Where Does Quality Management Fit in Public Health Nursing?

In March 2000, the Association of State and Territorial Directors of Nursing (ASTDN) published a public health nurse (PHN) model integrating nursing firmly with the core public health functions. Their paper defines the public health nurse's role and discusses specific avenues to address each function. Integration of the ASTDN PHN model and Juran's Quality Trilogy illuminates opportunities and benefits of the three quality approaches in public health nursing. Juran's Quality Trilogy is a framework of quality management methodologies that will build infrastructure, enabling stability and consistency within the framework of public health processes. Juran's Trilogy of Quality Planning, Quality Control, and Quality Improvement, integrates with the core public health functions of assessment, policy development, and assurance providing a schema for public health program and community health improvement. Within the trilogy are improvement systems and tools such as Six Sigma, Design for Six Sigma and Lean Six Sigma that provide a framework for quality improvement and planning. Use of a structured quality management system such as Six Sigma or Lean Six Sigma enables structured approach to an issue providing a roadmap for problem definition, stake holder input recognition, process review and development and implementation of remedies. Benefits of Juran's methodologies include budgetary control of projects and initiatives, ongoing process assessment, and creation of transparent processes that can be improved as needs and constraints change and transferred to other communities. We will include specific examples and areas for integration and which systems to use in each area addressed.