Continuous Quality Improvement in Quality Rating and Improvement

Systems (QRIS)

March 26-27, 2014

Good Morning – Welcome Back

Agenda: Day Two

Time Activity

8:00 Welcome back, agenda, housekeeping

8:15 Reflections/Review of State Learning Table Goals

8:30 Stages of Change – Change as a Process

9:00 CQI Definition + Applying CQI Philosophy and Approach

9:30 QRIS/CQI Relationship

10:30 BREAK

10:45 Pennsylvania Example – Leslie Roesler

11:45 Mapping State Examples

12:15 Working Lunch

12:45 Small Group Report Out on State Steps

1:30 Unanswered Questions and Next Steps, State Team Meetings, Webinars

1:45-2:00 Close/Evaluation

Reflections

State Team Goals

Holly Wilcher

March 27, 2014

Stages of Change:

Change as a Process

Why Is Readiness

to Change Important?

“A one-size-fits-all approach that

ignores differences in readiness to

change may result in a waste of

resources, lower program retention,

and worse outcomes for educators

and children.”

7 Source: Peterson, S. M. & Cairns, M. (2012). The stage of change approach for quality

improvement in early care and education. The Children’s Institute.

What Are the Stages of Change?

Stage 1: Precontemplation

Stage 2: Contemplation

Stage 3: Preparation

Stage 4: Action

Stage 5: Maintenance

8 Source: Peterson, S. M., Baker, A. C., & Weber, M. R. (2010). Stage of Change Scale for Early

Education and Care 2.0: Professional manual. Rochester, NY: The Children’s Institute

What Strategies Can Be Used at

Each Stage of Change?

Stage 1: raise awareness

Stage 2: raise confidence and identify

obstacles

Stage 3: set goals and gain commitment

Stage 4: assist with problem solving and

resource identification

Stage 5: support integration of changes

and team building

9 Source: Peterson, S. M. & Cairns, M. (2012). The stage of change approach for quality

improvement in early care and education. The Children’s Institute.

What Do You Know About Your

State’s Needs?

Determine fit and feasibility, and readiness to

change

Identify and validate needs

Determine target settings and sectors

Plan to meet the demand, and grow and sustain the

system

Link with professional development and quality

improvement efforts

Unify the field and avoid duplication

10

11

What can you/your State do to enhance readiness for CQI as a TA system philosophy and standard?

Share the example.

Explain what you have tried

so far.

Ask clarifying

questions.

Suggest and record

new approaches.

CQI Definition

What are the elements you feel would be important to include

in a definition of CQI?

Basically

The process of:

Identifying, describing and analyzing

strengths and weaknesses

(via multiple sources of evidence)

Establishing a plan with benchmarks, timelines, assigned tasks and responsibilities to improve

Testing and implementing solutions

Evaluating the results and revising the plan

CQI Process Visually

Do

Study Act

Plan

Continuous Quality Improvement: An Overview

Report for State QRIS Leaders

Interviews revealed that key informants believe CQI in QRIS is:

• grounded in human relationships;

• focused on enduring change, which may feel

significant and scary for early learning professionals;

• labor- and time-intensive; and

• likely to result in a process of incremental

improvements in teacher practice and program

quality over a long trajectory of time versus immediately.

“Change that lasts is slow and gradual.”

Kaizen

What do you think?

Is there a difference between the concept of Quality Improvement

efforts in QRIS and CQI?

CQI in Existing QRIS

• Specific standards/criteria

• Part of technical assistance and program support

• Several examples found in search of

statewide QRIS • LA, ME, NM, PA – CQI in standards • DE, ID – CQI in TA/supports

CQI as a Standard in QRIS

• Program conducts a self-assessment using ERS, CLASS, PAS/BAS, etc., or is assessed to get a score for rating

• Quality improvement plans developed after an assessment

– Self-assessment or score

• Quality improvement plans are used at all levels to track progress

Incorporating CQI in QRIS

• Importance of leadership adopting philosophy

• Importance of training staff – the “why” behind the standards

• Importance of educating providers/practitioners to communicate message to parents

• Importance of educating partners and stakeholders to communicate message to general public

QRIS/CQI Relationship

• In state teams, consider whether you believe your state should incorporate CQI in your QRIS as a philosophy, as a standard and/or as a framework for technical assistance and support.

• Then discuss how that decision (incorporating as a standard, criteria, and/or philosophy) looks at each level, program, partner state. Discuss what this looks like in each of these contexts.

Continuous Quality Improvement

To get better and better at getting better and better… • program level, • implementers/contractors, • state or systems level.

