Improving the Efficiency and Effectiveness of Parent Education in the Neonatal Intensive Care Unit.

BACKGROUND: March of Dimes partners with hospitals across the country to implement NICU Family Support (NFS) Core Curriculum, a program providing education to parents in neonatal intensive care units (NICUs) across the country. PURPOSE: This NFS project's goal was to increase the efficiency and effectiveness of NICU parent education by establishing consistency, improving quality, and identifying best practices. METHODS/SEARCH STRATEGY: A 5 topic curriculum was developed and implemented across NFS program sites. The project studied 4 main outcomes of interest related to efficiency and effectiveness: increase in parenting confidence, parent learning, knowledge change, and satisfaction. Data were collected from speakers and attendees immediately following educational sessions. Analytical approaches included descriptive statistics such as frequency, percentage, and response rate, and inferential approaches such as t test, χ, and analysis of variance. FINDINGS/RESULTS: Findings suggest that the NFS Core Curriculum improved both program efficiency and effectiveness. Sessions fully implemented according to recommended strategies had better outcomes than sessions not fully implemented according to recommended strategies (P < .0001). Across the 3648 attendees at 41 sites, 77% of parents reported learning "a lot" at the session they attended and 85% of attendees reported increased confidence. Attendees also reported positive knowledge change and high satisfaction. IMPLICATIONS FOR PRACTICE: Parent education best practices identified through this initiative can be utilized for future NFS Core Curriculum topics and potentially generalized to all NICU parent education and family education in other hospital intensive care units. IMPLICATIONS FOR RESEARCH: Content and best practices identified through this project will require regular review to ensure medical accuracy and appropriateness of best practices as the physical design of NICUs evolves.

Top Training Needs of the Governmental Public Health Workforce.

CONTEXT: Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments. OBJECTIVE: The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017. DESIGN: PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design. SETTING: Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments. PARTICIPANTS: Permanently employed governmental public health staff. MAIN OUTCOME MEASURES: Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area. RESULTS: The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management. CONCLUSIONS: The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public health.

Achieving Public Health Standards and Increasing Accreditation Readiness: Findings From the National Public Health Improvement Initiative.

OBJECTIVES: During 2010-2014, the Centers for Disease Control and Prevention implemented the National Public Health Improvement Initiative (NPHII) to assist 73 public health agencies in conducting activities to increase accreditation readiness, improve efficiency and effectiveness through quality improvement, and increase performance management capacity. A summative evaluation of NPHII was conducted to examine whether awardees met the initiative's objectives, including increasing readiness for accreditation. DESIGN: A nonexperimental, utilization-focused evaluation with a multistrand, sequential mixed-methods approach was conducted to monitor awardee accomplishments and activities. Data analysis included descriptive statistics, as well as subanalyses of data by awardee characteristics. Thematic analysis using deductive a priori codes was used for qualitative analysis. RESULTS: Ninety percent of awardees reported completing at least 1 accreditation prerequisite during NPHII, and more than half reported completing all 3 prerequisites by the end of the program. Three-fourths of awardees that completed a self-assessment reported closing gaps for at least 1 Public Health Accreditation Board (PHAB) standard. Within 3 years of the launch of PHAB accreditation, 7 NPHII awardees were accredited; another 38 had formally applied for accreditation. CONCLUSIONS: Through NPHII, awardees increased collaborative efforts around accreditation readiness, accelerated timelines for preparing for accreditation, and prioritized the completion of required accreditation activities.

Challenges and Innovations in Surveying the Governmental Public Health Workforce.

Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest.

Quality improvement coaching to build capacity within health departments: reflections and recommendations.

CONTEXT: Strengthening the Community of Practice for Public Health Improvement is a 2-year initiative that facilitates the exchange of best practices and builds capacity among the nation's health departments to become accredited and conduct quality improvement (QI). Launched as the Public Health Accreditation Board opened its doors to receive the first accreditation applications from health departments, the Community of Practice for Public Health Improvement is the next stage in the National Network of Public Health Institutes' efforts to nurture and expand a community of practice focused on accreditation and QI. A key component of the Community of Practice for Public Health Improvement is the QI Award Program, which provides small grants and distance-based QI coaching to state, local, tribal, and territorial health departments. OBJECTIVE: To understand the efficacy of distance-based QI coaching. DESIGN: The QI coaching model was evaluated using Web-based satisfaction surveys along with programmatic data collected through progress reports, coaching logs, and meetings. SETTING: During 2 QI Award Program cycles, 60 health departments (30 departments per cycle) received $5000 and QI coaching to engage in QI projects that address locally identified priorities and connect to efforts to prepare for public health accreditation. PARTICIPANTS: Data in this article represent findings from the first 30 sites and 9 coaches who participated in cycle 1. MAIN OUTCOME MEASURE(S): QI coaching hours and methods, sites' impressions of QI coaching, sites' accomplishments due to coaching, and suggestions for coaching improvement. RESULTS: Approximately 80% of QI satisfaction survey respondents indicated that they strongly agreed or agreed that distance-based coaching is effective. Sites also reported increased experience with QI processes, initiation of QI spread within the health department, and additional activity within and beyond the project team due to the QI Award Program.

Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative.

INTRODUCTION: Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). OBJECTIVE: Evaluate the extent to which NPHII awardees have achieved program goals. DESIGN: NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. SETTING: Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. PARTICIPANTS: NPHII performance improvement managers or principal investigators. MAIN OUTCOME MEASURE(S): Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. RESULTS: Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. CONCLUSIONS: NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

Driving a public health culture of quality: how far down the highway have local health departments traveled?

CONTEXT: There has been an extensive investment in building public health organizational capacity to improve performance and prepare for accreditation. An evolving perspective has focused not only on the practice of quality improvement (QI) within the health department but also upon the extent the culture of QI is embraced within the agency. OBJECTIVE: No studies have examined the current national baseline of QI culture implementation, nor estimated the degree of QI sophistication local health departments (LHDs) have attained. We attempt to fill this void by aligning the findings from the QI module of the National Association of County & City Health Officials (NACCHO) 2010 Profile of LHDs against the constructs defined by the QI Maturity Tool and the NACCHO QI Roadmap (Roadmap to a Culture of Quality Improvement). DESIGN: Specific questions regarding QI activities from the 2010 Profile Study QI module were used to assign responding LHDs to stages within the Roadmap. We also used data from the QI Maturity Tool administered to all LHDs in the 16 participating Multi-State Learning Collaborative states in 2010 and 2011. On the basis of this matched set, we applied the summative domain scores algorithm, classified agencies into 1 of 5 groups, compared our findings with those of the NACCHO survey, and aligned our categories to those of the Roadmap. RESULTS: Nearly 80% of LHDs classified using the NACCHO Profile data were assigned to group 3 or 4 versus 48% using the QI Maturity Tool. Results from the cross-tabulations of the matched data set between the QI Maturity Tool classifications and the NACCHO Profile classifications revealed exact alignment 30% of the time. Forty-nine of 163 agencies were classified in the same grouping in both schemata. In addition, 84% of the agencies were classified within 1 neighboring category. CONCLUSIONS: The results revealed that half, if not most, LHDs fall within the middle categories of QI maturity and sophistication, regardless of which classification system was deployed.