Embargoed Until:
July 13, 2008
12:00 a.m. Eastern Time



Christopher Fleming

Pilot Project Shows Potential Of Quality Improvement Techniques
To Increase Public Health Emergency Preparedness

Researchers Call For Development Of Preparedness Performance Metrics, Incentives For Quality Improvement Efforts In Preparedness Arena

Bethesda, MD -- The nation’s preparedness to respond to a large-scale public health emergency, such as an influenza pandemic, is inadequate, but it could be improved by using the same quality improvement (QI) techniques commonly used in the health care delivery sector, researchers report in an article published today on the Health Affairs Web site. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.5.w328

Originally developed in manufacturing, QI represents “a systematic approach to understanding and measuring performance, identifying solutions to performance shortfalls, and implementing changes to improve outcomes.” In the article, lead author Debra Lotstein of RAND and colleagues describe the successful use of a pilot QI learning collaborative, involving five state and local health departments, designed to improve readiness for an influenza pandemic.

“More than ever, the United States must be prepared to deal with natural public health emergencies, such as an influenza pandemic, and man-made emergencies, such as nuclear, biological, and chemical attacks. However, there is considerable variation in preparedness across public health agencies, and there have been few systematic efforts to close preparedness gaps once they are identified,” said Lotstein.

The researchers attempted to address this situation by adapting the “Breakthrough Series” QI learning collaborative model, originally developed by Donald Berwick’s Institute for Healthcare Improvement to improve health care delivery. One key feature of the model is an emphasis on “multiple, successive, and initially small tests of changes, rather than the wholesale implementation of a predesigned program.”

Lotstein and her colleagues at RAND and the Cincinnati Children’s Hospital and Medical Center cite a number of improvements achieved by participating agencies during the nine months the learning collaborative was in existence. Examples include the following:

-- The Genesee County Health Department in Michigan increased the percentage of its staff responding to an e-mail alert within 90 minutes from 50 percent to 83 percent.

-- The Georgia Division of Public Health tested multiple approaches to determine which types of nurses were best equipped to staff a triage and decision-support phone line for patients not sick enough to require in-person evaluation during a pandemic.

-- The Virginia Department of Health was able to adapt resources from an existing in-house telephone hotline to create a new Public Inquiry Center (PIC) for public health emergencies.

Although the success of their learning collaborative demonstrates the potential of QI for improving PHEP, several policy steps are needed to realize that potential, say Lotstein and coauthors. First, in the same way that performance measures have been developed for health care delivery, validated PHEP metrics must be created to allow public health agencies to track emergency preparedness over time. Second, agencies that commit to QI activities must be rewarded with financial incentives -- for example, with extra funds for QI -- and nonfinancial incentives, such as public recognition for agencies that improve performance. Finally, larger-scale QI efforts in the PHEP arena must be launched, evaluated, and publicized.

After the embargo lifts, the article by Lotstein and coauthors will be available online at



Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by a grant from the Commonwealth Fund.

©2008 Project HOPE–The People-to-People Health Foundation, Inc.