title: Driving a public health culture of quality: how far down the highway have local health departments traveled?
abstract: BACKGROUND
  There has been an extensive investment in building public health organizational capacity to improve performance and prepare for accreditation. An evolving perspective has focused not only on the practice of quality improvement (QI) within the health department but also upon the extent the culture of QI is embraced within the agency.
  
  
  OBJECTIVE
  No studies have examined the current national baseline of QI culture implementation, nor estimated the degree of QI sophistication local health departments (LHDs) have attained. We attempt to fill this void by aligning the findings from the QI module of the National Association of County & City Health Officials (NACCHO) 2010 Profile of LHDs against the constructs defined by the QI Maturity Tool and the NACCHO QI Roadmap (Roadmap to a Culture of Quality Improvement).
  
  
  METHODS
  Specific questions regarding QI activities from the 2010 Profile Study QI module were used to assign responding LHDs to stages within the Roadmap. We also used data from the QI Maturity Tool administered to all LHDs in the 16 participating Multi-State Learning Collaborative states in 2010 and 2011. On the basis of this matched set, we applied the summative domain scores algorithm, classified agencies into 1 of 5 groups, compared our findings with those of the NACCHO survey, and aligned our categories to those of the Roadmap.
  
  
  RESULTS
  Nearly 80% of LHDs classified using the NACCHO Profile data were assigned to group 3 or 4 versus 48% using the QI Maturity Tool. Results from the cross-tabulations of the matched data set between the QI Maturity Tool classifications and the NACCHO Profile classifications revealed exact alignment 30% of the time. Forty-nine of 163 agencies were classified in the same grouping in both schemata. In addition, 84% of the agencies were classified within 1 neighboring category.
  
  
  CONCLUSIONS
  The results revealed that half, if not most, LHDs fall within the middle categories of QI maturity and sophistication, regardless of which classification system was deployed.
authors.affiliation: Center for Medicine and Public Health, Florida State University College of Medicine (Dr Beitsch); National Network of Public Health Institutes, New Orleans, Louisiana (Dr Rider); Muskie School of Public Service, University of Southern Maine, Portland (Dr Joly); National Association of County & City Health Officials, Washington, District of Columbia (Ms Leep); and Benedictine University, Lisle, Illinois (Dr Polyak).
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Beitsch
authors.forename: Nikki Lawhorn
authors.initials: NL
authors.lastname: Rider
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Joly
authors.forename: Carolyn
authors.initials: C
authors.lastname: Leep
authors.forename: Georgeen
authors.initials: G
authors.lastname: Polyak
mesh_terms: D015279:Organizational Culture; D011635:Public Health Administration; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014481:United States