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

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

Resource inadequacy was often referenced in relation to the cost neutrality of the intervention and the current public health funding model, more broadly. While public health unit informants highlighted the quality of their agencies' human resources, some did not consider general resourcing to be adequate for achieving all targets -a phenomenon that was reflected by nearly one-third of surveyed public health managers. Issues of increased burden on public health units to show compliance with provincial targets and fulfill local priorities were, in some cases, compounded by rapidly expanding local populations that the current public health funding model does not compensate for. For example, one Site-B informant explained: "I think that both financial and human resources, I think for most if not all boards of health [our] reach is beyond our grasp … [our] population increases five to ten thousand a year. Basically I' ve been getting base budget increases for the last few years. In other words very few if any new staff to service a population even over the last four years that would be in the order of twenty to forty thousand additional people." -Site-B informant Ministry informants acknowledged the need for greater equity in the public health funding model, although some were not convinced that public health performance improvement required additional funding, but rather greater efficiency. Other barriers such as work overload did not have a strong profile in the data, although some public health unit and Ministry informants speculated that smaller, rural health units may struggle with performance expectations related to intensive analytical tasks such as population health assessment.