We can all relate to the expression "hindsight is 20/20." After time has passed, we can see clearly what we would have, could have or should have done. When we are in the year 2020, will we look back at the past 10 years and think about what we might have done better to prepare health departments for new challenges? Will we wish that we could have taught more of the public health workforce about quality improvement (QI)? Will we wish we had spent less time contemplating QI and more time equipping health departments to do QI? Will we be able to point to an evidence base that proves QI made a difference in the public's health?
The Public Health Foundation (PHF), like others, is sharpening its focus based on observations from its experiences in the field. This commentary is informed by the observations of nearly 200 QI consultations provided by the PHF and its consultants over the past decade.
A wealth of experience in working with health departments has yielded some striking conclusions about how to support QI efforts. Big sustainable success does not happen overnight. These experiences remind us that it takes a winning team comprising champions-leaders who share a vision for improved community health, coaches who share their tools, knowledge and wisdom; team players who put their best game forward; and fans, the public that stands to benefit the most from the team's greatness. It is not just about winning and success or for public health accreditation or QI. That would be shortsighted. We could ascribe success to that 20/20 vision we know as professional hindsight-where we look at a situation or decision after it has happened, knowing and appreciating what we now see and how we can use that knowledge to improve. We also know hindsight is not always 20/20. We can have the foresight, even when fraught with uncertainty, to recruit the best and the brightest and hold them accountable; design a plan for success that survives the pressures of execution; adapt what we learn from our successes and failures; and celebrate small, incremental successes.