The elements of the NACCHO roadmap include infrastructure, leadership commitment, employee empowerment, customer focus, and teamwork. Something that is being done well at the public health department is the infrastructure with the establishment of a council, quality program manager, and training on quality improvement tools and methods. Another thing that is present is customer focus because their goals include improving patient satisfaction and giving them decreased wait times for appointments. Employee empowerment is also present, as they are maintaining communication with staff to keep them informed and engaged. The only area they seem to be lacking in is teamwork. It took two years to train staff and leadership in quality improvement, and after that they only had a few small projects that were successful. The team has a good plan and commitment, however, they would be more successful if they were collaborating better by brainstorming, problem solving, and taking on larger scale quality improvement projects. The organization could address this by having meetings to get everyone to be more involved and work together as a team. More innovative solutions and ideas can come from doing this, and it would make staff feel more included and heard.

Three things the health department could do to ensure the sustainability of their continuous quality improvement efforts it's to regularly monitor changes made, try to get feedback from customers to ensure the changes are effective, and be consistent with changes to reduce variation.