Why Performance Improvement Still Matters in Your Health Department

by David Stone, MS, CPTD

The past year was one like most of us in public health have never experienced before. Certainly, much was learned about our public health practices. Some were upheld, others were revised, and still others were moments of growth. While there were plenty of issues to dissect from 2020, I’m going to start the year by focusing on some positive aspects that I think show the importance of having a solid performance improvement foundation.


For years, public health has stressed that a pandemic was a matter of “when,” not “if.” The “when” ended up being 2020. Public health was able to exhibit its flexibility to shift funds, people, and actions to respond – helping answer questions and reassure frightened individuals, correcting misinformation, and setting up response actions quickly. This ability to quickly pivot comes with a culture of performance and quality.


For many, public health is not just a job, but a calling to service in their communities. Public health staff worked long hours and endured personal attacks yet continued to respond to the pandemic with education, testing, and contact tracing. This comes from the individual but also from the workforce development of the health department. Developing the public health workforce has been an important outcome from the accreditation process.


This element came into play even before coronavirus was widespread. Public health’s preparation efforts were tremendously important because we faced a virus that we hadn’t seen before. While we had planned, we hadn’t planned for this specific agent. Public health demonstrated through its preparation that it could be flexible, could learn along the way, and could work with multiple partners. Through accreditation, departments enrich their partnerships and community relationships, which results in plans ready to implement when called upon.

Disparities and Equity

The pandemic revealed something that we in public health have known for a long time – that communities of color suffer from the disparities in all of our systems. Efforts around equity, inclusion, and the Black Lives Matter movement point out the work we have in front of us to bring true improvement to the disparities in health outcomes. Let’s commit to continuing this important work. Issues of equity spread throughout the accreditation standards and performance goals help us define what work needs to be done.


The way that the pandemic response – from masks to vaccinations – became politicized gave public health challenges to overcome. We had ridicule and flaunting of public health guidelines thrown at us continuously, yet public health persisted in sharing truth about defeating the pandemic. This emphasizes the importance of public health having great relationships with elected and appointed officials. Domains 6 and 12 are all about relationships with policy makers and governance and why public health must be at the table with political leaders.

Performance Improvement

This past year, with all of its issues, showed us that performance improvement and innovation are important elements in a highly functioning health department. Our response efforts should be more than a reaction – integrating COVID into our performance work, not adapting our work into just COVID.

So while we might be happy that 2020 is done and gone, we shouldn’t write off the important ways that public health developed and learned about itself in responding to the pandemic. There is much work to be done in 2021 to get the vaccine distributed and continue efforts to stop the spread of the virus. There will be bumps as we’re facing an unprecedented public health event. And while the event is unprecedented, our public health work is not. Thank you for all you do as you serve your communities every day.

David Stone, MS, CPLP

David Stone, MS, CPLP, is the Education Services Manager with the Public Health Accreditation Board or PHAB. David directs the development of educational services for PHAB including training, learning events, continuing education, webinars and online modules. His BS was in Zoology with a MS in Health Administration & Wellness. He became certified in Learning and Performance in 2015.

Prior to his current position, David was Accreditation Administrator for the North Carolina Local Health Department Accreditation Program. David has over 35 years of public health experience. He spent over nine years in local public health serving as Assistant Health Director in Appalachian District Health Department and as Health Director in Surry County.