Achieving a QI Culture Across a Public Health Agency


Impact Statement: 
This initiative describes how quality leaders at the Salt Lake County Health Department challenged the status quo to transform organizational quality culture. Members of the SLCHD Quality Council identified a need to increase the health department's emphasis on quality after a review and discussion about the Building Blocks of a Quality Culture (Moran and Riley) and reviewing examples of QI culture development at other local health departments. The SLCHD QI project team implemented an agency-wide applied learning initiative that combined didactic QI training, a variety of facilitated conversations and implementation of "big QI and little qi" projects. Survey data captured before and after the initiative showed major improvement in self-reported perceptions of QI culture; greater in upper management than in middle management.

After preliminary training on QI concepts, key SLCHD leaders assessed the overall quality culture in the agency by administering a QI building blocks survey and comparing upper management's responses to those from middle management. With a measure of the level in each area, SLCHD formulated the aim statement to improve the culture of quality, as measured by perceptions of upper and middle managers, before August 2013. Facilitated groups analyzed the identified areas needing the most improvement for each division: “process focus” for upper management and “empowerment” for middle management. In March, 80 managers met in groups to identify the most problematic issues, and they met again in May to identify solutions. After distilling the list and prioritizing solutions, they presented a proposal to the administration, who formally endorsed their recommendations. Solutions included such initiatives as rotating department committee membership, providing supervisory checklists to improve feedback, and planning for a new intranet for better interactions among programs. In August, a second survey was completed, and results showed that middle managers believed that the quality culture had improved in five areas, whereas upper managers believed that it had improved in all six areas.

Organization that conducted the QI initiative: 

Neville, B. Public Health Quality Improvement Exchange. Achieving a QI Culture Across a Public Health Agency. Fri, 09/15/2017 - 11:29. Available at Accessed June 21, 2024.

Submission Status: 
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Grace Gorenflo's picture
Submitted by Grace Gorenflo on

Thanks for sharing  your great work.  As you are experiencing, changing an organization's culture takes time and effort, and clearly you all are doing a lot to train staff and engage them in QI activities.  Given the importance of staff feeling empowered to make positive change, I'm curious about any plans you all have to focus on this particular aspect of a QI culture.  I read the actions listed on the storyboard that you shared, and I wasn't sure if some of them were targeted for this purpose.  Thanks in advance for any additional information that you can provide!


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