title: Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare.
abstract: Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed.
  
  
  
  The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada.
  
  
  
  In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out.
  
  
  
  A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers.
  
  
  
  The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers.
authors.affiliation: Doctoral Researcher, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
authors.forename: Alex
authors.initials: A
authors.lastname: Price
authors.affiliation: Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
authors.forename: Robert
authors.initials: R
authors.lastname: Schwartz
authors.affiliation: Professor, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Joanna
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Assistant Professor, Dalla Lana School of Public Health, University of Toronto, Chief Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON.
authors.forename: Heather
authors.initials: H
authors.lastname: Manson
authors.affiliation: Associate Professor, Faculty of Health Sciences, McMaster University, Hamilton, ON.
authors.forename: Fran
authors.initials: F
authors.lastname: Scott
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D015279:Organizational Culture; D058996:Quality Improvement / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States; D014492:United States Public Health Service / Q000458:organization & administration*