The following summary of an article written by Irv Rootman in
April 1997, was posted today in the Ontario Health Promotion E-mail
Bulletin. The longer paper was included in a package distributed to
participants in a follow-up meeting to the Symposium on Effectiveness of
Health Promotion, that was held on Monday May 26th. For further
information please contact Irv Rootman directly.
Alison Stirling
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Summary of Continuous Quality Improvement in Health Promotion
A Symposium on the Effectiveness of Health Promotion
took place from June 17-19 1996 at the University of Toronto to
celebrate the designation of the Centre for Health Promotion as a WHO
Collaborating Centre in Health Promotion. It was designed as an
opportunity to synthesize and critically examine Canadian and
International literature and experience on the effectiveness of health
promotion in relation to the five Action Areas of the Ottawa Charter for
Health Promotion.
During the Symposium audience members raised their
concerns about the effectiveness of health promotion. As a result a
workshop was organized in October (1996), to follow-up their concerns.
During this Follow-up Workshop, the participants identified key needs
and issues and grouped them into seven theme areas. One theme
identified was Evaluation/Best Practices.
The Evaluation/Best Practices Work Group was given the
responsibility of: (1) Developing an evaluation framework for health
promotion in Ontario; (2) Studying training needs, developing resources
and carrying out training in evaluation of health promotion activities
in Ontario; and (3) Identifying best practices, developing guidelines,
disseminating findings and conducting training in best practices. In
their first meeting, the group was reminded that the term "best
practices" was suggested as a more acceptable, less threatening term to
replace "Quality Assurance". However, in discussion, after reviewing the
work of the WHO-EURO Quality Task Force 2 the Work Group agreed that
"best practices" might not capture what we would like to get at either.
The Working Group decided the term "Continuous Quality Improvement"
(CQI) required more attention thus, a sub-group called the Continuous
Quality Improvement Work Group was formed.
Various materials pertaining to CQI were distributed and
read by group members. These included: Standards for Community Health
Services developed by the Canadian Council of Accreditation; an article
on "The Art of Health Promotion" published in a supplement to the
American Journal of Health Promotion, March/April, 1997; An annotated
bibliography on CQI and related topics assembled by a student in the
Health Promotion Program at the University of Toronto (Barbara Kahan);
an article by John Ovretveit which appeared in Health Promotion
International, Volume 11, No.1; Proceedings of a conference on Quality
in Health Promotion hosted by the London Borough of Thames in February,
1994; An article by Viv Speller published by the Wessex Institute for
Health Research and Development; and a publication on The Development of
a Quality Assurance Programme for Health Promotion produced by
the Institute of Health and Community Studies at Bournmouth University.
In discussing these materials, some reservations were
raised about CQI in practice. For example, CQI has been found to be
labour-intensive, with staff uncertain about its helpfulness. The
applicability to health services of the "manufacturing model' underlying
much CQI was questioned. The distributed articles were generally
well-received however. The rhetoric is empowering, the procedures are
not necessarily 'top-down' , and the concept of CQI invokes and image of
an informed,
reflective loop of ongoing involvement, in contrast to the
notion of enforced standards implied by Quality Assurance. It
potentially complements the notion of the 'learning organization' from
the organizational development literature.
It was agreed at the meeting that given the volume of
the material and Barbara Kahan's familiarity with it, she would develop
a CQI framework for health promotion, to be reviewed by the Group. It
was also agreed that the Group needed to continue to push on the
relationship between health promotion and CQI concepts, to gather
negative as well as positive case studies, to pay attention to
organizational culture and not just to individuals, and to consider the
pace and depth of change as factors in (or compromising) CQI. The Group
also needed to consider developing a dissemination strategy.
A draft background paper entitled "Continuous Quality
Improvement and Health Promotion" written by Barbara Kahan forms the
basis for a framework. The paper discusses terminology, history,
components, implementation and issues related to CQI and ends with
recommendations. Although the paper is currently being revised, the
issues discussed included the nature of health promotion outputs,
customer satisfaction, structure, data, evaluation and other agendas or
influences. The conclusion of this paper attempts to answer the
following questions relevant to CQI and Health Promotion:
(1) Is the philosophy of CQI compatible with health promotion
principles and values?;
(2) Is CQI methodology adaptable to health promotion?;
(3) If there are no irresolvable conflicts between CQI and
health promotion, will implementing CQI processes improve health
promotion practice and help achieve goals?;
(4) If CQI is adaptable to health promotion, what would a CQI
model look like?;
(5) Are there options that would be better for health promotion
than CQI (both in terms of improving practice and achieving goals)?;
(6) Are there reasons not to implement CQI?; and
(7) What, if any, are the consequences of not implementing CQI?
The Working Group still has some reservations about
moving too quickly in adopting a CQI approach. The questions raised by
Barbara Kahan deserve a through discussion, first. It has been
extremely interesting and valuable to walk down the CQI trail to this
point and we all look forward to our next steps.
Taken from "Continuous Quality Improvement in Health Promotion:
Some Preliminary Thoughts from Canada", written by Irving Rootman,
Ph.D.,
Director, Centre for Health Promotion, University of Toronto,
100 College Street, Suite 207, Toronto M5G 1L5.
E-mail: [log in to unmask]
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