The Healthy People 2020 Public Health Infrastructure Goal 16 is to increase the proportion of tribal, state, and local public health agencies that have implemented an agency-wide QI process.17 On the basis of the 2010 survey results, 11 respondents noted they have QI partially or fully implemented department-wide. Agencies are beginning to take action to encourage broader implementation of QI. Eighty-eight percent have at least some staff who received formal training in QI methods (72% have between 1% and 25% of their staff trained). Sixty-three percent of respondents have QI included in job descriptions for some employees and 57% of respondents provided training to staff in QI methods. With the implementation of NPHII, staffing and training at health departments in the areas of performance management will increase further.1