for the development of competency statements to guide individual practice in public health program areas, like emergency response. This article provides results from a project that developed emergency preparedness and response competencies for individual public health workers. Documentation of the qualitative research methods used, which include competency validation with the practice community, can be applied to competency development in other areas of public health practice.     

The use of the National Public Health Performance Standards to evaluate change in capacity to carry out the 10 essential services

Nationally, environmental public health programs have been struggling to find ways to measure their capacity to carry out the 10 essential public health services. The ability to make this kind of measurement is crucial to showing the benefits of local, state, and federal funding of environmental public health programs, It is also crucial to the continuation of this funding. One local health department in Pennsylvania, the Allegheny County Health Department, implemented use of the National Public Health Performance Standards as a mechanism for measuring current performance in carrying out the 10 essential services as well as to set a benchmark for improving capacity in areas of environmental health practice. By using these standards as a tool for assessing current performance, the health department was able to focus on strengthening areas in which little or no capacity was reported. This process made it possible to set priorities and allocate resources to improve the delivery of environmental health services. The tool was re-used two years later to measure the impact this capacity-building activity had on improving the ability of the environmental health program to carry out the 10 essential services.     

我国基本公共卫生服务标准化现状分析暨均等化的标准化策略初探

通过对基本公共卫生服务工作标准现状与基本公共卫生服务均等化项目和首批国家基本公共服务标准化试点项目的系统分析,了解我国基本公共卫生服务标准化的现状,探讨提出实现基本公共卫生服务均等化的标准化策略建议。收集国家基本公共卫生服务上述3个方面的内容,并将公共卫生标准与《国家基本公共卫生服务规范（第三版）》所包含的14项规范和《关于开展国家基本公共服务标准化试点工作的通知》中所包含的51项国家基本公共服务标准化试点项目进行系统比较。现行公共卫生标准基本符合国家基本公共卫生服务项目中的居民健康档案管理服务规范工作需要。然而,其余13项规范以及国家基本公共服务标准化试点项目中的公共卫生项目对应的公共卫生标准不健全或缺失。现行公共卫生领域标准与实施国家基本公共卫生服务项目存在较大差距。在实现基本公共卫生均等化的进程中,亟需根据基本公共卫生服务项目的相关内容,制定与之相配套的公共卫生领域标准,助推基本公共卫生服务均等化。     

How can performance standards enhance accountability for public health?

This article focuses on how a national system of measuring public health performance can help enhance accountability for public health. It describes the trend toward increased accountability in public health; provides an overview of the issues and challenges public health practitioners face in demonstrating how the resources they spend and programs they operate contribute to improved community health status and suggests how the results of participating in the National Public Health Performance Standards Program can help.     

Global public health security

The framework of the newly revised International Health Regulations is a key driver in the effort to strengthen global public health security. Unanimously agreed upon by the World Health Assembly on May 23, 2005, the regulations are the result of experience gained and lessons learned during the past 30 years. This global legal framework includes a commitment from the World Health Organization (WHO) and from each WHO member state to improve capacity for disease prevention, detection, and response. It provides standards for addressing national public health threats that have the potential to become global emergencies. Its success will rely on the capacity and performance of national public health systems, anchored by strong national public health institutes (NPHIs). The new International Association of National Public Health Institutes aims to strengthen and invigorate existing NPHIs, to create new NPHIs where none exist, and to provide funded grants to support NPHI development priorities.     

Towards medicines regulatory authorities' quality performance improvement: value for public health

The purpose of this article is to explore the possibility of implementing total quality management (TQM) principles in national medicines regulatory authorities in Europe to achieve all public health objectives. Bearing in mind that medicines regulation is a governmental function that serves societal objectives to protect and promote public health, measuring the effective achievement of quality objectives related to public health is of utmost importance. A generic TQM model for meeting public health objectives was developed and was tested on 10 European national medicines regulatory authorities with different regulatory performances. Participating national medicines regulatory authorities recognised all TQM factors of the proposed model in implemented systems with different degrees of understanding. An analysis of responses was performed within the framework of two established criteria—the regulatory authority's category and size. The value of the paper is twofold. First, the new generic TQM model proposes to integrate four public health objectives with six TQM factors. Second, national medicines regulatory authorities were analysed as public organisations and health authorities to develop a proper tool for assessing their regulatory performance. The paper emphasises the importance of designing an adequate approach to performance measurement of quality management systems in medicines regulatory authorities that will support their public service missions. Copyright © 2014 John Wiley & Sons, Ltd.     

Managing complex systems: performance management in public health.

The complexity of mobilizing and managing systems-wide public health responses has prompted Turning Point's Performance Management National Excellence Collaborative, funded by the Robert Wood Johnson Foundation, to develop a conceptual framework for performance management in public health. The framework has four integrated parts: (1) performance standards, (2) performance measures, (3) reporting of progress, and (4) a quality improvement process. The Collaborative based its framework on evidence gathered through a survey of current state performance management practices, a literature review, and its investigation of current practice models. This balanced and cohesive management model can be constructively used by public health programs, organizations, and community and state public health systems.     

Peer Reviewed: Assessing Local Health Department Performance in Diabetes Prevention and Control — North Carolina, 2005

Introduction

To improve the public health system''s ability to prevent and control chronic diseases, we must first understand current practice and develop appropriate strategies for measuring performance. The objectives of this study were to measure capacity and performance of local health departments in diabetes prevention and control and to investigate characteristics associated with performance.

