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Field Notes

Getting Started with Continuous Quality Improvement

Abby Alexanian
July 25, 2019

Continuous Quality Improvement (CQI) is a process of collecting, analyzing, & using data to improve the quality of services or products on an ongoing basis. Put simply, CQI helps teams “get better at getting better.”

About CQI

Over the past fifty years, the practice of CQI has been instrumental in improving products and services in various industries, including manufacturing and healthcare.  CQI can also be applied to the thousands of social service programs working to improve outcomes for people, from healthy birth, to a quality education, a well paying job, and healthy and secure aging.  

Root Cause has developed a holistic approach to strengthening the capacity of social service providers by applying CQI principles in their programs. Our approach enables organizations to:

  1. –  Clearly define intended results and the path to achieve them.
  2. –  Use the best available evidence of what works.
  3. –  Understand the barriers that hinder progress.
  4. –  Use data in real time to decide what actions to take.

Unlike third party evaluations, CQI offers opportunities for ongoing program learning and improvement of day-to-day activities so that services are better delivered and more effective.  It leads to professional development for program staff and improved satisfaction among program participants.

How to Start Practicing CQI

As we  share with organizations and communities about building their Continuous Quality Improvement (CQI) practice, we often hear the question: “This is great, but how can we get started?” 

Underneath this question I hear the ever-present reality of social service delivery: taking a first step into a new way of working is daunting, particularly when you already have a ton of work on your plate (and so does the rest of your team). While there is no doubt that developing a new practice (or building upon an existing one) takes additional time and effort, once implemented CQI can actually make improvement projects less daunting and easier to accomplish. It’s all about breaking down goals and challenges into manageable tasks and working to improve in an ongoing and cumulative way, rather than trying to tackle big issues all at once. That said, through our CQI coaching with social service providers, we have learned that there are a handful of actions that partners can take in order to prepare to practice CQI, and make those first steps feel less daunting in the process.

1. Select a program, department, or other specific area in which to begin.

Whenever you try something new, it’s much easier to start on a smaller scale. We work with direct service programs, many of which are part of larger organizations or agencies, providing coaching to the program director and their teams. When it comes to improving service quality, we find it helpful to work directly with the teams providing the services so that they can lead in the development of their own CQI process as it relates to the services they deliver. In other words, starting with a specific team (such as a program team) is more manageable for learning purposes and allows the team to co-create a CQI process that gets at what they really need. 

2.  Identify & support a “CQI champion”

Your champion is the person who drives the practice of CQI forward, engages the team, and possesses a strong belief in its value and usefulness in your work. A champion doesn’t need to be a program director or someone in a formal leadership position, but should be someone with the ability to motivate the team and support their CQI projects. Performing this role will require additional time and effort on the part of the champion. Depending on this person’s capacity, getting the right person into the “champion” role may mean that they need support in adjusting their workload to allow for this new set of tasks.

3.  Enlist your team in committing to learning and quality improvement

To be fully ready to launch into the practice of CQI, the whole team needs to be on board with the idea that improving service quality is something worth investing time and energy in. This means that front-line staff, managers, program leadership, organization leadership, and other relevant stakeholders agree that quality improvement is a worthy goal, and CQI is a process worth trying. It’s unlikely that everyone will be equally enthusiastic, and that’s ok! The key will be ensuring that there are regular opportunities to hear from all team members and learn from each other’s feedback and experiences with the CQI process – with the goal, always, of being curious and working together to continuously improve.

4.  Understand what data you already have

If your organization is like many social service providers, chances are you already collect more data than you’re using for program purposes (beyond compliance with funder requirements). Before launching into a new process of using data for programmatic decision-making, it will be useful to start by looking at what data you are collecting, for what purpose, how you track it, and at what points you or your team members are looking at it and/or analyzing it. To set CQI goals and test improvements you’ll need to use these data to be able to tell whether your efforts are achieving the changes you sought. Understanding what data you already have and can draw from in your CQI process will be the first step. From there, you can identify any additional data you may want to collect as you launch your CQI practice and dive deeper into learning what changes can improve the quality of your services, people’s experience with those services, and the outcomes people achieve through them.

Of course, there are many more factors to consider in getting started with CQI, and the details will depend on the specific strengths and needs of an organization or program, and the goals you are aiming to achieve in your work.  To learn more about our approach and discuss how to launch a CQI initiative in your organization or community, contact us.

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