title: Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.
abstract: BACKGROUND
  Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA.
  
  
  METHODS
  An online survey of key informants in Georgia's districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting.
  
  
  RESULTS
  Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments.
  
  
  CONCLUSIONS
  Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.
authors.affiliation: Center for Health Equity & Quality Research, University of Florida College of Medicine-Jacksonville, 580 West 8th St, Tower II, Suite 6015, Jacksonville, FL, 32082, USA. William.Livingood@jax.ufl.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Livingood
authors.affiliation: Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. apeden@georgiasouthern.edu.
authors.forename: Angela H
authors.initials: AH
authors.lastname: Peden
authors.affiliation: Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. gshah@georgiasouthern.edu.
authors.forename: Gulzar H
authors.initials: GH
authors.lastname: Shah
authors.affiliation: Department of Health Sciences, Armstrong State University, Savannah, GA, USA. nandi.marshall@armstrong.edu.
authors.forename: Nandi A
authors.initials: NA
authors.lastname: Marshall
authors.affiliation: East Central Health District (retired), District 6, Augusta, GA, USA.
authors.forename: Ketty M
authors.initials: KM
authors.lastname: Gonzalez
authors.affiliation: Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. rtoaluncguy@gmail.com.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Toal
authors.affiliation: Division of Pharmaceutical Outcomes & Policy, UNC Eshelman School of Pharmacy, Asheville, NC, USA. dsalexander@unc.edu.
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Alexander
authors.affiliation: Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA. aw06670@georgiasouthern.edu.
authors.forename: Alesha R
authors.initials: AR
authors.lastname: Wright
authors.affiliation: Center for Health Equity & Quality Research, University of Florida College of Medicine-Jacksonville, 580 West 8th St, Tower II, Suite 6015, Jacksonville, FL, 32082, USA. Carolyn.Woodhouse@jax.ufl.edu.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Woodhouse
mesh_terms: D019058:Community Networks; D005845:Georgia; D006801:Humans; D007857:Leadership; D015279:Organizational Culture; D015980:Public Health Practice / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration*; D012106:Research; D011795:Surveys and Questionnaires