There is a Quality Assurance (QA) section at the end of each standard and a Quality Improvement (QI) standard. What is the difference between QA and QI?
I am not familiar with Quality Improvement. Is there something to help me learn more about it and get started?
What happened to the Program Outreach and Marketing standard?
What happened to the performance codes: FR (Federal Requirement), RC (Recommended Criteria), and BP (Best Practice)?

 

There is a Quality Assurance (QA) section at the end of each standard and a Quality Improvement (QI) standard. What is the difference between QA and QI?
QA is more reactive and retrospective in that it demonstrates that a service has been provided or has met a set of requirements. In contrast, QI involves both prospective and retrospective reviews, measures where an agency is in meeting a standard, and facilitates determining how to make things better. Essentially, the difference between these two concepts is that QA generally answers a closed-ended question with one of two options: yes/no; pass/fail; meets expectations/does not meet expectations, etc., whereas QI generally asks an open-ended question, such as: “How can we improve our services?” or “How can ‘x’ process be more efficient?”

An example of a QI-focused question is: How are we creating an environment that supports breastfeeding? This question allows an agency to determine where they are in creating a breastfeeding supportive environment. In doing so, the agency may choose to use QA-focused questions (like that below), and/or other methods, to collect objective data and subsequently make that determination.

An example of a QA-focused question is: Does our agency provide educational and promotional materials that portray breastfeeding as the optimal method of infant feeding? To answer this question an agency must look back at what they have made available and determine whether or not the agency is meeting this specific criteria; therefore, it is a QA-focused question. The answer to this question can be part of the QI data collection to the above QI-focused question (see NSS Standard 16 C).

I am not familiar with Quality Improvement. Is there something to help me learn more about it and get started?
The MCH Navigator provides resources for both those with extremely limited time for exploring QI concepts and skills, as well as for those who can allocate larger blocks of time for learning about quality improvement. It contains a wide range of information including articles, presentations, training tutorials, and examples.

Additional QI resources are available from the organizations listed below. You can search these sites using the key words “Quality Improvement” or “QI” to find the various information and tools related to QI that are available from each site.

An additional resource is available from the Health Resources and Services Administration (HRSA). Though the HRSA Quality Improvement Planning Series focuses on a clinical environment, the information and concepts are highly relevant and transferable to the public health setting, including WIC.

There is also an online community designed to be a communication hub for public health professionals interested in learning and sharing information about QI in public health called the Public Health Quality Improvement Exchange (PHQIX).

Another important aspect to consider when developing QI program and QI project goals is the developing SMART goals (see FAQ on this in the NSS FAQs).

What happened to the Program Outreach and Marketing standard?
The Program Outreach and Marketing was eliminated as a standalone standard; however, the elements within that standard are incorporated throughout the document in other standards.

What happened to the performance codes: FR (Federal Requirement), RC (Recommended Criteria), and BP (Best Practice)?
Though WIC Federal regulations, policy and guidance still largely serve as the basis for the standards, the revised standards no longer use the performance codes (FR, RC, and BP) formerly assigned to each standard. Rather, the revised WIC NSS emphasize that, although not all standards and/or elements within a standard are Federal requirements, they are considered essential aspects of providing quality nutrition services. The NSS use the term standard to be defined as “a reasonable expectation and level of quality or excellence that is accepted as the norm and by which the provision of nutrition services is assessed.” To this effect, the WIC NSS describe quality nutrition services for State and local agencies regardless of the setting in which agencies provide services.