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2/18/2015
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Leadership and CQI Systems
Peter WatsonFebruary 25, 2015
CQI System vs. CQI Process
CQI systems are complex and require:•Sustained leadership•Engagement with multiple stakeholders•Willingness to adapt over time
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What is your CQI Framework?
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How Do You Create a CQI System?
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•Why do you want to create one?
•Who should be involved?
•What elements do you have in place already?
•Where do you need to prioritize?
What are Other Jurisdictions Doing?•CQI system assessments
•Engaging more staff and stakeholders in CQI
•Reconsidering case review approaches•E.g. use of CFSR process in CA
•Linking data from multiple sources
•Building data analysis skills at all levels•Focusing on action planning
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Turn Pressure into OpportunityAdvice from Minnesota and Oklahoma:
•Step back to assess and improve your CQI system
•Target resources to CQI and move agency into “learning/assessment” mode
•Daily question: “What can we learn from this?”
•Lesson: viewing CQI as an organizational shift may be LESS overwhelming than trying to implement a series of technical components
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Leadership vs. Authority•You are “given” authority•People want Direction, Protection and Order•You “exercise” leadership when you step outside the boundaries of your authority
•Leadership is necessary to create CQI systems
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What are Your Pressures?•What pressures are you experiencing to implement CQI systems or elements?
•How might different pressures within your county teams impact your work together?
•May need to consider these more carefully to make progress
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Lessons learned from State CQI Assessments
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NRCOI’s CQI System Assessment Process
•Child Welfare Matters issue has details•Pre‐work: interviews, surveys, review current system elements, identify meeting participants
•Assessment meetings include frequent brainstorming, voting, and action planning
•Post‐meeting action plan refinement with additional staff and stakeholders
•Meetings mirror CQI action planning process
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Lesson 1: Use Data to Inform CQI System Development Efforts
•Ask staff and stakeholders about your current CQI system or CQI components
•Use interviews, focus groups or surveys•Analyze the results and use them during CQI assessment meetings
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State “A” CQI Survey Results• Survey results informed CQI Assessment meeting•32 staff completed the survey: 12 county staff; 16 State Home Office Employees, 2 State regional employees, 2 stakeholders.
• Five‐point scale: strongly disagree through neutral and strongly agree.
• Slides show percent that agreed or strongly agreed with each statement and split out County and Home Office staff.
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State A: Focus on Results
87.180.6
59.4
40.6
91.7 91.7
83.3
53.8
81.3
66.7
43.8
25
0
10
20
30
40
50
60
70
80
90
100
Based on available data, I know whichchild and family outcomes are strong
and which are weaker.
I have a way of sharing my ideas toimprove practices, policies or results
for children and families.
I feel empowered to try differentstrategies that might improve
outcomes for children and families.
Everyone in my organization hasleadership responsibilities to ensure
high quality services.
All Respondents County State Home Office
Overall Average
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State A: Shared Leadership/Vision
38.7
62.5
28.6
4041.7
83.3
20 16.7
31.3
56.3
33.3
60
0
10
20
30
40
50
60
70
80
90
Continuous Quality Improvement is a sincere effort and priority at the state
level – not just talk.
State leadership is interested inhearing my ideas about how we mightimprove practices, policies or results.
State leadership would agree with myideas for improvement.
Others in my position would agree withmy ideas for improvement.
All County State Home Office
Overall Average
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Learning is Shared Throughout State A
32.3
40.6
74.2
60.7
45.5
25
66.7
41.7
25
43.8
75 76.9
0
10
20
30
40
50
60
70
80
90
We share learning across and withinState, among Counties and with other
stakeholders.
We work as a team in the State tounderstand and improve outcomes for
children and families.
The role of the state is to monitorCounty performance and achievement
of outcomes.
