Building and Maintaining a Sustainable CQI Process

1
Building and Maintaining a Sustainable CQI
Process

• Joan Nelson Phillips MSW
• Peter Watson MPP

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Workshop Objectives

• Through the workshop, participants will
• Understand some of the core CQI building blocks
  for creating a sustainable system
• Review illustrative examples from Illinois and
  other public child welfare systems
• Develop some ideas for moving forward with CQI in
  their own agencies

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Illinois CQI One States Perspective

• Implemented in 1997 Still going strong
• Key elements
• Active agency staff participation in Peer Record
  Review and other review activities
• Ongoing assessment of consumer satisfaction and
  risk management
• Use of evaluative data to support programmatic
  improvements
• Key participants
• Agency Staff from all levels and divisions
• Stakeholders foster parents, youth, private
  child welfare agency providers, and birth parents
  via existing advisory councils

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Illinois CQI One States Perspective

• CQI Structural Components
• Regional, and Local field office QI Councils that
  meet monthly
• Statewide Quality Council that meets quarterly
• Regional PIP workgroups (State agency and private
  child welfare providers) that meet quarterly
• Use of tracking mechanisms that ensure progress
  is made in achieving performance goals

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CQI in Illinois Evolving over Time
Perf. Contracting data introduced to CQI process
Regional CQI Councils est.
Regional PIP Workgroups est.
Statewide CQI Council est.
OER process Imp.
Local CQI teams est.
Peer Review Imp.
???
2007
1998
2000
2009
1997
2004
2003 Illinois CFSR
Whats driving these changes???

• Changes in leadership agency mission
• Greater caseworker/supervisor involvement

• Public/Private CW Agency Collaboration
• Outcome (CFSR) focused problem solving

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CQI in Child Welfare A National Perspective

• Changes in the Child Welfare communitys
  commitment to CQI over the past decade
• Focus on outcomes
• CFSR process and PIP focus on systemic changes
• Accreditation
• Lawsuits and settlement agreements
• Increasing complexity of casework and human
  service systems

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CQI in Child Welfare A National Perspective

• Key CQI functions
• Identify data/information that are consistent
  with agency mission practice
• Gather data/information
• Analyze data/information
• USE results to bring about change!

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One Potential CQI Model
Practice
Practice
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Making CQI Sustainable

• Connect CQI to the bigger picture of what your
  agency is trying to accomplish
• Organize case practice around mission, vision and
  values
• Support agency leadership priorities through CQI
• Assess CQI processes for relevance to the big
  picture eliminate those not targeted
• Integrate CQI with other key systems (e.g.,
  Training, HR, Service Array)

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Making CQI Sustainable

• Management investment/leadership in the CQI
  process is critical
• Management must lead by example to ensure
  buy-in
• Sometimes a top-down approach helps to
  reemphasize central themes and programmatic
  performance goals

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Making CQI Sustainable

• CQI must be grounded in a strong, broader model
  of QA in an agency
• Need access to reliable data and information
• Need to have solid accountability standards
• Need for a quality continuum some compliance
  monitoring still may be critical
• Should reinforce and help sustain practices over
  time that support improved outcomes

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Making CQI Sustainable

• There must be a clear vision and explicit plan
  for CQI
• Have long-term goals for CQI that are linked to
  agency vision and to practice
• Also have flexible, short-term strategies
• What needs to measured, monitored, reinforced?
• Create a solid CQI organizational structure (your
  CQI house) and be prepared to modify it over
  time

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Decisions Decisions Decisions What type of
structure does your agency CQI model need? (Hint
One size does NOT fit all!)
What do you put in first?
Your roof?
Walls/Structure?
Foundation?
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The Illinois CQI House 2002
Statewide Quality Council
What do you put in first?
Your roof?
Illinois DCFS CQI Structure
RQC C/N
RQC Northern
RQC Central
RQC C/C
RQC Southern
RQC C/S
Walls/Structure?
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
SQC
Foundation?
Local Quality Teams
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The Illinois CQI Compound2009
Statewide POS Quality Council
DCFS
Statewide PIP Committee
POS Regional Quality Councils
Stakeholder Advisory Councils
Statewide Quality Council
DCFS POS
POS
DCFS Regional Quality Councils
Individual POS agency internal QA/QI Systems
Regional PIP Workgroups
Site Clusters
Local QI Teams
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Making CQI Sustainable

• Consider existing organizational structures and
  resources
• Use data and information from a variety of
  sources
• Remember the goal is to provide targeted
  information and use it to make improvements (not
  just to sustain multiple processes indefinitely)

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Making CQI Sustainable

• Plan to invest in infrastructure to support CQI
  (its necessary and worth it!)
• Youll need sufficient staff to support the CQI
  process
• Training (initial and ongoing) for CQI staff

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Making CQI Sustainable

• Provide responsive, understandable and targeted
  CQI reports
• Too many systems produce an overabundance of data
  and information
• Narrow CQI reports to focus on core practices and
  critical outcomes
• Use CQI staff to support the understanding and
  use of data/reports throughout your organization
• Remember - Be flexible!

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Putting Down CQI Roots it takes time

• Engage staff and stakeholders in the CQI process
  and build genuine support in your agency over
  time
• Staff are generally more invested in using
  information they themselves helped to gather
• CQI Committees need to be tasked with using
  data/results to actually generate programmatic
  improvements

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Putting Down CQI Roots it takes time

• Be prepared to also address/resolve basic aspects
  of day to day work through CQI
• Sustainability Growth Provide opportunities
  for those invested in your CQI process to become
  active in other professional review activities
  (e.g. COA, CFSR)

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Putting Down CQI Roots it takes time

• I have so much enjoyed working with the QI
  Process over the years. We have accomplished much
  and have come so far. Way backwe embarked on a
  wonderful journey together.  That Summit brought
  all of us, workers and management, together at
  the table discussing how to improve our work and
  how to do it together. I will never forget the
  exhilaration that I felt after those two days
  together. We have worked to build the House of
  QI. We have a wonderfully sound foundation, and
  have moved forward with new projects.
• Email message from retiring Illinois
  caseworker, 2009

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Getting Started

• Is your CQI system connected to the agencys
  bigger picture and goals?
• Is your leadership invested in CQI?
• Do you have a strong, broad QA model?
• Do you have a clear and explicit CQI plan?

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Getting Started

• Does your CQI organizational structure support
  your goals and overall plan?
• Do you have sufficient CQI infrastructure?
• Does your CQI system provide responsive,
  understandable and targeted reports?
• How are staff and stakeholders involved in your
  CQI system?

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Contact Information

• Peter Watson
• 207-228-8330 (office) 207-632-0892 (mobile)
• pwatson_at_usm.maine.edu
• Joan Nelson-Phillips
• 312-814-5527
• Joan.Nelson-Phillips_at_illinois.gov