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

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

"… there has been a very strong undercurrent in my organization … that your programming is evidence-based and you have a method for reviewing it and each time trying to learn more about how it went and improve it. It' s a continuous cycle of implementation, reflection, evaluation, and review and kind of revision. So there is constant introduction of innovation as well as fine-tuning things as they go." -Site-B informant Site-C presented a dominant developmental culture. Risk-taking and innovation were often regarded as very important aspects of the organization' s culture. These aspects of developmental culture were contextualized in terms of evidence-informed decision-making, which was paradoxically argued to reduce risk at the same time. Risk-taking in the development of strategic plans and priorities and examples of innovative programming were highlighted as proof of the health unit' s commitment to a developmental culture. An example of one Site-C informant reflecting on the health unit' s organizational culture explained that: "… evidence informed decision-making is a large component. It' s one of the strategic priorities in our health unit and so really having that … engaging in processes of informed innovation certainly informs decision-making and out of that what are the risks that we are taking to do things differently than other health units based on the evidence that we have found." -Site-C informant Resistance to change, unrewarded achievement, and hierarchical and rational organizational cultures are regard as barriers to the cultural dimension. In this regard, there was limited evidence of an approach for rewarding achievement and good performance related directly to the province' s CQI initiative. However, some public health unit interviewees argued that celebrating achievement of targets was important -something that their health units did internally when goals were achieved or improved upon. Site-A provided an example of this: