Change Facilitation: A Catalyst for Quality Improvement in Local Health Departments

The purpose of this study is to evaluate a systems approach to quality improvement (QI) that includes the use of Change Facilitation to promote process improvement in the provision of services delivered by local health departments (LHDs). This is a quasi- experimental study design that compares pre and post- intervention assessments of knowledge and comfort using specific QI tools and QI in general, and perceived levels of health department engagement in QI activities. Change Facilitation (CF) was used to promote the uptake and application of QI strategies in LHDs. The CF approach includes three ½ day training and facilitation sessions delivered to QI teams. Study population includes 29 staff members of six Kentucky LHDs. Preliminary findings show a higher perceived knowledge of QI methods than comfort using QI methods in general. There was higher perceived knowledge and comfort specifically with PlanDoStudyAct (PDSA) and flow mapping tools, but lower knowledge and comfort with fishbone diagramming, root cause analysis, and logic models. Participants considered their LHDs to be sufficiently engaged in QI activities, however, there was inconsistency within LHDs as to previous participation in QI efforts. Posttest surveys will be administered and analyzed in summer 2011. Tailored QI training through CF may be a successful method of promoting improvement in comfort using QI in general, and improvement in knowledge and comfort using specific QI tools. Improving knowledge and comfort using QI methods can lead to an organizational shift towards a culture of continuous quality improvement.