Performance Management and Quality Improvement
Definitions and Concepts
In recent years, there has been a rapidly growing interest in performance and quality improvement within the public health community. In reviewing definitions and activities in public health and other sectors, it is apparent that different names and labels are often used to describe similar concepts or activities. Other sectors, such as industry and hospitals, have embraced a diverse and evolving set of terms but which generally have the same principles at heart (i.e., continuous quality improvement, quality improvement, performance improvement, six sigma, and total quality management).
In the public health field, an array of initiatives has set the stage for attention to improving public health practice, but has used assorted terms as well. The Turning Point Collaborative focused on performance management, the National Public Health Performance Standards Program uses national standards to drive performance improvement, the Multi-State Learning Collaborative has addressed quality improvement, while the US Department of Health and Human Services has provided recommendations on how to achieve quality in public health. Drawing from all of these efforts, the Public Health Accreditation Board is preparing to launch a national voluntary accreditation program that catalyzes quality improvement but also acknowledges the importance of performance management within public health agencies. Regardless of the terminology, a common thread has emerged; one that focuses on continuous improvement and operational excellence within public health programs, agencies, and the public health system.
To anchor common thinking, below are some of the definitions that are frequently used throughout these pages and its resources.
Key Definitions
- Quality improvement in public health is the use of a deliberate and defined process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality services or processes which achieve equity and improve the health of the community. (Source: Riley et al, “Defining Quality Improvement in Public Health”, JPHMP, 2010, 16(10), 5-7.)
- Systems performance improvement is defined as positive changes in capacity, process and outcomes of public health as practiced in government, private and voluntary sector organizations. Performance improvement can occur system-wide as well as with individual organizations that are part of the public health system. It involves strategic changes to address public health system (or organizational) weaknesses and the use of evidence to inform decision making. (Source: National Public Health Performance Standards Program)
- Performance management is the practice of actively using performance data to improve the public's health. This involves the strategic use of performance standards, measures, progress reports, and ongoing quality improvement efforts to ensure an agency achieves desired results. Ideally, these practices should be integrated into core operations, and can occur at multiple levels, including the program, organization or system level.
(Source: Turning Point Performance Management Collaborative, 2003.)

Source: Turning Point's Performance Management Collaborative
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