Continuous Quality Improvement: Overview Report

CQI applies to three levels and different strategies are used at each level. The three levels are:

• the program level which includes both program staff (e.g. providers and teachers) and leadership;

• the implementing partner level comprised of professional development and technical assistance practitioners, higher education institutions, and regional QRIS managers

like child care resource and referral agencies; and

• the state system level which can encompass

different state agencies, statewide organizations, policymakers, private funders, and

contracting entities.

State/Systems Level

Implementing Partner Level

Program Level

Reflecting…

After reading about this and reflecting on our work together in the past day, consider if you are most interested in discussing improving the CQI relationship with QRIS at the program level, the implementing partner level, or at the systems level. As you know, we will be following up with webinars that will be targeted to each of these stakeholder groups.

For example…

• If your team is focused on the program level, a relationship may be using a core body of knowledge combined with teacher observation and evaluation, self-evaluation, and goal setting to improve the skills of early learning teachers and directors;

• If your team is focused on the implementing partner level, a relationship may be establishing a feedback loop between programs and professional development providers that is two-way, collects on-going feedback from programs, and leads to improvements in QRIS at the program level;

• If you are focused on the state system level a relationship may be using available data and feedback from the early learning community as well as employing research to inform QRIS protocol and policy improvements.

Work in small groups to discuss and brainstorm the following questions:

• In this (program, partner, state) sector of the system, – How does a QRIS/CQI relationship encourage collaboration

amongst people and organizations? – How does a QRIS/CQI relationship elicit 'ownership' by a

director and staff, implementing partners or state leaders (depending on your team’s focus)?

– How does a QRIS/CQI relationship engage stakeholders in self-reflection?

– How does a QRIS/CQI relationship encourage engagement in goal-setting? – How are results shared, communication and used to engage in the cycle of CQI?

Continuous Quality Improvement

“One major purpose of a QRIS is to recognize quality and promote a culture of continuous improvement

among providers.

The rating is not a destination; it is a set of benchmarks along a pathway of ongoing improvement.”

Anne Mitchell,

Considerations for an Efficient, Inclusive and Implementable Quality Rating and Improvement System

April, 2012

PA’s CQI Approach

• At all levels of operation in a cross sector manner a focus on how we are addressing CQI for individuals, classrooms, facilities, programs, and systems. Strategy: Developing a framework which supports all the PA initiatives under a Continuous Quality Improvement umbrella. Continued work toward aligning requirements, standards and processes across programs.

Supporting the people facilitating continuous quality improvement and system development is essential to strengthen supports to bolster and strategically improve the work of our professionals who assist practitioners, programs, and families. Strategy: Intentional thinking about the core job competencies, professional development needs, communication about best practice, and exploration of new options including accountability for results will help facilitate the improved quality of the services these professionals provide.

PA’s CQI Approach

CQI: A Pennsylvania Early Learning Program Culture

Directors: Leading CQI Using the Habits of Mind

PQAS Instructors: Using the Big Three to Implement a C3

TA Consultants: CQI and Cultural Competency: Serving Hard to Reach, Hard to Serve Populations

STARS TA and RK TA Mgrs: ERS and CQI: Collaborative Leadership

STARS Managers: CQI and Building Communities of Practice

RK PD Managers: CQI In Professional Development Implementation

Resources and Support: Needs based PDII's, Best Practices Documents, Online Module Conversion, competencies, accountability systems, CQI Standard

Pennsylvania Examples

CQI Specified in the QRIS Standards: • Leadership and Management - Continuous Quality Improvement

Criteria

Star 1 • Annual site-based professional development plan completed. • Program uses documents for tracking illnesses and injuries, including plans of

action to prevent further occurrences. Star 2

• Complete and provide an annual Facility Professional Development Plan (FPDP) (or equivalent).

• System of site safety review including strategies for supervising children and corresponding plan of action are instituted.

Star 3 • Provider develops and implements a Continuous Quality Improvement Plan

using multiple sources. Star 4

• A Strategic Plan is aligned with the program’s mission statement and put in place.

• Environment Rating Criteria – an improvement plan is developed if ERS score

is below a certain score at each level.

State Level Example

Resources and Support:

Best Practices Document: “Good, Better, Best Pennsylvania’s Continuous Quality Improvement Guide to Best Practice”

An optional tool that supports programs :

• Understanding the more subtle continuum of quality contained within a standard and in n meeting targeted standards

• Identify/consider making incremental improvements within a STAR level or standard (particularly if not moving up a STAR level)

• Identify areas where the minimum standard is exceeded and can be used to determine at what point in the spectrum a standard is being met

PA Example of Continuum

Standard: Provider develops and implements a Continuous Quality Improvement Plan using multiple sources. (STAR 3 and above) Good Better Best

Description of Criteria at each STAR

Level

• Written plan of improvement documents timelines and persons responsible for completing that portion of the plan

• Sources of information and/or items to include on a CQI plan utilize resources found at www.pakeys.org in the CQI section

• Items in a CQI plan include short- term objectives

• CQI plan updated annually

• Include the Strengthening Families Self-Assessment as a source of information for the annual evaluation/review

• Five Year Plan with short and long term objectives

• The CQI plan addresses the diverse needs of staff/families within the program as appropriate

• Sources of information for an annual evaluation/review of program may include surveys of families, staff, and/or school-aged children, ERS, LIS, audits, FPDP plan, etc.

