Improving the efficiency of local public health using quality improvement processes: Small change yields significant success in Berrien County, Michigan

In collaboration with Robert Wood Johnson Foundation, the Berrien County Health Department (BCHD) completed an eighteen month initiative to explore whether purposeful continuous quality improvement would increase efficiency and quality in public health delivery. Specific focus areas were the Children Special Health Care Services (CSHCS) and Environmental Health Food Inspections Service.

BCHD employed the Institute for Healthcare Improvement's Model for Improvement as the framework for our CQI intervention. The evaluation has assessed both processes and outcomes using static analysis including comparison measures but also dynamic analysis including trend lines and run charts to examine process variation.

Improvements far surpassed our expectations. CSHCS average client encounters increased by 312%, nearly doubling revenue for that service area. The monthly average time it took clinic staff to complete a customer requested task decreased significantly from 2.80 ± 3.02 days prior to the CQI intervention to 0.28 ± 0.50 days within seven months, showing a substantial decrease in variance over time. Client satisfaction also improved.

For food inspections, the time between discovery of a critical violation to re-inspection after restaurant improvement decreased by 5.17 days, indicating a significant special cause trend. Now, 90% of re-inspections occur within fourteen days after discovery. In addition, variation among food service inspectors has decreased substantially.

Findings show that initiating continuous quality improvement interventions using the Model for Improvement framework yielded significant improvements in both efficiency and quality in two unique service areas. Through CQI efforts, health departments are better equipped to serve their clients, and to keep people safe from health threats thus improving the health of a community.

Public health is moving towards a system of national accreditation which represents quality assurance for the public. This project contributes to the body of evidence showing the significant improvements toward accreditation standards that can be gained from implementing CQI.