Monitoring QI Maturity of Public Health Organizations and Systems in Minnesota: Promising Early Findings and Suggested Next Steps

Published in Frontiers in Public Health Services & Systems Research

Public health departments and systems are increasing investments in quality improvement. This paper presents methods used to identify a select number of items from a previously validated QI Maturity Tool as the basis for calculating organizational and system-level QI maturity scores that could be followed over time. Findings suggest that the abbreviated tool measures variation in QI maturity across LHDs, and differences in scores among divisions within a state health department. Minnesota has incorporated the abbreviated tool into an annual reporting system for the MN Local Public Health Act, thereby enabling stakeholders to monitor a system median score and distribution of scores every year. Such information will be used by state and local partners to identify opportunities for system-wide improvements.

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• Monitoring QI Maturity of Public Health Organizations and Systems in Minnesota: Promising Early Findings and Suggested Next Steps

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Analysis of Local Health Department Factors that Accelerate Population-Based Intervention Implementation and Support Success

Presented at the March 2013 SCHSAC Meeting.

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• Analysis of Local Health Department Factors that Accelerate Population-Based Intervention Implementation and Support Success (PDF: 777KB / 14 slides)

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Multi-network Practice and Outcome Variation Examination (MPROVE) Study

The Multi-network Practice and Outcome Variation Examination (MPROVE) Study is a national study with participation from seven public health practice-based research networks (PBRNs), with leadership from the PBRN National Coordinating Center. Minnesota is collaborating to develop and test a package of local public health service measures.

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• Multi-network Practice and Outcome Variation Examination (MPROVE) Study (PDF: 201KB / 1 page)

Related Documents

• MPROVE Selection Criteria for Public Health Service Delivery Measures (PDF: 111KB / 3 pages)
• Principles for Selecting Measures of Public Health Service Delivery: MPROVE Measure Selection Meeting (PDF: 138KB / 1 page)
• MPROVE Core Measures (PDF: 208KB / 11 pages)

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Financing Local Public Health Services in Minnesota:
Trends in Local Tax Levy Expenditures

State and local leaders in public health and health care have long called for adequate, stable and flexible funding for local public health services in Minnesota. A recent report by the Institute of Medicine underscores urgency around public health financing nationwide. Emerging research increasingly supports the central role of funding in the performance of public health departments as well as population health outcomes.

When adjusted for inflation, Minnesota’s per capita local tax levy increased nearly 16 percent during the 5-year period 2006-2010. Conversely, per capita local tax levy expenditures decreased 2.4 percent across Minnesota local health departments.

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• Financing Local Public Health Services in Minnesota: Trends in Local Tax Levy Expenditures (PDF: 518KB / 4 pages)

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Local Health Departments

• Executive Summary: Local Public Health Quality Improvement Organizational Survey (PDF: 227KB / 2 pages)

From 2009-2011, Robert Wood Johnson Foundation monitored the organizational QI culture in the 16 states that participated in the Multi-States Learning Collaborative. This brief highlights findings related to organizational culture, quality improvement and readiness for accreditation.

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• Organizational Quality Improvement Culture in Minnesota
  Local Health Departments (PDF: 350KB / 3 pages)

• Quality Improvement Capacity in Minnesota Local Health Departments (PDF: 342KB / 3 pages)

• Quality Improvement Practice in Minnesota Local Health Departments (PDF: 340KB / 3 pages)

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Minnesota Department of Health

• Executive Summary: Organizational Culture at the Minnesota Department of Health (PDF: 229KB / 2 pages)

A department-wide survey relating to quality improvement (QI) capacity and organizational culture was fielded to all employees at the Minnesota Department of Health (MDH) in June 2011. This survey asked questions related to: QI culture and capacity; employee empowerment; cultural competency; and readiness for national, voluntary accreditation. The survey was designed to serve as a baseline for maturity of QI within the department, as well as identify specific areas in which MDH could strengthen its activities around QI. In addition, questions related to organizational culture and employee empowerment provide opportunities to examine the work culture at MDH and how employees might be supported in their work.

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• Alignment and Spread of QI Culture in the Minnesota Department of Health: Results from 2011 Survey (PDF: 355KB / 3 pages)

• Quality Improvement Capacity in the Minnesota Department of Health: Results from 2011 Survey (PDF: 352KB / 3 pages)

• Quality Improvement Culture in the Minnesota Department of Health: Results from 2011 Survey (PDF: 362KB / 3 pages)

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Factors Associated with Local Public Health Department Performance: Literature Review

Until recently, most of the public health systems and services research related to local health department (LHD) performance relied on cross-sectional data sources that made it difficult to determine cause and effect of various factors associated with performance.

Two recent studies used longitudinal approaches to study factors related to local health department structure, financing and capacity. These studies were also unique in that they examined those factors with respect to population health outcomes. They found strong associations between LHD spending and staffing with respect to measures of morbidity and mortality.

Overall, the factors most strongly associated with LHD performance included: population size served, expenditures, funding, staffing, and organizational structure. Weaker associations were found with Director qualifications, partnerships, community characteristics and organizational leadership. Research is needed related to newly merged organizations, such as health departments joining with human services agencies, and how that has affected LHD performance.

Executive Summary

• Factors Associated with Local Public Health Department (LHD) Performance: A Summary of the Research Literature
  (PDF: 156KB / 2 pages)

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• Factors Associated with Local Public Health Department Performance: Literature Review (PDF: 314 KB / 9 pages)

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Authority and Positioning of Minnesota CHS Administrators and Local Health Directors

Little is known about the extent to which community health service (CHS) administrators and local health directors have key authorities related to budgeting and access to elected officials. Information on authority and organizational positioning is needed to help articulate roles of public health leadership. Issues related to authority and positioning are crucial considerations during succession planning, and when discussing changes to local public health governance and organization.

Minnesota's State Community Health Services Advisory Committee (SCHSAC) has begun to more fully articulate the expected authorities of a CHS administrator, in order to focus attention on this issue, motivate discussion and change where needed, and help assure that these authorities endure periodic changes to local public health governance and organizational structures.

This brief will examine the authorities of CHS administrators in relation to their community health boards (CHBs), and the authorities of local health directors in relation to their county boards or city councils.

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• Authority and Positioning of Minnesota CHS Administrators and Local Health Directors (PDF: 362KB / 8 pages)

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Governance and Organization of Local Public Health Services in Minnesota

Between May 2009 and May 2010, 28% of county boards, and 28% of community health boards (CHBs) considered, proposed or decided to change their organizational or governance structure.

Almost all attention to organizational structure focused on merging with another department or division of government, and most attention on governance structure addressed adding a jurisdiction to a CHB or organizing under Statute Chapter 402 so that the Human Services Board (HSB) serves as the CHB.

Most local health directors and CHS administrators in organizations affected by potential changes reported having a role with elected officials by providing information, tools, guidance, and/or recommendations.

Some top public health officials expressed satisfaction with current structures, whereas others identified limitations with current structures or concerns about the motivation for changing structures.

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• Governance and Organization of Local Public Health
  Services in Minnesota (PDF: 438KB / 8 pages)

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