• CQI plan updated quarterly

• Practitioner utilizes the Good/Better/ Best tool when completing their improvement plan

• The program works with key stakeholders, including personnel, children and youth, families, and the community, to collect and analyze data relevant to desired goals, objectives, and outcomes

• CQI plan updated monthly or as objectives are achieved/adjusted

Implementing Partner

Supports for Knowledge Mediators

• Professional development for Instructors, Consultants, STARS Managers; content based on annual competency survey

• Series developed to address deeper understanding of CQI (multi-year, multiple sessions, multiple audiences)

– The Art and Science of Technical Assistance (TA Consultants)

– Deepening Our Understanding of Continuous Quality Improvement (STARS

Specialists)

– ERS and CQI: Collaborative Leadership (TA Managers)

– CQI In Professional Development Implementation (PD Managers)

– The Big Three Processes of Professional Development (Instructors)

Implementing Partner

Measurable impact on provider

80%

Qualifications, Professional Development & Professionalism

90%

Reporting Obligations

90%

Basic eligibility Knowledge of system, standards, process Required and ongoing professional development Appropriate preparation for consultation

Timeliness, accuracy of reports Records maintained for referrals Timely follow-up and completion of referral Communication with Regional Key Meets targets

Reviews plans Closed-Evaluated between April 1 and March 31 on the following factors:. Achievement of specific goals as identified in Action Plan (80%*) STAR level change (min. 33% meet)

* Up to 10% may be justifiably exempt

STARS TA Accountability Plan

Virtual CQI Guide

(a seven and a half minute online session describing the CQI process)

http://www.pakeys.org/presentations/CQIVirtualGuide/player.html

Program Level

Program Level

Directors’ Community of Practice:

• Habits of Mind for Directors: An Essential

Leadership Tool for Continuous

Quality Improvement

After-School Quality: The Process

of Program Improvement

• 5 step approach

• Implement team approach to CQI

• Program manual and TA support

Establishing a CQI Framework

Crafting a conceptual framework for the state that demonstrates how the cross sector CQI

is related to the rating and monitoring work. http://www.youtube.com/watch?v=NugRZGDbPFU

WORKING LUNCH

• Take a break, eat your lunch, finish your project and get ready to present your model and thinking…

Share your thinking…

Measuring CQI

• What is the research telling us?

• How can we measure the success of a CQI approach?

Global Quality

Teacher

Knowledge & Practice

Child Development

& Learning

• Child-adult ratio and group

size

• Technical assistance to

achieve higher program

standards

• Facilities enhancements

• Leadership and

administrative practices

• Culture of data-driven

decision making

• Financial incentives

Setting

Interventions

• Training

• Relationship-based supports

• Credentialing

• Formal education

• Curriculum implementation

• Data-driven instruction and decision making

• Financial incentives

Workforce

Interventions

• Consumer education

• Financial incentives

Family Interventions

Key

Strongest evidence

Moderate evidence

Little evidence

• Professional development and

training registries

• Higher education

• Strengthened licensing and

regulations

• Financing

• Governance

• High-stakes accountability based on

data and quality rating and

improvement systems

System Interventions

Figure 1. Early Care and Education Quality

Improvement Framework

Strategies and ‘To Do’ List Plan of Action

• Continuous Quality Improvement - Learning Table Work Plan Template

• Taking this information back to your state and working with your teams on strategies

• Unanswered questions

• What additional support

do you need from us?

Pre-Session Preparation for Next Session

Each State should come prepared to report on the following:

1. Update on the state team activities and use of the work plan template.

2. Most interesting strategy your state is using to support programs in a CQI approach. Meet with your team between sessions to compete the planning template and work together on activities

Questions, Reflections, Comments

Wrap Up

Thank You

Landing Pad: http://qrisnetwork.org/lt/2014-continuous-quality-

improvement-quality-rating-and-improvement-systems-qris-learning-table/one

Follow-up Contacts: Debi Mathias, dmathias@buildinitiative.org

Lindsey Allard Agnamba, allard@schoolreadinessconsulting.com

Holly Wilcher, Hwilcher@zerotothree.org