Creating quality improvement culture in public health agencies.
OBJECTIVE
We conducted case studies of 10 agencies that participated in early quality improvement efforts.


METHODS
The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture.


RESULTS
Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues.


CONCLUSIONS
Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.
At the time of the study, Mary V. Davis, Elizabeth Mahanna, and Michael Zelek were with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Brenda Joly is with the Muskie School of Public Service, University of Southern Maine, Portland. William Riley is with the School of Public Health, University of Minnesota, Minneapolis. Pooja Verma and Jessica Solomon Fisher are with the National Association of County and City Health Officials, Washington, DC.
Mary V
MV
Davis
Elizabeth
E
Mahanna
Brenda
B
Joly
Michael
M
Zelek
William
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Riley
Pooja
P
Verma
Jessica Solomon
JS
Fisher
D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D011634:Public Health / Q000592:standards*; D036301:Qualitative Research; D058996:Quality Improvement; D014481:United States