Quality Improvement Success Stories

“Data helps us see what needs to be improved. In Onslow County, the team is offering individual training on essential data skills. Things like how to use Excel, how to read graphs, which data to monitor (and why), and how to use data to guide improvements. The larger goal is for every division to track meaningful metrics and develop an internal data display system for all teams throughout the health department. Not as a punitive measure, but to celebrate progress and strengthen connections across divisions and within sections.  When teams hit their goals, everyone can see it, and other divisions can get a clearer picture of what their colleagues are working towards.”  – Sara Eighmy, November 2025

"Albemarle Regional Health Services (ARHS) worked hard to make QI more than just a checklist — it’s a mindset that guides how we operate. Staff are engaged in reviewing processes, being open to new ideas, and discussing challenges as they arise. One of our recent QI projects focused on restructuring finance team roles and responsibilities and improving the purchasing and receiving processes. During our twice-weekly team huddles, staff shared barriers they were facing, brainstormed solutions, and tested new workflow adjustments. We used several QI tools, such as a value stream map, which helped the team visualize the current process, pinpoint areas for improvement, and create a roadmap for enhancements to improve overall flow and reduce errors. Staff conversations were open, honest, and supportive. Team members were willing to try new ideas and make corrections when things didn’t work as planned. For the finance team, QI has shifted from feeling like an “extra task” to becoming an integral part of daily operations at ARHS." 

– Amy Underhill, October 2025

"Giving staff the chance to spot improvement opportunities and lead changes builds confidence and momentum. In Person County, succession planning became a priority as several retirements and vacancies occurred. Staff created a simple, formal way to capture the knowledge behind each role, so work continues smoothly when someone retires or leaves. They introduced a position profile form that every employee completes each year, documenting key tasks and responsibilities. This protects the continuity of operations and keeps important knowledge from being lost."  – Leigh Ann Creson, November 2025 

"Macon County's work on their appointment scheduling system reflects an organization transitioning from Informal or Ad Hoc QI Activities (Phase 3) toward Formal QI Activities Implemented in Specific Areas (Phase 4). Leadership formalized its commitment to improvement by creating a quality program manager position, establishing a QI Council, and providing agency-wide training in Lean and PDSA methods. After beginning with smaller projects to build staff engagement, the department applied structured QI tools to redesign a siloed appointment scheduling system that had caused long wait times and inefficiencies. By defining the project scope, testing changes on a small scale, and measuring patient satisfaction and wait times, MCPH reduced appointment waits from as long as 1 to 2 months to under 72 hours, decreased no-shows, improved staff efficiency, and reinvested cost savings into mission-critical services. This success prompted ongoing QI successes in child health visit flow, environmental health complaints, medical records flow, the client feedback process, laboratory flow, men's health, school health information technology, vaccine storage and management, and the workflow of their WIC program."  – 2009 Case Study published in Bruckner et al., 2023

"Beaufort County’s 2010 breastfeeding initiative demonstrates a department operating in Phase 3 (Informal or Ad Hoc QI Activities) while moving toward Phase 4 (Formal QI Activities Implemented in Specific Areas). Prior to the initiative, the department lacked formal processes to sustain QI, though staff had some experience using improvement methods to reduce waste. Leadership’s participation in the 6 month ‘QI 101’ training with other LHDs and formation of a multidisciplinary QI Team* marked a shift toward more structured improvement work. Using the Model for Improvement and PDSA cycles, the team addressed lower than average breastfeeding rates in the WIC program through a pilot program that surveyed WIC recipients and responded to their feedback, achieving a 17% absolute increase within one year. While highly successful and supported by leadership, the work remained concentrated in a specific program area, signaling progress toward formalized QI without yet reaching full agency-wide integration. Success was then shared through a 2012 case study, promoting QI in our state." – 2009 Case Study published in Wright et al., 2012

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*QI Team included: Health Director, a WIC nutritionist, the business officer, the maternity care coordinator, and the public health education specialist. Outside stakeholders surveyed and initiative support provided by The Center for Public Health Quality.

