Strategic and Performance Planning in US Local Health Departments: A Comparative Analysis of Strategic, Community Health Improvement, and Quality Improvement Plans.

Abstract

Context: Local health departments (LHDs) are a critical component of the US public health infrastructure. To guide their work and evaluate progress, LHDs develop and maintain a range of planning documents, including strategic plans (SPs), community health improvement plans (CHIPs), and quality improvement plans (QIPs).

Objective: The goal of this study was to provide information on current LHD practices related to strategic planning and performance improvement.

Design: The study used an environmental scan and document analysis of a sample of 93 plans from 31 LHDs to explore commonalities and differences within the strategies, goals, and priorities of SPs, CHIPs, and QIPs. Framework analysis was used, involving initial document review, development of a coding framework, and applying this framework to all documents iteratively. To ensure reliability, 19% of documents were double-coded, with discrepancies resolved through team discussions.

Results: Of the 31 LHDs included in this analysis, most were urban (89.7%) and medium-sized (64.5%), with a large percentage from the Midwest (41.9%). The analysis revealed that most LHDs used established frameworks to develop plans and identify priority areas. Frequently listed priority areas included behavioral health, social determinants of health, access to care, chronic disease, and nutrition and physical activity. Frequently listed strategies to improve priority areas included building collaborations and partnerships, advocating for policy change, increasing access to services and resources, and increasing awareness of issues. While CHIPs frequently incorporated social determinants of health as part of a guiding framework, QIPs focused on fostering continuous quality improvement. Differences were documented based on jurisdiction size, degree of rurality, and region.

Conclusions: The study identified a widespread commitment to develop plans using established frameworks, community engagement, and data-driven decision-making, while also highlighting the diverse needs and capacities of LHDs in addressing public health challenges.