Developing a quality improvement system is no easy feat. It takes patience, creativity, vision and a fine eye for detail (oh, and did I mention lots and lots of coffee?). Getting started can seem daunting, but it doesn’t have to be so scary. With every major project comes challenges, some of which you didn’t see coming, and that’s all part of what ultimately makes it so rewarding. However, there are some common barriers that keep organizations from staying on track with developing (or significantly revising), their quality improvement system.
1. Differing visions: Compliance vs. quality improvement
A shared, clear vision of what QI means internally is critical. Is your organization solely focused on meeting licensing, funding, and regulatory body requirements, or is it determined to delve deeper to strengthen its practices on a continuous basis? It’s the difference between being compliance-driven and quality-driven. The Health Care Compliance Association defines compliance as “systematic procedures instituted by an organization to ensure that the provisions of the regulations imposed by government agencies are being met.” The operative word here is imposed – the organization is guided by deliverables set by an outside entity. Quality improvement includes aspects of compliance. Joseph DeFeo, author of Juran’s Quality Handbook, views quality improvement as being of “exceptionally high quality, defined only in terms of the organization’s internal standards.” Both compliance and quality improvement are connected to the same end user – the client — but success is defined in different ways.
A quality-driven organization begins with quality-driven leadership. Leadership is responsible for creating a culture of improvement guided by factors beyond the expectations of external entities, and they need to be significantly motivated by internal targets/goals. This requires that leadership embrace transparency, and not disregard information that may cast certain aspects of the organization in an unflattering light. Exposing organizational weaknesses is fundamental to improvement, and leadership needs to be straightforward about it early on as they develop and commit to a definition of QI that will lay the foundation for the work ahead.
2. “We have plenty of time!”
Building a QI system takes time, so it’s better to err on the side of caution and give yourself a lot of it. True, time isn’t always on our side, and often those who oversee QI activities do so on top of other responsibilities. Don’t let time be the enemy; start early, and begin by educating staff on all the moving parts that comprise a quality improvement program. This way they’ll understand why you’re starting twelve months in advance rather than three months prior to the target implementation date.
There are two major phases in this process: planning and implementing. In the planning phase, you need time to develop a work plan, meet with all programs and administrative departments to brainstorm metrics, create procedures, and put all the pieces together. Take into account that brainstorming sessions will likely take place over the span of several meetings. The implementation phase includes collecting, analyzing and reporting data, and meeting with different forums to discuss the information. These exercises shouldn’t be rushed, and may take significant time to complete.
In the implementation phase, it’s important to obtain staff feedback on data reports and analyses to ensure the information is clear, beneficial and useful. To get perspective and efficiently address barriers in the way of advancing your QI system, schedule on-going meetings with departments and programs to get their perspectives on pieces that do and don’t work.
3. Neglecting the power of cheerleaders
The cheerleaders are your champions – those who have informal and/or formal influence within the organization and can push the PQI agenda forward. Your cheerleaders understand the value of quality improvement and can explain its significance to other staff. They provide guidance and foster a culture of improvement by creating spaces for staff to get excited about data. How is this done? Adding QI to meeting agendas, providing additional context to data reports, or exploring obstacles to using data with staff.
Cheerleaders also support QI coordinators by offering tips on how to get certain busy individuals to meet their QI deliverables, or help determine when a task needs to be postponed or expedited. To implement quality improvement, you need eyes and ears on the ground to ascertain the organizational climate as the initiative is rolled out. Establishing a quality improvement system can have its challenges, especially when unforeseen hiccups occur. Champions can help you strategize how to achieve objectives and deal with underlying issues as they arise.
How do you know who your champions are? Meet QI cheerleaders, Nancy and Jesse…
Nancy, the chief operating officer, has oversight of the QI department at the organization. While the role of managing the agency’s QI system has been delegated to the QI coordinator, Nancy receives weekly updates on progress of the QI initiative. When she is informed that directors have been unresponsive to emails and meeting requests, in the next director’s meeting, she makes QI an agenda item to discuss the importance of the initiative and allow an open dialogue for questions and concerns.
Jesse, the office manager, has a warm and outgoing personality. He welcomes all clients and staff who enter the building with a smile. With his friendly demeanor and passion for helping others, Jesse knows most of the staff. He is just the person to bring excitement and energy to the PQI initiative. While he may not know all the ins and outs of QI processes, he is eager to learn and appreciates the benefits the work will bring. He asks many process-related questions about PQI strategies in the meetings that helps the team strengthen procedures and clarify responsibilities.
