Objectives: To assess the current status of quality improvement (QI) within local health departments (LHDs) and examine the characteristics associated with such QI efforts.
Methods: A QI module was administered to a representative sample of 545 LHDs along with the core instrument in the 2008 NACCHO Profile survey of all LHDs nationally. Using the Profile survey data set, a quantitative approach was employed to determine the current status of QI within LHDs. Statistical analysis was performed to identify characteristics of LHDs associated with QI. The response rate to the QI module was 82 percent.
Results: Of the 448 LHDs that responded to the QI Module, 55 percent reported conducting formal QI efforts during the previous 2 years. Forty-four percent of these LHDs used a specific framework for QI, 56 percent used at least one of four commonly employed QI tools or techniques, and customer focus and satisfaction was the most frequently reported area (76%) of QI efforts. LHDs with large size of jurisdiction population and those with centralized governance were more likely to have engaged in quality or performance improvement, have managers who received formal QI training, and have provided QI training to staff.
Conclusion: The 2008 NACCHO Profile QI module furnishes an excellent baseline for measuring progress of health department QI activities as accreditation and other related activities intensify. A clear definition of QI in public health that is understood by practitioners will greatly increase our ability to measure the adoption of QI by LHDs. Further research is necessary to identify and explore some of the predictors and possible barriers to increasing the application of QI by LHDs.
The article assesses the current status of quality improvement within local health departments and examines the characteristics associated with such quality improvement efforts.
Leslie M. Beitsch, MD, JD, is Professor of Health Policy, Florida State University College of Medicine, Tallahassee, and Director, Center for Medicine and Public Health, Tallahassee, Florida. He currently serves as Associate Dean for Health Affairs.
Carolyn Leep, MS, MPH, is Director of Research and Evaluation, National Association of County and City Health Officials, Washington, District of Columbia.
Gulzar Shah, MStat, MS, PhD, is Senior Analyst, National Association of County and City Health Officials, and Adjunct Professorial Lecturer, Department of Health Policy, George Washington University, Washington, District of Columbia.
Robert G. Brooks, MD, MBA, MPH, is Associate Vice-President, Health Care Leadership, University of South Florida, Tampa, Florida.
Robert M. Pestronk, is Executive Director, National Association of County and City Health Officials, Washington, District of Columbia.
Corresponding Author: Leslie M. Beitsch, MD, JD, Florida State University College of Medicine, Center for Medicine and Public Health, 1115 West Call St, Tallahassee, FL 32306 (firstname.lastname@example.org).
The authors express their appreciation to the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation for providing funding support for the collection of data reported herein through the 2008 NACCHO Profile.