Quality improvement in local health departments: progress, pitfalls, and potential.

Objectives: To assess the current deployment of quality improvement (QI) approaches within local health departments (LHDs) and gain a better understanding of the depth and intensity of QI activities.

Methods: A mixed quantitative and qualitative approach was employed to determine the current status of QI utilization within LHDs. All respondents from the 2005 NACCHO Profile QI module questionnaire who indicated that their LHD was involved in some kind of QI activity received a follow-up Web-based survey in 2007. A smaller convenience sample of 30 LHDs representing all groups of respondents was selected for the follow-up interview to validate and expound upon survey data.

Results: Survey response rate was 62 percent (181/292). Eighty-one percent of LHDs reported QI programmatic activities, with 39 percent occurring agency-wide. Seventy-four percent of health departments had staff trained in QI methods. External funding sources for QI were infrequent (28%). LHDs that were serving large jurisdictions and LHDs that were subunits of state health agencies (centralized states) were more likely to engage in most QI activities. However, interview responses did not consistently corroborate survey results and noted a need for shared definitions.

Conclusion: Multiple factors, including funders and accreditation, may be driving the increase of QI for public health. Additional research to confirm and validate these findings is necessary. A common QI vocabulary is also recommended.