Measuring Quality Improvement in Public Health: The Development and Psychometric Testing of a QI Maturity Tool

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Cutler, Population Health and Health Policy


There is growing interest and investment in improving the quality of public health services and outcomes. Following the lead of other sectors, efforts are underway to introduce systematic quality improvement (QI) tools and approaches to state and local public health agencies. Little is known, however, about how to describe and reliably measure the level of QI maturity within a public health agency. The authors describe the development of a QI Maturity Tool using research from the fields of organizational design, psychology, health care, and complexity theory. The 37-item assessment tool is based on four quality domains derived from the literature: (a) organizational culture, (b) capacity and competency, (c) practice, and (d) alignment and spread. The tool was designed to identify features of an organization that may be enhancing or impeding QI; monitor the impact of efforts to create a more favorable environment for QI; and define potential cohorts of public health agencies for evaluation purposes. The article presents initial steps in testing and validating the QI Maturity Tool including: (a) developing a theoretical framework, (b) assuring face and content validity, (c) determining the tool's reliability based on estimates of internal consistency, (d) assessing the dimensionality, and (f) determining the construct validity of the instrument. The authors conclude that there is preliminary evidence that the QI Maturity Tool is a promising instrument. Further work is underway to explore whether self-reported survey results align with an agency's actions and the products of their QI efforts.