The Couinties have the capacity toreview and use performance data todevelop and implement program
improvements
ALL County Home Office
Overall Average
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State “B” Survey Results
•Results used to inform CQI Assessment meeting•34 staff completed the survey: 16 Executive and Central Office staff and 18 Regional Managers
•Survey had nine‐point scale from disagree through neutral to agree
•Slides show average rating by Central and Regional staff OR percent that agreed to strongly agreed with each statement
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State B: Differences between Executive Staff and Regional Managers
5.83
6.44
5.13
3.88
4.44
5.28
3.41
5.94
0
1
2
3
4
5
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The data presentation and meetingfostered a learning climate
When I have ideas for improving agencyresults, I have a way of regularly sharing
these ideas.
I have the reports I need to manage mywork
In the past six months, I have used QSRresults to identfy practice strengths or
issues
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Lesson 2: Develop Clear CQI Vision
•CQI is more than just a set of activities
•Develop CQI vision with your stakeholders by posing questions:•What are we trying to achieve with CQI?• If CQI were working optimally, what would you see (e.g., differences in your work, the work of others, stakeholder responses)?
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Sample Participant Vision Statements•We will see measurable and sustained improvement in outcomes
• Practice will be more consistent and counties will share practice knowledge
•Our CQI Unit will be more responsive to the field
• Both qualitative and quantitative data will be utilized for learning that results in action planning and follow‐through
• The agency will transform into a learning organization that is reflective, progressive, flexible and action‐focused
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Lesson 3: Turn Data Into “Information”•Create common understanding to spark discussions and inform action planning
•Review data regularly and share broadly•Train CQI staff to prepare, present and facilitate the use of data from different sources
•Working paper on this topic: http://www.nrcoi.org/rcpdfs/CQIdataintoinformation.pdf
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Lesson 4: Support Action Planning•Move beyond just collecting and analyzing data•Set expectations AND support efforts to use data to adjust practices and systems
•Actively engage stakeholders in action planning•Start with small, doable experiments rather than grand solutions
•Follow up and adjust!•Model action planning during CQI assessments
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S
U
P
P
O
R
TA C T I O N P L A N N I N G !
Supporting Improvement in State A
42.6
62.1
51.9
70.466.7 66.7
50
75
21.4
61.5
54.5
75
0
10
20
30
40
50
60
70
80
State has a process in place to developaction plans and use them to improveoutcomes for children and families.
In my experience, improvement effortshave successfully resulted in improved
programs or practices.
In my experience, improvement effortshave successfully resulted in improved
family and child outcomes.
The "roundtable" approach would bean effective forum or method forexpanding CQI to the County
All County Home Office
Overall Average
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Using Data to Support Change in State B
82.476.5
56.6 54.650
44.1
0
10
20
30
40
50
60
70
80
90
In the past month, I haveused data to identify
trends
In the past month, I haveobserved a colleague usedata to identify trends.
We develop action plansthat result in
improvements to State'sprograms
In the past six months, Ihave observed peers use
QSR results
In the past six months, Ihave used QSR results toidentfy practice strengths
or issues
State has a process inplace to develop actionplans and use them toimprove outcomes.
Overall Average
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Lesson 5: Implementing CQI is a Challenge•Struggles to implement CQI Action Plans
•Perception that CQI conflicts with other priorities•Build relationships across the organization to strengthen credibility
•Prepare to be in “learning” mode throughout implementation to lessen frustrations when change is continuously required…flexibility is an absolute must!
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The Eureka Moment
CQI Should Help Promote Insight
“You’ve got to know when to step back. If you’re in an environment that forces you to produce and produce, and you feel very stressed, then you’re not going to have any insights.” John Kounious, Cognitive Neuroscientist at Drexel University (p.44, New Yorker article)
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CQI Should Help Promote Insight•CQI not just a technical approach•Create an environment where staff and stakeholders can make connections and try new approaches
•“The Eureka Hunt,” by Jonah Lehrer The New Yorker, July 28, 2008.
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Please Contact Me With Questions
Peter Watson
207‐228‐8330 (o)
207‐632‐0892 (m)
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