Applying the model for improvement in a local health department: quality improvement as an effective approach in navigating the changing landscape of public health practice in Buncombe County, North Carolina.

In local health departments across the nation, problem solving and rapid change occur every day. Often, the results of these changes or problem-solving techniques may not be studied or evaluated fully to determine whether desired results were achieved. In fact, program evaluation, research, and technical assistance at the local level may be reduced or eliminated in many states during a time of rapidly diminishing resources and increasing demand for public health services. In delivering population-level programs, quality improvement (QI) methods may provide a much-needed alternative and more efficient approach than traditional research and evaluation to help answer public health practice questions such as "How do we know when a project or program really works, and, more importantly, how can we do it better?" This article focuses on the Buncombe County Department of Health's (BCDH's) experience utilizing a QI approach called the model for improvement (MFI), incorporating plan-do-study-act cycles and small tests of change, on a specific H1N1 influenza-awareness public health preparedness communication project. In addition, results of the BCDH's participation in QI initiatives and training resulted in success implementing change in other areas of the health department including decreasing wait time and addressing a backlog of prenatal visit appointments from 54 to 15 days, and more than doubling prenatal history efficiency uptake in a 5-week period. These case studies in the BCDH present how the MFI introduced the foundation of a culture of continuous QI within the organization.