4. “Let’s skip the basics.”
Compartmentalize! Compartmentalize! Compartmentalize! Oh, and did I mention you should compartmentalize? Patience is key in the planning phase, but slow and steady wins the race. It’s important to start small so everyone is on the same page. You might have colleagues who are eager to start data collection and try to skip over important preparation steps, or those who want to focus on high level outcomes without first getting a solid foundation for the basics. Slow them down! Looking at basic output data may not be super exciting, but when developing a formal system, you want staff to understand (and follow) the process just as much as you want to be able to make inferences about the data generated. Data that supports what staff know anecdotally through program experience and data that contradicts it are both equally important. This is what makes an organization data-informed.
Meeting with programs to determine what indicators will be used to measure the impact of services on clients, also known as client outcomes, is an important step in developing your QI system. Once leadership approves the QI program, it’s easy to assume that all staff are on the same page in how QI is perceived and understood. This is not always the case, and it’s helpful to be prepared. Your colleagues may be confused, annoyed, excited, or anxious, about what needs to happen. You may need to train program directors, managers and staff about what QI means to the organization before you can explore the possibilities for outcomes.
Ideas for training? Provide context by talking about the history and how the organization has gotten to this point with its QI efforts. Make the training fun and encourage creative thinking with games or trivia. Use your cheerleaders to get others excited. Even if there is a desire for QI, there may be a gap in knowledge and skill that needs to be addressed. Provide clarity on the objectives to be accomplished and define key terms so that everyone is clear on the tasks and expectations. Share resources on data analytics, embracing change, and outcome measurement with colleagues so they may continually learn and challenge one another.
The end goal is to develop a quality improvement system that provides a framework to use data to support decision-making and enhance practices. The culmination of all this hard work is an organization that is able to transform data into knowledge, and strengthen its practices to better meet the needs of its stakeholders. Remember, improving practices does not mean they were inadequate before. It is using a platform to evaluate organizational performance in a thoughtfully planned manner.
When beginning the accreditation process – specifically the completion of the Self-Study – one of the most intimidating challenges can be trying to figure out how to organize the work and delegate it to your staff. You don’t need a certificate in project management to accomplish this task (although having one won’t hurt!). What you do need is prep time, focus, and a solid understanding of what’s expected.
This post will discuss how to form effective workgroups that can assist your organization with completing the necessary work in order to achieve accreditation – and hopefully improve your organization’s operations as well. Now let’s get started.
When talking with organizations in COA’s network, we see a variety of types of workgroups. Some small organizations do not form new workgroups; they simply utilize a currently existing structure to fill the role. On the other hand, large organizations may develop multiple workgroups that focus on different aspects of the Self-Study. Only the organization can determine what the best model is going to be, but we can certainly explore some basic characteristics.
According to Kozlowski, S. W. J., & Bell, B. S. (2013), workgroups have the following qualities:
- They consist of two or more people
- Their participants are part of the same organization
- They have a common goal
- Their tasks are completed together and individually
- They involve social interaction
- They retain boundaries established by the organization
- They are part of the culture of the organization
One is the loneliest number
If your workgroup only consists of you thenyou should probably revisit your plan to achieve accreditation. Even for small organizations, all levels of staff should be involved in some way. There are multiple benefits to involving many people. First off, staff will have a better understanding of the importance of accreditation if they are embedded in the process. If the process is presented to them in a positive way then they can take ownership. A common question is “how can you present accreditation to staff in a positive way?” While it’s difficult to imagine how anyone can view accreditation in a negative light, talk with your staff – particularly those that you want to engage in workgroups – and bring the focus to achieving client outcomes. The purpose of accreditation is to improve outcomes for those that receive your services. Every action that takes place in accreditation should be tied to the end user: the consumer.
Another way that staff can buy-in to participating in a workgroup is to view it as a professional development opportunity. In fact, you would be remiss if you didn’t. Think about your shining case managers, clinicians, administrative assistants, residential managers, and foster care workers who have impeccable paperwork, organized with to-do lists, and always volunteer for new projects. Working on COA-related activities can improve their administrative and leadership skills, expand their knowledge of social service management, and program development.
“Every action that takes place in accreditation should be tied to the end user: the consumer.”
A chance for collaboration!
