Quality improvement training for mid-sized public health departments is most effective when it includes both didactic training and opportunities for application, according to this evaluation of the effectiveness of training modalities.

Quality improvement (QI) has been identified as a “key strategy” to improve the performance of public health departments, but this study is one of the first to evaluate the effectiveness of alternative training techniques. At various times from 2007-2009, a national association of local health officials offered three kinds of training to local health departments: webcasts (basic level); face-to-face workshops (midlevel); and applied training at demonstration sites (high-level). Participation was self-selected by individuals or their agencies. At the end of the study period, participants answered a questionnaire that assessed their knowledge and skill gain, skill application, QI receptivity, and ability to successfully participate in a QI project. Responses from 284 participants who worked in 143 predominantly mid-sized health departments were analyzed.

Key Findings:

• Respondents who participated in multiple types of training—most significantly in both webcasts and demonstration sites—showed more knowledge and skill gain and skill application than those who participated in a single type.
• Demonstration site participants had “significantly greater gains” in knowledge and skills, skill application, and ability to participate in a project.
• Webcast participants scored significantly higher on QI receptivity, perhaps because many were new to QI training and felt they had much to learn.

The authors note important limitations, including a 24-30 month delay for some respondents between participating in training and receiving the questionnaire.  Moreover, the health departments who elected to participate were generally mid-sized and may have already had a QI-receptive culture. Future research should examine whether these results can be generalized.