Objective 4.2.1 Update (December 2015) – The department has made progress towards this objective by making considerable investments in training prerequisite for the successful implementation of a quality improvement program. The department has formed a performance management and quality improvement team (e.g. subcommittee/charter) that meets bi-weekly to continue learning quality improvement methodology as a group and discuss projects. One small QI project has been completed, and several others are currently underway. Several obstacles to having the quality improvement program fully integrated into all programmatic and operational aspects of the department currently exist. Future opportunities to conduct focused QI projects are projected to coincide with upcoming reports generated from evaluation of department operational metrics as outlined in the implementation of the department’s performance management system. At present, the department is at stage four (some formal QI activities) of the National Association of County & City Health Official's (NACCHO's) Roadmap to an Organizational Culture of Quality Improvement.

Strategy 4.2.1.1 - Educate leadership and staff on quality improvement tools and techniques.
Strategy 4.2.1.1 Update (December 2015) – In September of 2016, key staff including division directors, supervisors, program managers and line staff received a three day Just-In-Time performance management and quality improvement training provided by the Pearls of Wisdom, LLC consulting firm. Subsequently, the performance management and quality improvement team (PMQIT) was chartered and began meeting bi-weekly in October of 2015. All members of the PMQIT completed a three part Continuous Quality Improvement for Public Health: The Fundamentals online training series through the Ohio State University Center for Public Health Practice (available at: http://cph.osu.edu/practice/).

Measure 4.2.1.1.1 - Percent of leadership staff trained in quality improvement tools and techniques.
Measure 4.2.1.1.1 Update (December 2015) – Sixty-two percent (8 out of 13) of the departments permanent Senior Leadership team members are concurrently serving on the PMQIT and have had all training outlined in the strategy 4.2.1.1 update above.

Measure 4.2.1.1.2 - Percent of selected staff that are participating on QI teams that are trained in quality improvement methodology.
Measure 4.2.1.1.2 Update (December 2015) – Thirteen percent (17 out of 128) of the departments current full time employees are currently serving on the PMQIT and have had all QI methodology training outlined above in the strategy 4.2.1.1 update above.

Strategy 4.2.1.2 - Establish a quality improvement oversight team that includes staff at all levels by XX.
Strategy 4.2.1.2 Update (December 2015) – In October 2015, the department formed a performance management and quality improvement team (e.g. sub-committee) that includes division directors, supervisors, program managers and line staff. As outlined in the PMQIT charter, all departmental QI projects must be approved by the PMQIT, the PMQIT co-chairs, and the department Director prior to commencement.

Strategy 4.2.1.3 - Establish quality improvement policies and procedures by XX.
Strategy 4.2.1.3 Update (December 2015) – This strategy has been implemented in part, as the departments PMQIT Charter provides several policies and procedures. However, the departments three year QI plan is currently under revision, and will provide additional policies and procedures for the departments QI program when published.

Strategy 4.2.1.4 - Develop a quality improvement plan that is PHAB compliant by XX.
Strategy 4.2.1.4 Update (December 2015) –The department’s three year QI plan has been drafted and is currently under revision.

Measure 4.2.1.4.1 - Percent of Administrative quality improvement projects completed by June 2016.
Measure 4.2.1.4.1 Update (December 2015) – The department underestimated the logistic barriers to implementation of the QI program, and as such has set a new output measure of the number of completed administrative QI projects by June 1^st, 2016 in lieu of the outcome (percent) measure. At present, there have been no administrative projects completed.

Measure 4.2.1.4.2 - Percent of Programmatic quality improvement projects completed by June 2016.
Measure 4.2.1.4.2 Update (December 2015) – The department has set a new output measure of the number of completed programmatic QI projects by June 1^st, 2016 in lieu of the outcome (percent) measure. At present, one small programmatic QI project has been completed related to the method of reporting Lyme disease cases to the state, significantly shortening the time in days from open to close of Lyme disease case investigations.