Last year we began coaching direct service providers focused on early childhood health and well-being, including nonprofits and public agencies, to strengthen their capacity to practice continuous quality improvement (CQI).  The goal of this effort, broadly speaking, is to improve the quality of programs that serve children under five, pregnant women, and families with young children. By improving program quality – especially improving participants’ experience of the program in terms of how well they find the service meets their needs – participants will be more likely to succeed.  In this case, success is measured in terms such as more children being born healthy and growing to become ready to learn in kindergarten.

Our CQI Coaching and capacity-building contributes to this community-wide effort to build a “connected, innovative system of care” led by our partners Ready for School, Ready for Life (Ready Ready) and The Duke Endowment.  CQI was identified as a priority for the Get Ready Guilford Initiative (GRGI) by the Guilford County community during a feedback and input process facilitated by Ready Ready.  With funding from The Duke Endowment, GRGI is providing resources including grants, a community of practice, and technical assistance support so that nonprofit and public programs focused on early childhood development can build their capacity to practice CQI.  The perspectives that follow, therefore, are as much for the foundations, intermediaries, and governing agencies that support social service providers as they are for the programs themselves.

Lessons Learned

1. Trust is crucial to the CQI coaching process and practice.

CQI coaching  begins with developing strong, trusting relationships between the CQI coach and program leaders and staff.  For me, the first step in building that trust is to recognize that program staff are the experts when it comes to delivering services to people they serve.  They are the ones working directly with participants and community partners. When we start to talk about program quality, I ask them about what keeps them up at night, what they wish they could do for the people and families they serve.  I follow their lead in defining goals for their CQI practice that are based on their experience and learning. In order to do this, I use a program assessment grounded in our CQI Framework that looks at current practices in key program quality areas.   As a coach, I am a facilitator of the process, and our work together is a judgement-free zone.  As a coach coming to work with a social service program, I’m not coming in with an agenda or a plan in mind.  I can serve as a guide for program leaders and staff to make a plan, and empower them to use their agency and newfound knowledge to make program improvements in programs that target the communities they serve.

2. CQI Coaches meet programs where they’re at.

Program leaders and staff bring all kinds of knowledge and capacity to their CQI practice.  Some program teams are small, others are large. Some benefit from diverse public and private funding while others rely on limited funding and volunteer time to operate their social service programs.  Some programs have funding requirements that include designated resource allocation for training and other professional development opportunities to support program implementation (i.e. require a set number of hours annually for staff development), while other programs struggle to find resources to support capacity building.

Our challenge is to help them build a sustainable CQI practice that works for their operating context and staff capacity and can be sustained with few or no additional resources.  It is important to identify some of the pain points in program design and implementation as they are experienced by program staff because it sparks curiosity and motivation to learn and practice CQI in order to address pressing challenges that can lead to systematic program improvement.

3. Keep people at the center of your CQI practice. 

In a social service context, practicing CQI means creating the time and space to ask questions and try new things so that people achieve better outcomes. Some driving questions:

–  What do participants need to reach their outcomes and how do we know this?  Have we asked them?

–  What can you and your team do differently in order to improve participants’ experience so they can reach outcomes and achieve success?  What resources and processes are needed?

As a coach it’s my job to help coachees – program leaders, staff, volunteers – articulate a hypothesis that connects the CQI process with this end in mind.  The CQI cycle is then our opportunity to test this hypothesis, one step at a time.

4. CQI is a mindset more than anything.

CQI prompts teams to get curious and ask questions, rather than taking their current tools and processes at face value.  In CQI we want to develop a practice of inquiry that helps us think and act in ways that lead to learning and improvement.  One of the programs that I am coaching uses a participant survey provided by a funder.  The program staff presumed that the survey tool was to be used “as-is,” rather than as a template that could be built on, adjusted, and shaped to collect the most useful feedback from participants to shape programming decisions.  When program staff shared with the funder their ideas for improving the survey in order to collect and act on better feedback data from participants, they found enthusiastic support and encouragement from their program officer. In this case, program staff found a clear and simple path forward – improving a participant survey – by looking at their current measurement tools and practices in a new way.

5. Programs must define their own shared vision of quality and success.

It is important for programs to define a shared vision of program quality and success that engages participants, staff, and other stakeholders.  This vision needs to be inclusive of participants and staff feedback, a nuanced understanding of community needs, and clear funder expectations.  This shared vision is a guidepost for continuous reflection on what may be working to bring this vision to life and what may be getting in the way. 

While this may seem obvious, when funders or intermediary organizations provide resources to support programming and/or capacity building, such investments are often accompanied by directives and expectations that need to allow for more flexibility for program improvements along the way.  CQI practices create a process for program leaders to experiment with innovations that can lead to systematic program improvements and better outcomes.

6. CQI is about experimenting with innovation, and getting better and getting better. 

Progress in building and launching a CQI practice may be slow at first, but the start of this process is an important time for empowering program leaders and staff as well as building the foundational skills and processes to drive CQI practice.  In coaching program teams, it is important that we create time and space for them to experiment with innovations that can lead to important learning and program improvement, one intentional step at a time. Agency leaders, funders, and intermediaries can support CQI by allocating time and resources to sustain the practice as an embedded part of effective program management.  It is also important to trust that program leaders and staff have a deep understanding and knowledge about the day-to-day needs of participants and programming. When the program team learns something new from the CQI process, it can lead to opportunities for improvement. Program teams need internal and external support to bring those improvements to life through the services they offer participants and their shared vision of quality and success.

7. CQI for nonprofits and public agencies is not a one-size-fits-all approach.

In Guilford County, we are working with 13 unique social service providers, and each one is working in different ways to learn about and improve program quality.  Participating organizations come with varying skills and capacity for practicing CQI. At the start of our work together, most program leads had concerns about the time commitment required to learn and do CQI practices with all of the competing demands of the program’s day to day operations that rested on their shoulders.  Now that we have completed two CQI cycles (4-6 months each) and are working on a third cycle, each program leader has charted a path that makes sense for their program, with unanimous and strong buy-in on the value of incorporating CQI practices. One program leader, Rashad Rodas, recently shared at the Guilford CQI Conference that CQI is not “something else to do… it is the thing to do”, as she shared the benefits of embedding CQI practices across the Guilford Child Development Early Headstart program. 

8. Keep it simple.

CQI in a social service setting does not have to be complex and onerous.  Program teams need user-friendly tools and guides. They value opportunities to learn and share with peers.  The practice of CQI can be straightforward and nimble and still lead to profound benefits for the people who participate in the program.  Innovations to improve program quality can be small, progress can be incremental, and timelines for testing them should be grounded by program cycles and calendars.  Remember, the goal here is continuous quality improvement – as in, a process that is embedded and repeats on regular intervals that can inform program changes.  When it’s simple, it is easier for program leaders and staff to maintain.