Quality Improvement Myths: Busted!

Changing culture and building quality improvement (QI) capacity in the health department setting are difficult tasks. Driving forces and restraining forces are always active as you work to strengthen QI in your agency. Myths or “wrong assumptions” are restraining forces that can pose a serious threat to your QI efforts. Let us explore some of those QI myths.

Myth 1: It is impossible to build a QI culture in my health department.

This myth about QI culture often shows up in comments like these:

  • QI is a distraction from my “real job.”
  • QI is a punitive program to get rid of bad employees.
  • Eventually, the QI fad will pass.

Pause for a moment and consider your health department. What does your health department value? What words and images come to mind when you think about your health department? Did you think about QI? If not, then building a QI culture starts with naming QI as a health department value, then working to weave QI into the fabric of your agency. Building QI culture is possible, and as you begin making progress, staff will begin to embrace QI.

Are you interested in building your agency’s QI culture but don’t know where to start?

Check out the Roadmap to a Culture of Quality Improvement from the National Association of County & City Health Officials (NACCHO). 

The QI Roadmap is a “go-to” resource for many health departments that provides information and tools as agencies progress through six developmental phases of QI maturity.

The Phases of a Culture of Quality
  • Phase 1: No knowledge of QI
  • Phase 2: Not involved with QI activities
  • Phase 3: Informal or ad hoc QI activities
  • Phase 4: Formal QI activities implemented in specific areas
  • Phase 5: Formal agency-wide QI
  • Phase 6: QI culture

The QI Roadmap outlines six Foundational Elements of QI Culture, which are specific areas that need attention to transform health department practice. Health departments can make progress toward developing QI culture by addressing these six areas.

Foundational Elements of QI Culture (from NACCHO’s QI Roadmap)
  1. Teamwork and collaboration
  2. Leadership commitment
  3. Employee empowerment
  4. Customer focus
  5. QI infrastructure
  6. Continuous process improvement

Myth 2: QI training is overwhelming and expensive.

This myth about QI training often shows up in comments like these:

  • QI training is time consuming and complicated.
  • I’ve never been trained, so I can’t do QI.
  • QI training is expensive.

Training is an essential part of building QI capacity in your health department. Consider these tips as you plan the next QI training for your agency.  

Plan for appropriate QI training.

Identifying the right training program for your agency takes some effort. Your first steps might include a workforce assessment to determine what type of QI training is needed.

Look for a training program that emphasizes adult learning concepts.

Try to find a training program developed with adult learners in mind. This approach will help staff understand why QI is important to them, and it will connect QI to their daily tasks.

Free QI training resources are available.

QI training does not have to be expensive; in fact, free training resources are available now:

Remember that training alone is not sufficient to build QI culture. Staff training should be part of a comprehensive QI plan. Leadership attitudes and actions, and agency practices and policies, must reinforce the application of skills gained through training.

Myth 3: I am incapable of managing a QI project.

This myth about QI project management often shows up in comments like these:

  • Getting buy-in for this initiative will be a cinch!
  • Launching a QI initiative is easy. Just call a meeting!
  • A QI project team can fix any challenge faced in the health department.

The skill set that is needed to manage a QI project is similar to what is needed to manage any project, and many public health professionals are already well equipped in this area. For staff who are new to project management, providing them with tools and skills to plan, manage, and close out a QI project is important. This skill set can also help staff succeed in other areas of their work! 

Here are some other considerations for building effective QI project leaders in your agency:

QI project leaders should be able to plan and manage a meeting effectively.

Planning a meeting requires the ability to schedule meetings, develop agendas, and prepare for discussions and updates. Leading a meeting requires small group facilitation expertise and time management and leadership skills. Meeting follow-up requires the leader to translate notes into action items and hold team members accountable for carrying out those actions on time.  

QI project leaders should understand QI fundamentals.

A QI project leader should also be equipped with QI skills and an understanding of the improvement model and tools. This skill set includes the ability to define the problem and develop an aim statement.

Developing the skills to be an effective QI project leader takes time, and every QI project will present a new opportunity to hone those skills! It is also important to remember that not every QI attempt will be a success. Failure to meet the QI goal just means there is an opportunity to complete another test!

Myth 4: QI belongs in the QI “program”

This myth about QI roles and responsibilities often shows up in comments like these:

  • The QI coordinator and QI council are responsible for QI.
  • Our customers are not interested in participating in QI.
  • The director and managers have the most important role in making improvements.

Indeed, a single staff member such as a QI coordinator may be accountable for agency-wide QI activities; however, staff at multiple levels should be involved in carrying out that work. In fact, the idea that QI belongs in the QI “program” conflicts with four basic principles for QI in public health.

Four Principles for QI in Public Health
  1. Develop a strong customer focus.
  2. Continually improve all processes.
  3. Involve employees.
  4. Mobilize data and team knowledge to improve decision making.

All health departments should strive to engage staff at all levels in QI activities and to make connections throughout the agency. QI efforts can also reach beyond the health department walls by engaging customers in the QI process. This can include customer satisfaction surveys, focus groups, and other conversations. Finally, QI efforts are most successful when they include information and perspectives from diverse project teams.


Do not let these QI myths get you sidetracked. Challenge these common assumptions to keep your QI efforts on track. Heard another QI myth lately? Talk about it on the PHQIX Community Forum.


PHQIX has a variety of customer satisfaction resources, including several Community Forum topics, a QI Spotlight article, and a webinar.



Kane, T., Roberts, G., & Gorenfo, G. Quality Improvement Myths: Busted! Tues, 07/03/2018. Available at https://www.phqix.org/content/quality-improvement-myths-busted. Accessed 12/07/2023.


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