Nandi A. Marshall

Assessing a Quality Improvement Project in a Georgia County Health Department

The study and evaluation of quality improvement among Georgia’s public health systems continues to be a major priority for the Georgia Public Health Practice Based Research Network (GAPH-PBRN). This article focuses on the application and evaluation of a Quality Improvement project in a Georgia County Health Department. The QI team sought to reduce the waiting time in the teen clinic; thereby, increasing the Quality Improvement culture one project at a time in this Health Department. The project revealed that Quality Improvement is a continuous process that requires change and adaptation by employees. This initial Quality Improvement project was the first step in helping to establish Quality Improvement culture in the County Health Department.

Building Capacity to Support and Study QI in Local Georgia Public Health Systems

The study of quality improvement within Georgia’s local public health systems provides important insight into the use of regional bodies as quality improvement (QI) collaboratives and multijurisdictional entities. This report describes QI initiatives following a RWJF funded quick strike research grant to assess health district capacity to conduct QI in Georgia’s local public health systems. These QI initiatives use QI to improve public health outcomes including: Adolescent pregnancy and Sexually Transmitted Infection prevention, HIV prevention and control, and HIV Management.

Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.

BackgroundPublic health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA.MethodsAn online survey of key informants in Georgia’s districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting.ResultsIncreases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments.ConclusionsAgency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.

Evaluating Quality Improvement to Improve HIV Reporting

The incorporation and evaluation of Quality Improvement into Georgia’s public health systems continues to be a focus of the Georgia Public Health Practice Based Research Network. This report describes the process, preliminary results and lessons learned from incorporating Quality Improvement into one of Georgia’s public health districts.

The Southeast Telehealth Network: using technology to overcome the barriers to rural public health practice.

Georgia’s Southeast Public Health District (SEPHD), like many rural public health districts, is struggling to cope with drastic cuts in funding and staff. Furthermore, like many rural public health districts, the SEPHD covers a vast geographic area. Effective communication and administration are ongoing challenges. A staff meeting or training may require practitioners to drive hundreds of miles. Besides being inefficient, this is unsustainable and environmentally unsound. In response to these challenges, the SEPHD has implemented a program that harnesses telehealth technology to connect SEPHD health departments and has been able to eliminate most administrative travel. To our knowledge, this is the first evaluated use of telehealth technology for this purpose. An evaluation showed that, each month, telehealth saves the SEPHD roughly

Health Districts as Quality Improvement Collaboratives and Multijurisdictional Entities

31 500 in mileage reimbursements and salary, SEPHD staff spends 650 fewer hours on the road, and 35 000 miles of driving are avoided.