Question 1

Please read the attached Case Study:  Institutionalization of Continuous Quality Improvement. 

-What do you think are the most important two steps that the Macon County Health Agency took to implement CQI into the daily work lives of their staff and physicians?

-Describe how you might use one of these steps in your work as a health care leader.

Question 2

The use of CQI tools and methods has been both successful and challenging in low- and middle-income countries.  

-Based on your learnings up to now, what do you think are the best CQI tools for use in low- and middle-income countries?

-Explain why you made this choice and why you think they could be successful.

IMPORTANT: Minimum 200 words required for each question. No formatting or APA required. Thank you. 

CASE STUDY: INSTITUTIONALIZATION OF
CONTINUOUS QUALITY IMPROVEMENT
This case study presents an example of a local public health
agency that adopted and institutionalized continuous quality
improvement. As you read through the case, refer to the NACCHO
Roadmap to a Culture of Quality Improvement (NACCHO, 2013)
and consider these questions:

• ■   According to the NACCHO Roadmap, which elements
of a CQI culture are present and which appear to be lacking?


• ■   What could the organization do to address elements
that appear to be lacking?


• ■   What are three additional steps the organization could
take to ensure sustainability of their CQI efforts?


CQI in a Local Public Health Agency: Macon County, North Carolina
After becoming accredited through North Carolina’s accreditation
program in 2008, the Macon County, North Carolina, Public Health
Department began to focus on changing its quality culture. They
established a QI council and part-time position for a quality
program manager and began to implement a quality improvement
program. Over the course of 2 years, they trained staff and
leadership in quality improvement tools and methods, including
Lean (see Chapters 4 and 5).

During this time, staff members completed small quality
improvement projects, which helped them apply the concepts they
were learning and secure buy-in throughout the organization. After
staff were trained and had completed a few successful small-scale
projects, the health department began focusing on “projects that
would have a greater impact on the organization’s overall
performance, improve patient/customer service outcomes, and
achieve demonstrable cost savings.” One such project aimed to
improve the appointment scheduling process by seeing all patients
within 72 hours of requesting an appointment, while also improving
patient and staff satisfaction. The team participated in a rapid cycle

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improvement event (or, kaizen event) that involved using Lean and
Plan-Do-Study-Act cycles, performing a gemba walk (direct
observation of the work), creating work flow diagrams and detailed
process maps, and generating and testing change ideas. Soon
after, the clinics were scheduling patients for visits in less than 72
hours. Their no-show rates decreased, visit numbers increased,
staff downtime decreased, and both patient and staff satisfaction
increased.

Leveraging this success, the health department began to spread
quality improvement initiatives to other areas of the organization
and focused on projects related to the client feedback process,
child health visit flow, and vaccine storage and management
among others. To keep staff informed of the organization’s quality
improvement work, as well as foster ongoing staff engagement, the
health department keeps an electronic directory of their work
(including project aim statements, meeting notes, process maps
and flow diagrams, as well as other team-related communication)
and highlights activities and results in the hallways of their
organization. They also reinvest cost savings from the projects into
other vital activities of the health department. Overall, the health
department’s continuous improvement efforts have led to
organizational efficiency as well as improved care and patient
experience (Bruckner, See, & Randolph, 2013).

▶ Conclusions
The need to improve the public’s health in the United States is
evident. Although public health organizations are still early in the
process of institutionalizing CQI compared to organizations in
many other industries, they have made remarkable progress and
adoption in the second decade of the 21st century, particularly with
the support of accreditation locally and nationally. The increased
attention placed on the adoption of CQI in public health is both
timely and encouraging. Numerous factors are presented to explain
the growth of CQI in public health and, most important, the
substantial progress that has been made toward true
institutionalization of CQI in public health. Among those factors is
accreditation, with similarities to the impact accreditation has had
on health care globally (see Chapter 12). Continuing to use

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accreditation efforts to promote CQI and learning from health care
and other industries will help accelerate widespread adoption and
institutionalization of CQI. Public health organizations that adopt
CQI to help employees work as a team, address gaps in
performance by analyzing and redesigning processes, and
encourage innovation to meet the needs of communities hold the
promise for a healthier future, both in the United States and
throughout the world.