APHL-Association of Public Health Laboratories
The Ten Essential Public Health Services were developed nationally in 1996. Taken together, they represent the capacities that must be present in a public health system, whether at the local, state or national level, to assure a fully functioning system. They were created for the broader public health system - not specific to the laboratory. They include:
- Monitor health status to identify community health problems
- Diagnose and investigate health problems and health hazards in the community
- Inform, educate,and empower people about health issues
- Mobilize community partnerships to identify and solve health problems
- Develop policies and plans that support individual and community health efforts
- Enforce laws and regulations that protect health and ensure safety
- Link people to needed personal health services and assure the provision of health care when otherwise unavailable
- Assure a competent public health and personal health care workforce
- Evaluate effectiveness, accessibility, and quality of personal and population-based health services
- Research for new insights and innovative solutions to health problems
The core functions and capabilities of public health laboratories were developed to more clearly define the role of public health laboratories in protecting our nation's health and were intended to serve as the basis for assessing and improving laboratory quality. They include:
- Disease Prevention, Control and Surveillance
- Integrated Data Management
- Reference and Specialized Testing
- Environmental Health and Protection
- Food Safety
- Laboratory Improvement and Regulation
- Policy Development
- Emergency Response
- Public Health Related Research
- Training and Education
- Partnerships and Communication
- What is the bottom line mission of L-SIP?
To strengthen the State Public Health Laboratory System (SPHL System) by developing and implementing an improvement plan based on identified strengths and weaknesses.
- Why should we do a SPHL System Assessment?
To measure, through a collaborative process with system partners, the strengths and weaknesses of the system. The results serve both to direct improvement activities and as a baseline for subsequent measurement of improvement.
- What is the National Public Health Performance Standards Program (NPHPSP) and how does it differ from L-SIP?
NPHPSP is a national partnership initiative that developed public health performance standards for state and local public health systems and for public health governing bodies, using the Ten Essential Public Health Services as the framework. The purpose of the program is to improve the quality of public health practice and the performance of public health systems. More information is available at the NPHPSP website It differs from L-SIP principally in scope. NPHPSP addresses performance at the broader public health system level, while L-SIP addressed performance at the public health laboratory system level.
- Are all of the 11 Core Functions of Public Health Laboratories encompassed in the 10 Essential Services?
Yes they are. In some cases, more than one core laboratory function is represented in a single essential service.
- What is the “gold standard” as applied to a performance standard?
The gold standard is when the very best possible level of service and system attributes has been identified and attained. It indicates that performance is at or near optimal levels although improvement can always occur. Gold standards continually change as breakthroughs in performance occur at broad levels.
- What is a System Improvement Plan?
A system improvement plan is a plan designed to address the findings of state system assessment to raise the level of performance among system partners, both collectively and individually. The goal of a system improvement plan is to move the public health laboratory system toward operational efficiency, effectiveness and adaptability.
- Who should participate in a system assessment?
Inclusion of the following, as appropriate to individual states, is encouraged: State and local public health service providers, university/academia, hospitals, private and independent laboratories, federal and state law enforcement, environmental agencies and others as appropriate. Any group of individuals who participate in working with the state Public Health Laboratory to achieve a healthy public may be included. Reviewing sections of the user’s Guide and Toolkit that identify partners for each essential service is very helpful.
- How much time is required of the convening organization (usually the state public health laboratory) to organize and prepare for the assessment?
The amount of time will vary, but the range most frequently noted by field test states was 71-90 hours of preparation time. The checklist included in the toolkit provides guidance of specific activities and the recommended time frames.
- What resources are needed to conduct an assessment?
Resources needed are pretty well summarized in the L-SIP User’s Guide, available here Those that are advised include:
- A project coordinator to coordinate the planning and organization of the assessment
- A facility, preferably outside the state lab, that can accommodate one room for plenary sessions and two additional breakout rooms
- Three facilitators who should be skilled in facilitation, independent and objective, and whose roles are to set the ground rules and to guide the discussion.
- Three (or more) theme takers, who are responsible for 1) noting the key concepts from the discussions that are important items for follow up or consideration and writing them onto a “back burner or parking lot”, 2) recording the negotiated score for each question, 3) recording the top 1-3 next steps for each essential service, and 4) submitting the notes electronically to the coordinator following the assessment.
- What is the “Parking Lot” (or back burner)?
This is the place to record discussion items of importance that may directly or indirectly relate to the essential service being discussed. It is important to identify these key concepts for future discussion and follow up while enabling the group to move on in their consideration of the assessment instrument. This is a key strategy to assuring that the assessment is completed within the planned timeframe.
- How are the assessment scores shared?
A scoring tool is available to record the scores and to provide a graphic display of the results. It is recommended that the results be shared at the end of the meeting, and by subsequent distribution and meetings.
- What actions should follow the assessment?
It is recommended that all participants (and others, as appropriate) be reconvened within no more than 3 months following the assessment to review the results and to begin planning for system improvement.