Performance Management and Quality Improvement

The Public Health Improvement Journey

Throughout the years, numerous drivers and catalysts have advanced the awareness and use of performance management and quality improvement (PM/QI) in public health. The following list, while not exhaustive, highlights key milestones and initiatives:

  • Institute of Medicine (IOM) Reports and Recommendationsexternal icon – The Institute of Medicine, now renamed the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine, has provided leadership and national guidance throughout the decades—including the 1988 report that established the core functions of public health, the 1996 report about community health improvement, the 2003 report that included recommendations for catalyzing accreditation and increasing system partnerships, and the 2010 report providing recommendations on performance measurement.
  • Assessment Protocol for Excellence in Public Health (APEX/PH) – Released in 1991, this workbook provided local health departments with guidance for conducting an organizational capacity assessment and a community health assessment.
  • 10 Essential Public Health Services – This framework was established in 1994 and outlined essential areas of public health responsibility. It has set the stage for much of the subsequent work in standards and performance management.
  • National Public Health Performance Standards Program – Begun in 1998, this long-standing partnership effort is intended to advance the quality and performance of public health systems through the use of public health system standards and performance improvement processes. The national performance standards for public health systems and governing bodies—which are based on the Essential Public Health Services framework—have been used in more than 1,000 local jurisdictions and 30 states.
  • Turning Point Performance Management model and resourcesexternal icon – The Turning Point Performance Management Excellence Collaborative was a group of seven states and five national partner organizations that studied and promoted the use of performance management systems in public health. The initiative developed a package of resource materialsexternal icon to help public health systems manage performance.
  • Accreditation – CDC, in partnership with the Robert Wood Johnson Foundationexternal icon, is supporting the implementation of a national voluntary accreditation program for state, tribal, local, and territorial health departments. The Public Health Accreditation Board (PHAB)external icon, a nonprofit 501(c)3 entity, serves as the independent accrediting body. PHAB led the development and testing activities, with significant participation from local, tribal, state, and national leaders and launched the national accreditation program on September 14, 2011. PHAB began accrediting health departments in 2013.
  • Multi-State Learning Collaborative – This Robert Wood Johnson Foundation-funded initiative was put in place in 2005. This effort paralleled development of a national accreditation program and brought together states implementing agency performance and capacity assessment, accreditation programs, and quality improvement initiatives to further current efforts and add to the public health knowledge base.
  • Quality in Public Healthexternal icon – The US Department of Health and Human Services has led a series of efforts focused on improving quality in public health and health care. Through this effort, a Consensus Statement on Quality in the Public Health System and a report describing Priority Areas for Improvement of Quality in Public Health have been developed.
  • National Public Health Improvement Initiative – The National Public Health Improvement Initiative (NPHII) was an innovative program started by CDC to infuse quality and performance improvement methods into health departments across the country. Learn more about NPHII’s accomplishments and read a compendium pdf icon[PDF-12.3 MB] describing its accomplishments, including 71 stories from state, tribal, local, and territorial health departments.

Other Efforts and Activities in PM/QI

In addition to the initiatives noted above, considerable work has focused on disciplinary or programmatic areas. The Laboratory System Improvement Programexternal icon and the Environmental Public Health Performance Standards are just two examples of how we can to link with and learn from more focused efforts.

Finally, throughout the above list, the experiences and resources from those outside of public health were heavily used. Sectors such as industry, business, health care, and education have provided a foundation for many of these initiatives. Links to sites featuring some of this work can be found on the Resources page.

Page last reviewed: August 21, 2018