Another commonality in workgroups is that they are all part of the same organization. Note that it’s within the organization, but not necessarily within the same department, division, or satellite office. Workgroups foster cross-departmental collaboration. For example, let’s say that you are going to create a workgroup that focuses solely on drafting and reviewing procedures for the organization. For medium-large organizations, having this type of committee helps ensure that there is consistency across the organization, standards are still being met, and duplications are avoided. Including staff from different departments and different levels can provide different perspectives. Perhaps a member of management reviews a procedure and thinks “wow, this is great and will really help improve the reliability of our data.” Then a member of the direct service staff, who is also part of this committee, reviews the same procedure. She may have a comment such as “the intent of this procedure is spot-on, but the ability to put this in practice is unrealistic.” What’s better than a well written procedure? – A procedure that is actually practical. Having a diverse group of individuals within your organization as part of the accreditation workgroup is essential to change that is effective.
Find common ground
Common goals are an essential characteristic of workgroups. Having common goals relates to proper planning. If you establishing one committee or 3 committees to complete the work, there needs to be a goal that is achievable. You may think, “The goal is to get accredited.” Good point, that is the goal, but that’s the goal of the entire organization; not of the workgroup. The workgroup’s goal may be to establish a working PQI system, assess current practices to COA standards, or assemble the Self-Study. The goal of each workgroup will clearly delineate its role in completing the larger mission: achieving accreditation – and as we discussed earlier - to improve outcomes for consumers.
To further break down the goal, we need to identify specific tasks that support the actual completion of the workgroup’s goal. Planning, again, comes into play. Recognizing that planning is not everyone’s strong suit, there are some resources out there to assist. While COA doesn’t endorse any specific resource, we do find these helpful. Meister Task is an efficient task management application that can be used to organize individual tasks as well as collaborative tasks. Consistent with our definition of workgroups, there are both individual tasks and tasks that people must work on together. This web application can help support and provide structure to both. Another great application is Wunderlist. It provides some of the same functionality with a different style. If you are not quite ready for that level of organization and need some foundational support, try reading Getting Things Done: The Art of Stress-Free Productivity by David Allen. It’s an easy read that will help you organize your life, as well as your accreditation work. Remember, if you do utilize any of these resources, it’s recommended to take a full day to sit back and focus on implementing these systems for your work.
Assigning the work
However you handle the workload, a workgroup has tasks that are completed individually and some that are completed by more than one person or a subgroup of the committee. When tasks of the workgroup are being assigned to its members you will want to consider the strengths and weaknesses of each member. Initially, it may be your gut reaction to assign tasks that are good matches to individuals’ strengths; however, also consider matching someone’s weakness to a task to help them further develop. Perhaps pairing that person with someone who does have more experience can be a great learning opportunity. Make the most out of your accreditation experience and use it to support a positive learning environment. Maybe you can even develop mentorships within your staff, with the accreditation work as the central theme.
Involve social interaction, have you ever tried to hold a committee without social interaction? Typically that’s an email with directives to everyone involved with no discussion. Sometimes effective; most of the time not. At the beginning of the process of forming your workgroups, you will be concurrently developing the buy-in of the workgroup members. Meeting in-person, with sugary treats, that typically helps (personal favorite: Insomnia Cookies). If you can’t have fresh cookies delivered, consider holding the meeting outside of your organization, at least for the first time. Use this common goal, develop strong collegial bonds that last past COA Accreditation. And finally, manage your meeting efficiently. Here are some tips from Mindtools.com.
Introducing accreditation to your culture
Maintaining boundaries that are consistent within the organization may be a little bit more challenging for an accreditation workgroup. The group may be perceived by others in the organization as closed-off or working on something has nothing to do with the rest of the staff. One remedy for this perception is to provide communication about the status of the workgroup throughout the process to the rest of the organization. The workgroup is not charged with setting completely new and rigid policy, determining who at the organization is underperforming, or planning a coup d’état. Transparency is key, solicit feedback from staff who may not be directly involved. Always ask for volunteers, although don’t expect a waitlist. The accreditation workgroup is not a clique; it is a model for how people work as a team to achieve a seemingly insurmountable task.
Lastly, it is important to maintain key components of the organization’s culture. You can expect shifts, bumps and slides during the process, but the core of your organization will grow stronger. Your culture is the cornerstone of stability for your staff, who spend 40 hours of their lives there each week. It is a safe place for consumers whose lives you change. It is part of the connective tissue that holds your community together. Change may be inevitable but the culture of your organization is the reason for your continued success.
Share your tips!
What tips do you have for developing a strong workgroup or sustaining it once it is in place? Please leave a comment below and help others learn from your experiences.