Quality Improvement in Local Health Departments

Progress, Pitfalls and Potential

Most local health departments (LHDs) engage in quality improvement (QI) practices on a program-by-program basis. Less than half support agency-wide QI.

Health care organizations, in particular those in public health, have lagged behind the private sector in their efforts to institute formal QI measures. The 2005 National Profile of Local Health Departments questionnaire specifically addressed QI. In 2007, with funding from the Robert Wood Johnson Foundation, the National Association of County and City Health Officials (NACCHO) conducted a follow-up study to assess the role of QI in local health departments. For the follow-up, researchers conducted web-based surveys and telephone interviews with LHD personnel. The interviews covered several QI related topics, including: QI within specific LHD programs, funding support and staff training.

Key Findings:

  • A majority of LHDs reported having formal QI in place in nine out of 10 program areas, including: family planning, STD screening and childhood immunization.
  • LHDs that are part of vertically-integrated state health departments and those serving larger jurisdictions are more likely to engage in agency-wide QI.

Following the lead of the private sector, public health officials are paying more attention to formal principles of QI.