Sustaining a quality improvement culture in local health departments applying for accreditation.

Context: This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI.
Objective: To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs.
Design: Quantitative data from a self-reporting survey and qualitative data from telephone interviews.
Setting: Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews.
Participants: QI lead staff at LHDs that are advanced in accreditation preparation and QI.
Main Outcome Measures: Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives.
Results: Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI.
Conclusions: When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.