What is already known on this topic?
Although the implementation strategies and effectiveness of quality improvement (QI) activities have been examined extensively for many industries, including the health care sector, very few studies have focused on QI activities in the public health context.
The study's results indicate that Nebraska’s LHDs still face significant barriers for QI implementation, including low capacity, knowledge gaps, inadequate resources, and low institutional QI maturity.
What are the implications for public health practice/policy/research?
Policy-makers and LHDs should provide QI training and external QI expertise to LHD staff and better integrate QI strategies into LHDs’ organizational culture and structure. Given the great complexity of QI methodologies, it may be helpful for LHDs to start their QI efforts by adopting and implementing relatively simple QI techniques and strategies, such as the PDSA approach, which some Nebraska LHDs (i.e., early adopters) have found to be effective, based on our qualitative research results.