Methods

In 2005, we conducted a cross-sectional mailed survey of all 85 North Carolina local health departments to assess capacity and performance in diabetes prevention and control based on the 10 Essential Public Health Services and adapted from the Local Public Health System Performance Assessment Instrument. We linked survey responses to county-level data, including data from a national survey of local health departments.

Results

Local health departments reported a median of 0.05 full-time equivalent employees in diabetes prevention and 0.1 in control. Performance varied across the 10 Essential Services; activities most commonly reported included providing information to the public and to policy makers (76%), providing diabetes education (58%), and screening (74%). The mean score on a 10-point performance index was 3.5. Characteristics associated with performance were population size, health department size and accreditation status, and diabetes-specific external funding. Performance was not better in localities where the prevalence of diabetes was high or availability of primary care was low.

Conclusion

Most North Carolina local health departments had limited capacity to conduct diabetes prevention or control programs in their communities. Diabetes is a major cause of illness and death, yet it is neglected in public health practice. These findings suggest opportunities to enhance local public health practice, particularly through targeted funding and technical assistance.     

Public Health Department Accreditation Implementation: Transforming Public Health Department Performance

In response to a call for improved quality and consistency in public health departments, the Public Health Accreditation Board (PHAB) is leading a voluntary public health accreditation initiative in the United States.The public health department accreditation system will implement a comprehensive set of standards that set uniform performance expectations for health departments to provide the services necessary to keep communities healthy. Continuous quality improvement is a major component of PHAB accreditation, demonstrating a commitment to empower and encourage public health departments to continuously improve their performance.The accreditation process was tested in 30 health departments around the country in 2009 and 2010, and was launched on a national level in September 2011 at the National Press Club in Washington, DC.ACCREDITATION IS A WELL-established process for improving performance within organizations1 and takes place when a formal authority concludes that an organization meets predetermined standards.2 In the health care field, the Joint Commission and National Committee for Quality Assurance are long-standing, respected accreditation authorities recognized for establishing standards and advancing quality through accreditation of health care organizations.3,4 Initiatives undertaken in 4 states—North Carolina, Michigan, Missouri, and Illinois—have demonstrated the relevance and usefulness of similar accreditation systems in public health. 5–8 Important lessons have been learned from these programs about the need for and development of a national public health accreditation system. Nonetheless, despite state examples and the critical role of public health in the health of the nation, no national accreditation organization has been established to ensure public health department standards of performance, until now.Public health department accreditation has become one of the most important initiatives in public health today, representing the culmination of many years of collaboration and research. Leading this initiative is the Public Health Accreditation Board (PHAB), a nonprofit organization dedicated to advancing the continuous quality improvement of state, local, tribal, and territorial health departments through accreditation.9 The goal of the PHAB, set by the Robert Wood Johnson Foundation and the Center for Disease Control and Prevention, is to ensure that 60% of the US population is served by an accredited health department by 2015.10,11 Achievement of this goal is expected to promote and protect the health of the public by advancing the performance of state, tribal, territorial, and local public health departments.9,12We have provided an overview of the voluntary national accreditation program led by the PHAB, the current status of accreditation, and a roadmap for next steps that will be undertaken in the transformation of public health quality in the United States.     

A model for public health workforce development using the National Public Health Performance Standards Program.

Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies.     

关于我国公共卫生人才核心能力的思考

在我国各级公共卫生机构“硬件”建设得到明显改善情况下,作为“软件”之一的公共卫生人才队伍素质已经成为制约公共卫生事业发展的关键因素。本文从核心能力入手,介绍了国际上有关的理论和实践进展,分析了我国在专业技术资格(职称)、继续医学教育和岗位聘任各环节中对公共卫生人才能力标准的相关界定。最后,就提升我国公共卫生人才核心能力提出四点建议:一是从战略高度重视发展公共卫生核心能力,二是以现有管理系统为基础建立公共卫生核心能力传递链,三是根据公共卫生人才结构确定核心能力的适宜能级,四是以制度作保障持之以恒地提高公共卫生人才核心能力。     

Linking accreditation and public health outcomes: a logic model approach.

Emerging public health standards, performance assessment tools, and accreditation models hold significant promise for defining and standardizing public health practice, yet the lack of empirical research on their relationship to outcomes represents a serious barrier to adoption. Given the growing interest and momentum related to public health agency assessment and accreditation efforts, there is increasing need for evidence that performance standards and associated accreditation programs are effective means for moving public health systems toward the ultimate goal of population and community health improvement. This article provides an overview of accreditation in health and other industries, and its relationship to outcomes. We examine lessons that might have meaningful public health translations, as well as influences in and on public health that pose challenges for research and evaluation in this area. Finally, we propose a logic model framework to help depict the ways in which we can begin to explore the impact accreditation has on various levels of outcomes. This logic model is intended to guide the development of measures and to serve as a tool to help convey the breadth and depth of research needed to link accreditation to health outcomes.     

The Role of the World Health Organization on Pharmaceuticals in Europe

The World Health Organization (WHO) is the specialized agency of the UN on public health. It gives worldwide guidance in the field of health, sets global standards for health, cooperates with governments to strengthen national health care programs, and develops and transfers appropriate health technology, information, and standards. Within the WHO European region, health status and health expenditures vary greatly. In this paper, disparities between health status, health services, and health care expenditures between countries of the WHO European region are presented. The objectives, performance, and dilemmas facing health care systems are discussed, including the recent performance ranking published by the WHO. The paper focuses particularly on access to medicines, their appropriate use, and rising drug expenditures. Strategies used by European countries to improve drug use and contain health care expenditures are outlined. Finally, the future of pharmaceuticals and public health is explored.