Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare

Price, Alex; Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

"So we had examples where we are absolutely convinced that we should vary the standards or not conform exactly with the [tuberculosis] protocol. This is the Ministry telling us how to practise public health where actually we know more about practising public health than they do … It always ends up the same way because their lawyers advise them to stick to the letter of the law. I don' t know. Something to do with liability. This is not the best use of our resources." -Site-C informant Considerable concern with the quality of performance measurement information relating to the provincial initiative was raised by all parties. The choice of population health outcomes as measures of public health performance was identified as problematic because of externalities that made attributing public health outputs difficult. Some performance indicators were perceived as unreflective of public health performance by health units. For instance, the tobacco use indicator was highlighted as one such problematic measure: