Cutler Institute for Health and Social Policy

Creating Quality Improvement Culture in Public Health Agencies


The authors conducted case studies of 10 agencies that participated in early quality improvement efforts. Case study participants included health directors and quality improvement team leaders and members. They implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. They categorized agencies according to the extent to which they had developed a quality improvement culture.

Key Findings: Agencies were conducting both informal and formal quality improvement projects, or creating a quality improvement culture. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues.

Findings of this study support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

Suggested Citation: Davis, M. V., Mahanna, E., Joly, B., Zelek, M., Riley, W., Verma, P., & Solomon Fisher, J. (2014). Creating quality improvement culture in public health agencies. American Journal of Public Health, 104(1), e98-e104. doi: 10.2105/AJPH.2013.301413

Publication Type: 
Journal Article
Publish Date: 
January 1, 2014