Realizing transformational change through quality improvement in public health.

OBJECTIVE: This article discusses the specific components necessary to achieve transformational change within public health departments as a means for creating sustained performance improvement and better outcomes in the health of the community.
DESIGN: This article provides a review of transformation change concepts and application to public health departments.
RESULTS: Transformational change for public health departments must be intentionally designed to achieve high performance. While all improvement requires change, not all change results in improvement.
CONCLUSION: The successful transformational change effort always occurs from the top-down, while the process improvement occurs from the bottom-up. Transformational change is possible in public health departments when small incremental improvements are linked with large-scale management changes to continually improve public health performance resulting in better population outcomes.