Continuous Quality Improvement Framework
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.”
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 to apply CQI principles in their programs. Our approach enables organizations to:
– Clearly define intended results and the path to achieve them.
– Use the best available evidence of what works.
– Understand the barriers that hinder progress
– Use data in real time to decide what actions to take.
CQI Framework for Social Service Providers
1. Life Outcomes & Indicators
The practice of Continuous Quality Improvement is grounded in a deep understanding of how a social service provider aims to improve people’s lives, and how it measures progress and success.
Performance measurement starts with understanding how a social service provider aims to enable people to succeed. Services and programs must clearly define the milestones – in terms such as health and well-being, education and youth development, economic security – that they are designed for. For example, a nonprofit provider of math tutoring might aim to help high school students graduate.
Indicators are the specific and measurable ways that show whether people are on track for achieving intended outcomes. Indicators provide evidence that a service or program is – or is not – achieving its desired results. For example, proficiency in geometry skills is one indicator that a high school student is on track to graduate.
Research on the efficacy of social service programs points to several quality domains that are critical for improving people’s lives. These domains, along with performance measurement capacities, are the foundation of our Continuous Quality Improvement tools and practices, including CQI Assessment, Planning, and Coaching. As our team continues to learn and improve on our own CQI practice, we will continue to update and amend resources such as these domains of program quality for social service providers.
Barriers exist that prevent some children and families from accessing programs and services. These barriers tend to be more prevalent among populations that have traditionally been less able to use existing services available, for a wide variety of reasons. These barriers to services tend to be more significant in low-income neighborhoods; certain cultural and immigrant groups; rural and remote areas; and non-traditional family structures. As a result, these groups tend to face more challenges and be less able to get the supports and services needed to experience lifelong success. Accessibility describes how programs account for these barriers. It requires the deliberate and active identification of barriers and biases as well as organization and service designs that reflect the actual past-to-present experiences of these groups.
Family engagement refers to the systematic inclusion of families in programs that promote children’s development and wellness including the planning, development, and evaluation of program services. In family-centered programs, traditional parental roles as program helpers are transformed into creative roles in which families partner with staff to establish goals and make decisions related to the programs. Through active and dynamic forms of family engagement, families share power and responsibility with program staff which leads to improved parent/guardian-child and parent/guardian-program relationships, resulting in improved program efficacy.
Referrals & Partnerships
As different functions of human services become fragmented or siloed into distinct service categories, families are falling through the cracks of the system because the connections between services are either absent or problematic, or needed services are missing all together. As a result, direct service providers are encouraged to coordinate their services with one another under the assumption that collaborative activity can facilitate access to services, reduce unnecessary duplication of effort, and produce a more effective and efficient social service system. Direct service providers that make effective referrals across programs and systems in the community can contribute significantly to meeting existing and projected needs in their communities.
Staff Support & Performance
Staff support is a critical component of organizational and program performance. When staff members feel supported professionally, personally and financially by their organization, they are better prepared and more motivated to perform and excel in their roles. Staff turnover, burnout, and lack of adequate support negatively impact service quality and a program’s ability to achieve its outcomes. Organizations and programs with strong staff support and performance practices prioritize staff supervision, development, and retention initiatives within the organization, as well as provide cultural competency training, with the aim of ensuring that staff have the support and preparation they need to deliver quality services.
Research shows that families, especially children, may experience trauma from economic struggles, lack of food, housing instability, and other life challenges. A program that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization. This approach should be implemented in any type of service setting and is distinct from trauma-specific interventions or treatments designed specifically to address the consequences of trauma and to facilitate healing.
Use of Evidence
There is a growing movement around using evidence of effectiveness to spread what works and to avoid what does not work, thereby maximizing results from limited resources and increasing impact on people’s lives. This includes reviewing the best available research evidence that already exists in your field, increasing the evidence of effectiveness for your organization’s own work, and incorporating best practices.
Program measurement refers to a program’s ability to use data to understand its performance and make adjustments to improve performance. This means having the skills sets, organizational culture, systems, and process in place to collect, analyze, and report on data about participants, quality of services and outcomes, and make decisions based on the data. Three types of performance measurement capacity include:
Successful measurement, learning, and improvement begins with a program’s senior leadership and board prioritizing and embedding it within the program’s culture. Guiding this commitment is clarity on the program’s primary objectives and motivation for its measurement efforts and the learning questions it seeks to answer.
A clearly articulated hypothesis is essential to anchor a program’s performance measurement efforts by defining what will be measured and why. A program’s hypothesis should rest on sound logic and clear assumptions explaining how and why its activities address a need and produce the outcomes it aims to achieve.
A strong measurement system helps to ensure that performance data is readily available and used to support continuous improvement and to report out to key stakeholders. Measurement systems include staff time, processes, and tools to collect, store, analyze, report, and learn from performance data on an ongoing basis.
CQI Process for Social Service Programs
Root Cause partners with public and nonprofit organizations to strengthen the capacity of social service programs to practice continuous quality improvement. Using Root Cause’s approach, programs work with their CQI coaches to take the following steps.
1. Lay the Groundwork
The path to practicing continuous quality improvement starts with a clear vision of what quality looks like and an understanding of how a program works.
2. Assess Program Strengths and Challenges
3. Set Improvement Cycle Priorities
Root Cause coaches review CQI Assessment results with program staff and together they identify opportunities for strengthening their practice.
4. Plan / Do / Study / Act (Repeat)
Root Cause coaches and supports program leaders and staff in implementing Continuous Quality Improvement cycles to that strengthen program capacity in priority areas. The cycle follows a Plan / Do / Study / Act (PDSA) model and can be repeated as often as the program chooses to focus on various areas of the CQI Assessment.
5. Strengthen Capacity and Culture
Programs retake the assessment to gauge how their capacity has improved after an appropriate amount of time has passed since PDSA cycles have been completed. Successfully building and sustaining a CQI practice depends on creating a culture that fosters learning and a spirit of inquiry. Programs that excel collect and use data in ways that go beyond compliance with funder requirements or other external performance standards, and create time and space for staff to develop skills that support CQI practices.