Quality improvement in public health: moving from knowing the path to walking the path.

This issue of the Journal of Public Health Management and Practice, the second to focus on quality improvement in public health, moves from “knowing the path,” described in the January/February 2010 issue, to actually “walking the path.” The 2010 issue outlined important components of transformation (eg, leadership to give clear vision, breaking down silos, and creating a work environment to sustain continuous quality improvement [CQI]) and set forth an ambitious challenge for adoption of quality improvement (QI) by public health. The foundation of this issue is a series of case studies, addressing not only how public health agencies are conducting QI projects but also how they are sustaining their QI efforts by creating the necessary infrastructure and culture to support CQI. These case studies demonstrate how and under what conditions QI and CQI succeed. Recognizing that many agencies throughout the country are performing exemplary QI work, the local health departments and projects highlighted in these case studies were primarily selected for pragmatic reasons. Many of these agencies are located in North Carolina, which made it easier for the authors to efficiently develop the case studies with little travel and with the necessary relationship building already accomplished. However, several other factors guided the selection of these case studies. North Carolina’s public health system enabled the selection of several rural and smaller agencies to highlight. Most literature to date has focused on urban and larger agencies. It is important to address this gap because there is potentially greater impact for QI in agencies with fewer resources, and there is concern about the feasibility of QI in smaller agencies. Agencies using common QI methods, such as “Lean” and “Model for Improvement,” were pur-