Quality Improvement

Quality Improvement in Public Health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.

The culture of an organization is the embodiment of the core values, guiding principles, behaviors, and attitudes that collectively contribute to its daily operations. Organizational culture is the very essence of how work is accomplished; it matures over several years, during which norms are passed on from one "generation" of staff to the next. Because culture is ingrained in an organization, transforming culture to embrace QI when minimal knowledge or experience with QI exists requires strong commitment and deliberate management of change over time. Here you can view NACCHO's resources for building and sustaining a culture of quality.

Roadmap to a Culture of Quality

Quality improvement (QI) is increasingly being embraced as a means to achieve efficiencies and other improvements with limited resources. Beyond discrete QI efforts, a comprehensive approach to QI – one in which the concepts of QI are ingrained in the shared attitudes, values, goals, and practices of all individuals in the agency – will ensure that QI is institutionalized and becomes part of the way that LHDs do business. To assist LHDs to this end, NACCHO has developed a Roadmap to a Culture of Quality Improvement.

NACCHO's Organizational Culture of Quality Self-Assessment Tool

NACCHO's Organizational Culture of Quality Self-Assessment Tool enables beginner, intermediate, and advanced LHDs to conduct a baseline assessment of organizational maturity within critical aspects of a culture of quality, revealing opportunities for improvement, and informing a trajectory for next steps to reaching a culture of quality.  The tool is intentionally designed to complement NACCHO's Roadmap to a Culture of Quality which provides high level guidance on progressing through six phases of QI maturity by incrementally building six foundational elements of a quality culture.

The Self-Assessment Tool is framed around these six foundational elements and further sub-divided into 20 sub-elements, providing an in-depth assessment of the people, systems, and structures that support a quality culture. Based on assessment results, this tool also identifies tangible transition strategies for moving along the Roadmap.

The Self-Assessment Tool contains three main components

  1. Diagnostic Statements to assess the current organizational culture and identify priority gaps.
  2. Corresponding Transition Strategies that provide suggested actions to close priority gaps.
  3. A Scoring Summary sheet to document results and assist with organizational planning efforts.

Please contact Pooja Verma at pverma@naccho.org for more information.

An annual QI plan sets the organizational direction for QI initiatives.

According to a paper published by the Public Health Foundation*, a QI plan is "a living document and needs to be revised on a regular basis to reflect accomplishments, lessons learned, and changing organizational priorities. It is not a one-time static document but one that should constantly describe the current state and future state of quality in any local health department." 

The Public Health Accreditation Board requires a QI plan as documentation for measure 9.2.1 A of the Standards and Measures Version 1.5. Below are some examples and resources for QI Plan development.

Several other QI Plan examples can be found online at PHQIX - the Public Health Quality Improvement Exchange (login required).

QI Plan Templates, Examples, and Resources

PLEASE NOTE: The examples on this page have not been evaluated against PHAB’s standards and measures. They serve only as examples.

The Public Health Accreditation Board requires a QI plan as documentation for measure 9.2.1 A of the Standards and Measures Version 1.5.

A QI governance committee (e.g. QI Council) leads and oversees all QI initiatives in the organization.

This template will help outline the mission, targeted goals and objectives, and team member roles and responsibilities for any team including a Quality Council and QI project teams. A team charter helps to clarify the mission of a team and helps the members stay on task.

All staff, from executive leaders to frontline staff, should continuously improve their work. Empowering employees to engage in QI requires the provision of training and resources. NACCHO has developed some presentations and compiled other resources for LHDs to use when the need for training arises.

NACCHO’s Ready-Made Training on QI

Has your staff asked, "What exactly is QI?" If so, this training is for you! These materials are intended for LHDs to introduce the basics of QI to LHD staff. The information presented serves as a primer before delving into more in-depth information on how to use and apply QI in the agency. The following training materials have been designed to save LHDs time in preparing materials prior to presenting to staff:

  • Powerpoint Presentation—each slide contains talking points and instructions on how to tailor the slides to each LHD;
  • Presenter's guide—designed to accompany the PowerPoint, this guide provides the presenter with slide-by-slide instructions and talking points, along with additional tips to prepare for the presentation;
  • ABCs of PDCA paper—provides step-by-step instructions of how to move through the Plan-Do-Check-Act (PDCA) process and is designed for the beginner who has been introduced to QI methods and techniques;
  • Levy County QI Storyboard—provides a one-page graphic representation of how Levy County Health Department used the PDCA process to increase accurate and timely animal bite reporting; and

OSU Center for Public Health Practice Training Courses

OSU's Center for Public Health Practice has created online courses for understanding and conducting continuous quality improvement (CQI) in public health.

CQI for Public Health: The FundamentalsCQI for Public Health: Tool Time are free and available to anyone looking to learn more about these valuable topics and tools. Many LHDs use these modules for Just-in-Time training for staff.

QI involves the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act, to achieve measurable improvements in the efficiency, effectiveness, or services and processes. This page explains process options that are available and provides examples of QI projects conducted at LHDs around the country.

Prioritization Guide

Selecting an appropriate QI project can be an overwhelming without the use of formal prioritization techniques. Where do you start doing QI? How do you choose QI efforts? This document outlines five prioritization methods LHDs can use to choose among the many and narrow them down to select the few best to start. It includes descriptions of each method as well as examples of how LHDs have used the methods.

QI Processes

Health Departments across the country use various frameworks for conducting their QI initiatives. Below is a list of some common processes used to perform quality improvement activities:

  • Plan-Do-Study Act (PDSA): Perhaps the most common framework for QI at LHDs, PDSA (or sometimes known as PDCA) is an intuitive introduction to quality improvement that can provide an excellent starting point as health departments try QI processes.
  • Kaizen: Kaizen, simply a term that means “change for the better,” is an event methodology that can be utilized to achieve rapid improvements in work processes. A kaizen event is a team-based approach that enables improvement to be made by stepping through all phases of the quality improvement cycle in an effective and rapid fashion.
  • Lean: Lean is a term often used in manufacturing, enterprise, or production. It is a systemic method for the elimination of waste within a process.
  • Baldrige: The Baldrige Performance Excellence Program provides a framework and an assessment tool for understanding organizational strengths and opportunities for improvement. Agencies working towards the Baldrige criteria strive to deliver ever-improving value to customers and stakeholders, improve overall organizational effectiveness, and contribute to organizational and personal learning.

QI Resources

ASTHO produced this document to define what CJQI is and the value of it. They provide several tips to help make your CJQI project successful, along with additional resources to support those efforts. For more information, click here.

These resources are from a variety of organizations and agencies working across the country to advance public health performance.