Building quality public health: Bottom-up and top-down approaches

How do you change quality and capacity in health departments? In Wisconsin we have found this to be a challenging but worthwhile process that is beginning to show positive results.

In 2008, through involvement in the Multi-State Learning Collaborative, the Wisconsin Public Health Quality Initiative was developed. This initiative is working to integrate quality improvement into practice, and prepare for emerging national voluntary accreditation. So far, 24 local health departments as well as sections of the state Division of Public Health (WDPH) have assessed capacity to provide the essential services, and used quality improvement processes to address identified gaps. Significant “bottoms-up” work has been done through meetings, networking, trainings, and technical assistance to participating agencies to build a community of practice. This community of practice will provide a foundation on which to build quality public health in Wisconsin.

Along with a strong foundation, strong leadership is also necessary to move these efforts forward. Efforts to develop a “top-down” approach have also been considerable. Ongoing outreach has been done to engage the leadership of key public health organizations and the WDPH. In addition, public health capacity and quality was selected as a focus area in the Healthiest Wisconsin 2020 state health plan – the policy document that will guide the state public health system for the next 10 years. Objectives were developed in the areas of quality improvement implementation and accreditation. This presentation will discuss further the simultaneous bottom-up and top-down approaches taken to develop capacity and quality in the public health system in Wisconsin, and the challenges and opportunities that have emerged throughout the process.