​Optimizing immunization rates was a goal of Healthy People 2010. Health departments from three different Ohio Counties used Quality Improvement (QI) methods to raise their DTaP series (4 shot series) immunization rates. The project began with a joint QI training in which each health department team analyzed their clinic flow and current immunization practices, and identified improvement opportunities. Throughout the project, Public Health Foundation (PHF) QI Experts worked with the counties by providing training and needed  guidance at key stages in the QI process. The value of the QI tools and methods was evident when unexpected disruptions such as the H1N1 outbreak affected all counties, when Hocking County faced a department merger, and when Franklin County had a server crash. The tools each team used varied based on their needs, but each team improved its immunization rate, learned how to implement QI techniques, and gained the skills necessary to integrate QI into their daily operations.