“Craven County Health Department has worked for years to create a culture of quality assurance and improvement on their environmental health teams, which prepared them well for the recent Consolidated Agreement quality assurance reporting requirement changes which took effect in fiscal year 2026. They embed quality assurance throughout onboarding, maintain open communication, seek external feedback, and have normalized a culture of documentation and reporting. Their Food & Lodging and Well/Onsite teams have both embraced advance features of the Customized Data Processing (CDP) program to help document and report program compliance. As a result of their quality assurance efforts and detailed reporting efforts, they notice improved onboarding, more self-awareness among team members, and improved internal communication. By prioritizing this as an agency, and building it into their culture, the new Consolidated Agreement requirements feel easily achievable rather than burdensome. Their approach ‘helps us ask why something is out of compliance and determine how to help move things back into compliance. It changes the way we’re doing our work.’”   – Margareta Slagle and Devin Lennon, January 2026

“For a time, QI at Onslow County Health Department felt stuck. We had completed a suite of training tools for our leadership team, which gave them a solid working understanding of QI concepts. However, after some staffing changes, it became clear that an academic approach alone would not create the momentum we needed. Real change wasn’t going to come from theory—it had to come from how we worked together every day. Our Quality Assurance Specialist took the first step by examining every process, in every section, across every division, which created space for staff to candidly share where things were working well and where they weren’t. These conversations became the spark that began shifting how we think about QI. Instead of QI being something handed down from leadership, we are moving toward a bottom-up approach—one where process improvement is a team effort. By focusing on the experiences of staff who carry out the work each day, we are building ownership, trust, and practical solutions. Leadership still provides structure and support, but the real progress comes from staff recognizing that their voices matter and their ideas can directly shape how we move forward. This change in mindset—from QI as an academic exercise to QI as a collaborative, agency-wide practice—has been key to our progress. It has reframed QI as something tangible, relevant, and achievable, which has allowed us to take steady steps toward embedding it into our culture.”  – Sara Eigmy, August 2025

“Albemarle Regional Health Services (ARHS) is a big proponent of HUDDLES!!!  Our finance and billing teams, along with HR and Clinical admin actually use this tool weekly.  ARHS uses Microsoft Teams, where we have created a team/channel for each huddle, and record notes there every week to keep us on track.  The huddles are just an opportunity to share what is going on, where everyone is, who needs help with what, and address any concerns. As Amy says, ‘Improving communication channels and providing regular updates helped build trust and engagement so we could advance to the next phase.’”  - Ashley Stoop, February 2026

“Since Fall 2024, UNC Gillings’ Public Health Leadership and Practice (PHLP) faculty and students have partnered with the Chatham County Public Health Department through the PUBH 730 Continuous Quality Improvement (CQI) case study. This collaboration focuses on the North Carolina Local Health Department Accreditation Activity 5.1, which requires local health departments to maintain a 24/7 system for receiving reports of communicable diseases and public health threats. During the most recent site visit, this activity was not met due to the lack of documented distribution and education of partners regarding the current notification protocol. Each semester since Fall 2024, Master of Public Health (MPH) students work in teams to analyze this real-world challenge and propose actionable, evidence-informed solutions. At the close of every term, de-identified student insights are shared with the Chatham County Local Health Department Director to support continuous improvement and strengthen readiness for the next reaccreditation cycle. This partnership not only enhances student learning but also advances the department’s capacity to protect community health. Chatham County Local Health Department Director Michael (Mike) Zelek, MPH, reflected the value of this collaboration in his December 19, 2025 note of appreciation: “Thank you for sending this! It will be helpful as we prepare for our reaccreditation visit next year.” This ongoing teamwork exemplifies how academia and public health practice can work hand-in‑hand to build stronger, more resilient systems, while training the next generation of public health leaders.”  – Marie Lina Excellent, February 2026