Quality Improvement

The public health field is a dynamic environment with health departments having to navigate emerging public health threats while dealing with budget cuts and increasing political pressures. Quality improvement (QI) has been introduced to, and embraced by, the field of public health as a means to achieve efficiencies and improve quality of services to improve overall community health. 

Quality Improvement (QI) in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act,1 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 that achieve equity and improve the health of the community.2 NACCHO offers the following resources for integrating QI into local public health practice. 

1.  Plan-Do-Study-Act (PDSA) is an iterative, four-stage problem solving model used for gaining learning and knowledge for the continual improvement of a product, service, or process.

2. Riley, W., Moran, J., Corso, L., Beitsch, L., Bialek, R., and Cofsky, A. Defining Quality Improvement in Public Health. J Public Health Management Practice 2010; 16(1)5-7.

Public Health Infrastructure

QI Roadmap

NACCHO’s QI Roadmap provides guidance on six foundational elements of a QI culture.

Public Health Infrastructure

QI Roadmap

Public Health Infrastructure

QI Self-Assessment Tool

Assess your organization's culture of quality using the QI SAT.

Public Health Infrastructure

QI Self-Assessment Tool

An agency QI plan provides and establishes accountability around formalizing the QI program. It outlines the agency QI vision, establishes the QI program governance structure, specifies QI processes and methods for selecting and implementing projects, and provides an action plan for how to grow the QI culture. QI assessment results should be used to select the priorities in the QI plan. An adopted QI plan should be monitored for progress, evaluated at least annually, and should align with other agency plans including to maintain focus on overall strategy and performance.

QI Plan Guides

Example QI Plans 

Below are example local health department (LHD) QI plans, each of which were informed by QI assessment results and have been reviewed for quality by NACCHO staff.*

*These QI plans were evaluated against the PHAB Standards and Measures Version 1.0 by NACCHO Staff. These individuals, based on their understanding of the standards and measures, have classified them as meeting the PHAB requirements and being high-quality documents. These have not been approved by PHAB or any PHAB site visitors for the purposes of meeting relevant standards and measures.

**These QI plans are from accredited agencies.

All staff, from executive leaders to frontline staff, should continuously improve their work. Empowering employees to engage in QI requires access to QI training and resources. NACCHO has developed some presentations and compiled other resources for LHDs to use when the need for training arises. Listed below are a collection of QI trainings available for different levels of health department staff. 

For more resources around QI trainings, visit the QI Roadmap Resources section and sort by the foundational element, “Employee Empowerment.” 


As an agency gains more expertise and experience with QI projects, QI should spread to all departments, programs, and services. The following resources provide guidance on selecting and implementing QI projects. 

QI Project Prioritization and Selection

The agency QI Committee or QI leaders should create criteria and processes for selecting a QI project to ensure selection of projects with the greatest potential for impact. Potential projects should also be screened to determine whether they are appropriate for a formal QI process. The following resources provide guidance implementing these processes: 

There are a variety of QI processes and tools that can be used to implement QI projects. It is important to define for staff the QI processes that will be used and to cultivate expertise around selecting and implementing the most appropriate methods. Some common QI methods include Plan-Do-Study-Act (PDSA), Kaizen, Lean, and Six Sigma. There are also several QI tools and templates that can be used to implement different phases of these QI methods (e.g. flowcharts, cause-and-effect diagram, control charts). The following resources may assist with implementing QI projects: