The Public Health Foundation (PHF) and the Orange County Health Department in Florida have worked together over many years to improve the quality of public health in Florida. The Orange County Health Department produced this document that explains their quality journey in "Implementing a Quality Management System." 

The project goal was to "connect disparate functions into a cohesive and seamless operation where information is freely shared, and acted upon, to facilitate continuous process improvement and eliminate waste to meet ever increasing customer demands."  They used the Lean Six Sigma quality method in their project management and used various quality tools such as tree diagrams, prioritization matrices, Pareto charts, and 5S (Sort, Straighten, Sweep, Standardize, and Sustain).

They created the Onsite Sewage Treatment and Disposal System Permitting Process Action Team II (PPAT) and developed objectives and goals to meet. They provide visuals that show "before" and "after" shots of the health department when implementing the 5S tool.