Lessons Learned From Introducing Staff to Quality Improvement Through Systematic Training at the Boston Public Health Commission

Context: The widespread adoption of quality improvement (QI) in public health departments holds the promise of transformational change for the American public health system; however, there is a lack of published literature pertaining to organization-level experiences with introductory QI training programs for health department staff. This practice report aims to share the innovative approach, experience, and results of introducing staff to QI principles at the Boston Public Health Commission (BPHC). Program: The BPHC is an accredited health department that introduced more than 80% of its 1100 staff members to QI between January 2015 and December 2018. The commission's QI training program benefited from (1) visible support from senior leaders, (2) well-documented QI training plans, (3) innovative QI training curricula, (4) flexible delivery methods, and (5) a responsive monitoring and evaluation system. Methods: To assess the effectiveness of QI training at the BPHC, participant questionnaires from QI training sessions (run between January 2015 and June 2018) and a separate questionnaire on organizational QI culture (administered to the supervisory staff in May 2018) were assessed using the Kirkpatrick model of training evaluation. Evaluation: On the basis of Kirkpatrick's 4 levels of training effectiveness, 91% of participants were satisfied with training content (level 1), 94% of participants found the facilitators effective (level 2), 84% of participants indicated they would apply QI concepts in everyday work (level 3), and 75% of supervisors reported an organization-wide improvement in QI culture (level 4). Discussion: These results show that the BPHC's QI training program has been resoundingly effective, with positive outcomes across all 4 levels of the Kirkpatrick model. These results reinforce the idea of the BPHC's experience as an exemplar for introductory QI training. Interested health departments should heed the lessons learned from this and other organizational experiences as they attempt to scale up QI competencies among staff members.