Continuous

Quality

ImprovementLearning Contract

Management & Planning IISue Roh

4/28/2014

Continuous Quality

Improvement/CQI

Contract Activity 1: How does CQI fit into DHS’s IOC initiative?

IOC Framework

Single Case Management provided by CUAs to promote consistency and accountability

DHS Safety Model of Practiceapplied to all service home settings

Family-Centered Services to ensure continuous focus on maintaining family and individual integrity

Community Engagement where child welfare services are enmeshed in the specific community served

Family Team Decision Modelapplied to the entire case process where the family, service providers, and system partners are included in case planning activities,

(Department of Human Services, 2014)

CQI Framework

Acknowledges and treats those closest to the work (staff, children, youth, families, and stakeholders) as the true “experts” in the work

Creates an environment in which these experts are also actively engaged in assessing the outcomes of practices, programs, and policies, and making improvements based on those assessments

Transforms organizations that are compliance-focused into true learning organizations that rely on their mission, vision, and values to constantly improve their practices,

(Casey Family Programs & National Child Welfare Resource Center, 2005, p. 2)

Contract Activity 2: Review available evidence-based

research related to CQI approaches in child welfare

program development CQI is the complete process of identifying,

describing, and analyzing strengths and problems

and then testing, implementing, learning from, and

revising solutions

Relies on an organizational culture that is proactive

and supports continuous learning

Dependent upon the active inclusion and

participation of staff at all levels of the agency,

children, youth, families, and stakeholders

throughout the process,

(CFP & NCWRC, 2005)

CQI: Background Started in the Japanese and

American business community

to improve products and

services to gain higher customer

satisfaction and retention

QI principles, tools, and

techniques: meets/exceeds

customer needs/expectations,

aims to getting it right every time

instead of meeting

quotas/numerical goals

*have been found to work

effectively for 40+ years

QI has been adopted by human

service industries (healthcare,

education, and child welfare)

over the past three decades,

(Council on Accreditation,

n.d., p. 2)

Contract Activity 3: Advice from influential program leaders at

various levels of CQI implementation

Feb. 2005- Casey Family Programs and the Nat’l Child Welfare Resource Center for Organizational Improvement convened 28 child welfare CQI experts (administrators, supervisors, & workers; service recipients– caregivers & youth; researchers, academics, & policymakers)

Resulting Key Principles (all interrelated and equally important):

Quantitative & qualitative data, seeking input from all available systems, valuing those involved with and in the system

Purpose of data, measurements, and analysis is to guide & improve child welfare practice and policies

Staff and the system that supports them make improving outcomes for children and families a priority

There is always room for improvement, never wait to act until a problem arises

CQI emphasizes continuous learning about practice and outcomes beyond basic, but expected, compliance

CQI is dependent upon the meaningful and active engagement of staff at all levels, children, youth, families, and stakeholders

CQI implementation should be agency-wide, support must be consistent and come from all levels of the agency,

(CFP&NCWRC, pp. 2-3)

Program Stand-OutsCQI

Call Management Initiative with a single 1-800

number available 24 hours a day, follow up

protocol, monitored by Consumer Affairs

Tracking System,

“Secret shopper” visits to agency waiting

rooms observing interactions between workers

and make service calls to assess services at all

levels

Peer record reviews using a protocol that

allows workers to identify strengths and

challenges of a particular case record --

completed mainly by frontline workers

(Center for the Study of Social Policy,

2007).

Contract activity 4: Compile & synthesize findings, as they

apply to Community Umbrella Agency (CUA) program

development CUA Region 6 provider, Tabor Northern Community Partners (TNCP), CQI

implementation plan includes an ongoing process of design, measure,

assess, and improve, and control (DMAIC)

Information from performance management activities collected and

aggregated by CQI Team, quarterly.

Along with using data and measurements to guide services, aggregated

scores will determine program element effectiveness.

Summary reports and subcontractor scorecard will provide DHS required

performance measures reports.

Contract activity 4, cont.

Under the direction of the CQI Department, performance measures will be developed as part of an ongoing process that ensures the following:

Treatment services incorporating evidence-based best practices are appropriate to the consumer’s specific needs are readily available;

Consumers’ specific goals, needs and expectations are sought, respected and incorporated into treatment planning to promote a higher level of functioning;

The concepts and essential elements of quality-based treatment will be highly valued;

Service excellence will be pursued through CQI activities and functions based upon the DMAIC model;

Consumers and their community-based support system will be encouraged to exercise their right to participate in decision making about the therapeutic services provided and treatment modalities utilized;

Procedures, treatments and services are provided with sensitivity and in a compassionate manner across all phases of care; and

Consumer and stakeholder feedback and satisfaction are key elements of the CQI process

Contract activity 5: Action plan where CQI methods could be

applied with TNCP CUA Exploration level activities: Identify need, according to IOC requirements (personnel skills/responsibilities,

technology); Define required data; Assess for additional data to meet organizational standards, according to stages of growth; Identify stakeholders and their requirements; Define the system/process for improvement

Installation level activities: Obtain related resources; Design criteria-based instruments; Redesign work processes accordingly; Design personnel education/feedback activities and determine timeline

Initial Implementation level activities: Test theories using CQI tools for patterns and trends; Measure results to evaluate effectiveness; Monitor change effects on service delivery; Resort back to Design, if necessary

Full Implementation level activities: Collect and assess data; Make recommendations for improvement; Ensure improvements are positively affecting outcomes; Standardize improvements; Resort back to Design, if necessary

Based on Implementation Science as they apply to IOC, (Metz & Bartley, 2012)

To conclude: Traditional Organizational Structure

Primary Staff

Goblin Valley (Utah), known for

mushroom-shaped rocks, formed

over millions of years

CQI-Driven Organization Structure

Built around core elements of perpetual

collective feedback, assessment and

response; therefore revised where and

when needed

Conceptual elements engrained in all

operations shape the resulting structure

Not within prescribed organizational

structures, which are often dated and

not applicable to human welfare

services

ReferencesCasey Family Programs and the National Child Welfare Resource Center for Organizational Improvement. (2005,

May 17). Using Continuous Quality Improvement to Improve Child Welfare Practice: A Framework for

Implementation, [Electronic version]. Retrieved from:

http://muskie.usm.maine.edu/helpkids/rcpdfs/CQIFramework.pdf

Center for the Study of Social Policy. (2007, February). Customer Satisfaction: Improving quality and access to services

and supports in vulnerable neighborhoods, [Electronic version]. Retrieved from: http://www.cssp.org/

publications/constituents-co-invested-in-change/customer-satisfaction/customer-satisfaction-framework-

improving-quality-and-access-to-services-and-supports-in-vulnerable-neighborhoods.pdf

Council on Accredidation. (n.d.). Quality Improvement: A Key to Success. Retrieved from: coanet.org/standards/pa-pqui/

Department of Human Services. (2014, Feb 10). The Improving Outcomes for Children Initiative Community Umbrella

Agency Practice Guidelines. The City of Philadelphia Department of Human Services. Philadelphia,

PA.

Metz, A., & Bartley, L. (2012, March). Active implementation frameworks for program success: How to use

implementation science to improve outcomes for children. Zero to Three. Nat’l Implementation Research

Network. Chapel Hill, NC.