Reinvigorating performance evaluation: first steps in a local health department.

The ability of a local health department to assess and improve employee performance through an effective evaluation process is critical to overall organizational success. A constructive performance evaluation process not only provides meaningful feedback on work performance but also provides opportunities to reinforce work behaviors that support the organization's mission, to recognize exceptional work, and to guide future growth and learning. The Los Angeles County Department of Public Health is creating a new approach to performance evaluation that recognizes 3 distinct components of work performance: standard business practices, competencies, and standards of practice. This multidimensional perspective acknowledges that the expectations of workers are complex and that evaluations of performance are not easily captured with single-dimension assessment tools. This report describes the conceptual relationships of these 3 components and how they integrate to form a single performance evaluation process. Key elements within this structure include a base document of competencies for all workers, expanded competency sets for professional staff, role-specific duty statements for workers who perform similar work, and standards of competent practice related to the mission of units to which individuals are assigned. Key first steps are to define the terminology of performance evaluation and to create role-specific duty statements.

The quality improvement experience in a high-performing local health department: Los Angeles County.

Quality improvement in public health is a key element in the movement toward accreditation. Multiple national, state, and local initiatives are under way to define quality in a public health context and to develop tools and promising practices to support quality-improvement efforts in local health departments. Until recently, efforts to improve quality at the local level have largely focused on performance measurement to assess the relationship between inputs, outputs, and outcomes. The Los Angeles County Department of Public Health has developed its own unique approach to quality improvement. This approach includes focusing on three overlapping areas (professional practice, performance improvement, and public health science) that align closely with essential public health services 8 (competent worker), 9 (evaluation), and 10 (research). Broadening the focus of quality-improvement efforts to include these three areas (rather than performance improvement alone) provides additional opportunities to address key infrastructure issues that may affect the quality of services that are provided to the public and, thus, health outcomes. While the experience in Los Angeles County parallels other efforts, it includes unique elements that will be of use to public health professionals in other agencies.

The Diversity of Challenges in the Control of Measles Outbreaks.

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org .

Laboratory-measured pregnancy rates and their determinants in a large, well-described adult cohort.

OBJECTIVE: To measure the pregnancy rate directly, to describe the characteristics of women who become pregnant, and to identify the predictors of pregnancy. No recent studies have estimated population pregnancy rates using objective, laboratory-based criteria. Furthermore, none have characterized predictive factors of pregnancy. METHODS: Population-based prospective cohort study of 5578 women, ages 18 to 44, on active duty at Fort Lewis, Washington, from 1995 to 1997. Main outcome measures were standardized pregnancy incidence rate and predictive factors for pregnancy. RESULTS: In the cohort, 887 pregnancies and 597 births occurred during the study period. The age- and race-standardized pregnancy rate was 108.1 per 1000 person-years. When compared with the 1995 U.S. population, the pregnancy rate ratio was 1.05 (95% confidence interval, 0.96-1.14). Factors that significantly affected the likelihood of pregnancy included age (=0.87/year), marital status (3.0, married versus single), race (1.2, African American versus Caucasian), Pap smear during study period (0.6), educational level (1.8, graduate training versus high school), and at least one prescription for oral contraceptives during the study period (0.8). CONCLUSIONS: Standardized pregnancy rates in the study population were statistically indistinguishable from United States estimates. Use of health care services was an important independent determinant of pregnancy occurrence.