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J Public Health Manag Pract. 2012 Jan-Feb;18(1):79-86. doi: 10.1097/PHH.0b013e31823788da.

Assessing quality improvement in local health departments: results from the Multi-State Learning Collaborative.

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Muskie School of Public Service, University of Southern Maine, Portland, Maine 04104, USA.



This study examined changes in quality improvement: (1) over a 3-year period, (2) among mini-collaborative participants, and (3) among agencies that were classified in the lowest QI performance quartile.


: A QI Maturity Tool was administered to all local health departments in the Multi-State Learning Collaborative states. Factorial ANOVA was performed to determine differences in composite factor scores and interaction effects were explored.


: The results revealed a significant increase in the percent of agencies that reported ever implementing a formal QI process from 2009 to 2011 and agencies that participated in a mini-collaborative were more likely than their non-mini-collaborative counterparts to report QI implementation. The findings also suggested significant changes in QI capacity and competency as well as alignment and spread over the course of the grant, among mini-collaborative participants, and among agencies that were originally identified in the lowest QI maturity quartile. No significant changes in organizational culture were revealed by year or among mini-collaborative participants. However, agencies in the lowest quartile saw significant changes in organizational culture during the project period.


Significant changes in specific QI domains are possible to detect during a 3-year period. Our research gives us confidence that the QI Maturity Tool measures the right domains and is an important contribution to quantifying the adoption and spread of QI in public health. However, further refinement is needed to better standardize language and definitions of the component parts of a QI system.

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