Pilot testing and legislation: Unpacking two health department skills sets needed to change communities

INTRODUCTION: Local health departments are increasingly being called upon to work on policy and system changes to transform communities so residents can more readily live healthy lives. Health departments can improve their ability to foster these changes by considering when to deploy two distinct strategies: a quality improvement approach with rapid testing of pilot projects or a legislative approach to change state or local government policy.

METHODS: The Seattle/King County health department used two methods to accomplish policy and system changes in Communities Putting Prevention to Work grants from 2010 to 2012. In the first method, a quality improvement approach offered a team of four contractors technical expertise on quality improvement processes and access to skilled consultants. Second, health department staff worked with county legislative staff to prepare staff reports for Board of Health members who crafted legislation prohibiting the sale of electronic cigarettes to minors.

RESULTS: In the first example, a farm-to-institution project used a short series of pilot tests to develop and disseminate food purchasing system changes among child care centers and senior meal programs. In the second, a Board of Health ordinance restricted the sales of “e-cigarettes” only to people 18 and older. Lessons learned will be discussed.

DISCUSSION: Analyzing the challenges and opportunities of a particular policy or system change so that the most effective change approach can be implemented is an important skill for health departments. Eventually a sequential approach that starts with pilot tests and ends in legislation can lead to sustained community changes.