Skip to main content
Health Districts as Quality Improvement Collaboratives and Multi-Jurisdictional Entities
Keeneland Conference for Public Health Systems and Services Research
  • William C. Livingood, University of Florida
  • Nandi A. Marshall, Georgia Southern University
  • Angela Peden, Georgia Southern University
  • Ketty Gonzales, Georgia Department of Public Health
  • Gulzar H. Shah, Georgia Southern University
  • Dayna S. Alexander, Georgia Southern University
  • Kellie O. Penix, Georgia Southern University
  • Russell B. Toal, Georgia Southern University
  • Lynn D. Woodhouse, Georgia Southern University
Document Type
Publication Date

Research Objective: The Georgia Public Health PBRN assessed the utility of the Multi-county Health District as a structured Quality Improvement Collaborative (QIC), and as multi jurisdictional entities for purposes of meeting standards for accreditation by the Public Health Accreditation Board.

Data Sets and Sources: Data were collected from online surveys followed up with phone interviews or paper surveys to maximize participation. A newly developed clinical care QIC instrument (Schouten et al, 2010) was modified to collect data with a revised focus on QICs for public health. We retained QI culture constructs in the instrument while shifting the focus from healthcare to public health essential services related to accreditation standards.

Study Design: Data was collected from a purposeful sample of local public health key informants in Georgia who were identified by the District Directors’ office as local key informants. Invitations Key informants included county and district staff and county board of health members.

Analysis: Psychometric testing of the QIC assessment instrument included tests for validity and reliability. Census-based and self-reported demographic characteristics were used to compare responses.

Principal Findings: Strong consensus emerged across various constituencies that Districts were critical for local public health to provide essential services. Key opinion leaders from both the rural and non-rural counties agreed that the Districts were important.

Conclusion: Regionalization using Georgia Districts has major potential for supporting QI and meeting quality assurance standards associated with accreditation.

Implications for Field of PHSSR: Accreditation has the potential to substantially clarify and enhance the role of public health in the 21st century. But local public health agencies, based on small municipality or county populations, are unlikely to possess and sustain capacity to meet the challenges of comprehensive essential services. Regionalization of local public health capacity is a critical emerging issue with the launching of public health accreditation.


Reproduced with permission of the National Coordinating Center for PHSSR and the Robert Wood Johnson Foundation, Princeton, N.J. Presentation obtained from the Keeneland Conference site.

Lexington, KY
Citation Information
William C. Livingood, Nandi A. Marshall, Angela Peden, Ketty Gonzales, et al.. "Health Districts as Quality Improvement Collaboratives and Multi-Jurisdictional Entities" Keeneland Conference for Public Health Systems and Services Research (2012)
Available at: