Term of Award

Fall 2018

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy & Management (COPH)

Committee Chair

Gulzar Shah

Committee Member 1

Rachel Schwartz

Committee Member 2

Jeff Jones


Background: The continuous improvement as applied to a local board of health (LBoH) is one of the six governance functions and focuses on activities that target LBoH’s self-improvement and improvement of local health department (LHD) it governs.

Purpose: The purpose of this study was to determine the engagement level of LBoHs in continuous improvement efforts and to identify factors associated with this function. The goal was to provide insights that will inspire LBoHs to improve their continuous improvement governance function for better practices, and in turn, enhance the performance of local health departments (LHDs) for which the LBoHs serve as the governing body.

Methods: Negative binomial regression was performed to analyze data from the 2015 Local Board of Health National Profile, a cross-sectional survey utilizing representative samples of LHDs governed by one or more LBoH(s) across the nation. The LBoH taxonomy was used as the guiding model. The LBoH taxonomy consists of seven (7) domains, six (6) governance functions as structural domains and boards’ characteristics and strengths as the central one.

Results: For 18 items comprised in the continuous improvement domain, the mean of the most desirable responses was 5.42 (SD = 3.73). In the negative binomial regression analysis, the summary scale for the other six (6) domains (IRR = 1.061, p < 0.001) and the summary scale for the other five (5) governance domains (IRR = 1.067, p < 0.001) showed positive associations with the continuous improvement domain. The other six (6) domains’ individual scales indicated positive associations with the continuous improvement domain, in the areas of policy development (IRR = 1.136, p < 0.001), resource stewardship (IRR = 1.183, p < 0.001), legal authorization (IRR = 1.094, p < 0.001, partnership engagement (IRR = 1.118, p < 0.001), oversight (IRR = 1.337, p < 0.001), and other characteristics & strengths (IRR = 1.173, p < 0.001). Within the central domain, seven (7) of 10 items displayed strong associations with the continuous improvement domain.

Conclusion: The findings of this study reveal that LBoHs did not significantly engage in the continuous improvement governance function. Furthermore, the results highlighted the relationship between LBoH’s governance functions. LBoHs may benefit from this study by better understanding the importance of continuous improvement and its role in improving LHD performance.

OCLC Number


Research Data and Supplementary Material