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Laboratory System Improvement Program (L-SIP)



City of Milwaukee Health Department (MHD) Laboratory

The MHD collaborates with a variety of internal programs and local, state, federal and international partners to detect, investigate, prevent, and control public health threats. These threats include infectious diseases, outbreaks of illness from consuming contaminated food or water; terrorism events; chemical hazards; and environmental conditions and emergencies.

MHD Laboratory website

Association of Public Health Laboratories (APHL)

APHL is the national nonprofit organization that represents governmental laboratories. APHL core membership is comprised of public health, environmental and agricultural laboratories. Representatives from federal agencies, nonprofit organizations, and corporations also participate in the association. International participation is expanding in response to the globalization of disease and APHL’s active global health program.

As the primary advocate for public health laboratories, APHL is active on many fronts, including:

  • Emergency response

  • Laboratory science

  • Education and training

  • Laboratory workforce

  • Health Policy

  • Global laboratory capacity

  • Laboratory systems

More information can be found at Association of Public Health Laboratories (APHL) website.

APHL On-Line Resource Center

The On-Line Resource Center (ORC) provides a range of resources for laboratory system improvement work.

On-Line Resource Center website

The Centers for Disease Control and Prevention Website

The Centers for Disease Control (CDC) is the national leader for most public health activities. CDC partnered with APHL to develop the L-SIP and its website is rich with resources. CDC addresses public health system performance improvement as a part of its National Public Health Performance Standards Program.

Public Health Foundation

The Public Health Foundation (PHF) is dedicated to achieving healthy communities through research, training, and technical assistance. For more than 35 years, this national, non-profit organization has been working with health agencies and other community health organizations to more effectively use information to manage and improve performance, understand and use data, and strengthen the workforce. 

Public Health Foundation website 

Public Health Reports

The May/June 2010 Public Health Reports Supplement is dedicated solely to articles regarding Public Health Laboratories and the concept of the Public Health Laboratory System. It is an important resource in the understanding the depth and breadth of the Public Health Laboratory System.

Public Health Reports - May/June 2010 Supplement 

Turning Point

Turning Point is a collaborative effort between state and local public health agencies, national public health organizations, and The Robert Wood Johnson Foundation. At the heart of Turning Point are efforts to transform public health so that it achieves the goals of preventing disease and injury, protecting the public from threats to health, and promoting healthy behaviors. Turning Point has developed specific models for a more effective and responsive public health system and tools to achieve the ten essential services.

Turning Point website 

Ten Essential Public Health Services

Laboratory performance measurements were designed around the ten Essential Public Health Services developed nationally in 1996. They represent the capacities that must be present in a public health system, whether at the local, state or national level, to assure a fully functioning system. They include:

  1. Monitor health status to identify community health problems

  2. Diagnose and investigate health problems and health hazards in the community

  3. Inform, educate, and empower people about health issues

  4. Mobilize community partnerships to identify and solve health problems

  5. Develop policies and plans that support individual and community health efforts

  6. Enforce laws and regulations that protect health and ensure safety

  7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable

  8. Assure a competent public health and personal health care workforce

  9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services

  10. Research for new insights and innovative solutions to health problems

Ten Essential Services 

Eleven Core Functions and Capabilities of Public Health Laboratories

The core functions and capabilities of public health laboratories were developed to more clearly define the role of public health laboratories in protecting our nation's health and were intended to serve as the basis for assessing and improving laboratory quality.  They include:

  1. Disease Prevention, Control and Surveillance

  2. Integrated Data Management

  3. Reference and Specialized Testing

  4. Environmental Health and Protection

  5. Food Safety

  6. Laboratory Improvement and Regulation

  7. Policy Development

  8. Emergency Response

  9. Public Health Related Research

  10. Training and Education

  11. Partnerships and Communication

Frequently Asked Questions

  1. What is the purpose of L-SIP?
    To strengthen the Local and State Public Health Laboratory Systems (PHL System) by developing and implementing improvement plans based on identified strengths and weaknesses.

  2. Why should we do a Local PHL System Assessment?
    To measure, through a collaborative process with system partners, the strengths and weaknesses of the regional system. The results provide the basis for improvement activities and provide a baseline to evaluate future improvement efforts.  

    What is the National Public Health Performance Standards Program (NPHPSP) and how does it differ from L-SIP?
    NPHPSP is a national partnership initiative that developed public health performance standards for state and local public health systems and for public health governing bodies, using the framework of the Ten Essential Public Health Services. The purpose of the program is to improve the quality of public health practice and the performance of public health systems. More information is available at the NPHPSP website.  NPHPSP differs from L-SIP in its scope. NPHPSP addresses performance at the broader public health system level, while L-SIP addressed performance at the public health laboratory system level.

  1. Are all of the 11 Core Functions of Public Health Laboratories encompassed in the 10 Essential Services?
    Yes they are. In some cases, more than one core laboratory function is represented in a specific essential service.

  2. What is the “gold standard” as applied to a performance standard.
    The “gold standards” identify what is currently thought to be the very best attainable levels of service and system attributes that can be achieved at the public health laboratory system level. Scoring a performance standard at the highest level implies that system performance is at or near optimal levels although improvement can always take place.

  3. What is a System Improvement Plan?
    A system improvement plan is a plan designed to address the findings of the assessment and is intended to raise the level of performance among system partners, both collectively and individually. The goal of a system improvement plan is to strategically move the public health laboratory system toward operational efficiency, effectiveness and adaptability.

  4. Who should participate in a system assessment?
    State and local public health professionals, representatives of university/academia, hospital infection control staff, hospital, private and independent laboratories, emergency planners and first responders, environmental agencies and others as appropriate. Any group of individuals who participate in working with the Local Public Health Laboratory to assure protection of the public’s health may be included.

  1. Tell me more about the assessment process? 

    • The assessment will begin with an orientation to the Local Public Health Laboratory System and the scoring process.

    • Three breakout groups based on subject matter expertise will be formed.

    • Each breakout group will assess three Essential Services throughout the day.

    • Each breakout group will have a professional facilitator with a background in public health who will guide the discussion.

    • Each breakout group will have theme takers and vote counters who will be responsible for 1) noting the key concepts from the discussions that illuminate system strengths and weaknesses, 2) documenting “back burner or parking lot” issues, 3) recording the negotiated score for each question, and 4) recording the top 1-3 next steps for each essential service.

  1. What is the “Parking Lot” (or back burner)?
    This is the place to record discussion items of importance that may directly or indirectly relate to the essential service being discussed. It is important to identify these key concepts for future consideration while enabling the group to move on in their consideration of the assessment instrument. This is a key strategy to assuring that the assessment is completed within the planned timeframe.

  2. How are the assessment scores shared?
    A scoring tool will be used to record the ratings and to provide a graphic display of the results. The scores will be shared at the end of the meeting and distributed to stakeholders throughout the system.

  3. What actions will follow the assessment?
    The City of Milwaukee Health Department intends to reconvene stakeholders in 2011 to review the assessment results and initiate strategic planning aimed at improving the regional laboratory system.

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