Title

Creating Quality Improvement Culture in Public Health Agencies.

Document Type

Article

Publication Date

1-1-2014

Keywords

Humans, Interviews as Topic, Organizational Case Studies, Organizational Culture, Organizational Innovation, Public Health, Qualitative Research, Quality Improvement, United States

Publication Title

American Journal of Public Health

Abstract

OBJECTIVES: We conducted case studies of 10 agencies that participated in early quality improvement efforts.

METHODS: The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture.

RESULTS: Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues.

CONCLUSIONS: Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

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