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

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

Training opportunities and the quality and availability of data are the primary facilitators in the technical dimension. In Ontario, training in quality improvement, and CQI specifically, manifested mainly at the local level, with public health units providing instruction to staff on strategic planning. Guidance in program and service provision was evident through provincial OPHS protocols, but these materials did not relate specifically to quality improvement training. A Site-A informant reflected on this gap: "I' m not aware of any kind of … the how stuff that' s come from the Ministry other than just … okay your targets are now being established with an expectation we do something about them." -Site-A informant Gaps in training and data systems can be precursors to frustration and false starts, according to Shortell et al. (1998) . Guidance from the Ministry on how public health units were to achieve performance targets or improve was limited. Moreover, some guidance materials, such as the previously mentioned tuberculosis protocol, were criticized by Site-C informants for not reflecting best available evidence and local expertise: