building and maintaining a sustainable cqi process

Building and Maintaining a Building and Maintaining a Sustainable Sustainable CQI ProcessCQI Process

Peter Watson MPPPeter Watson MPPJerry Milner DSWJerry Milner DSW

Joan Nelson Phillips MSWJoan Nelson Phillips MSW

Workshop ObjectivesWorkshop Objectives

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

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Illinois CQI Illinois CQI –– One StateOne State’’s s PerspectivePerspective

Implemented in 1997 Implemented in 1997 –– Still going strongStill going strongKey elements: Key elements: –– Active agency staff participation in Peer Record Review Active agency staff participation in Peer Record Review

and other review activitiesand other review activities–– Ongoing assessment of consumer satisfaction and risk Ongoing assessment of consumer satisfaction and risk

managementmanagement–– Use of evaluative data to support programmatic Use of evaluative data to support programmatic

improvementsimprovements

Key participants:Key participants:–– Agency Staff from all levels and divisionsAgency Staff from all levels and divisions–– Stakeholders Stakeholders –– foster parents, youth, private child foster parents, youth, private child

welfare agency providers, and birth parents via existing welfare agency providers, and birth parents via existing advisory councilsadvisory councils

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CQI Structural Components:CQI Structural Components:–– Regional, and Local field office QI Councils Regional, and Local field office QI Councils

that meet monthlythat meet monthly–– Statewide Quality Council that meets quarterlyStatewide Quality Council that meets quarterly–– Regional PIP workgroups (State agency and Regional PIP workgroups (State agency and

private child welfare providers) that meet private child welfare providers) that meet quarterlyquarterly

–– Use of tracking mechanisms that ensure Use of tracking mechanisms that ensure progress is made in achieving performance progress is made in achieving performance goalsgoals

Illinois CQI Illinois CQI –– One StateOne State’’s s PerspectivePerspective

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CQI in Illinois CQI in Illinois –– Evolving Evolving over Timeover Time

1997

Regio

nal C

QI

Coun

cils e

st.Pe

er R

eview

Imp.

1998

Loca

l CQI

team

s est.

Stat

ewide

CQI

Coun

cil e

st.

2000

2003 Illinois CFSR

What’s driving these changes???

OER

proc

ess I

mp.

Regi

onal P

IP

Wor

kgro

ups

est.

2004

Perf.

Con

tract

ing

data

intro

duce

d

to C

QI p

roce

ss

2007

???

2009

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 WelfareCQI in Child WelfareA National PerspectiveA National Perspective

Changes in the Child Welfare communityChanges in the Child Welfare community’’s s commitment to CQI over the past decadecommitment to CQI over the past decade–– Focus on outcomesFocus on outcomes–– CFSR process and PIP focus on systemic changesCFSR process and PIP focus on systemic changes–– AccreditationAccreditation–– Lawsuits and settlement agreementsLawsuits and settlement agreements–– Increasing complexity of casework and human Increasing complexity of casework and human

service systemsservice systems

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CQI in Child WelfareCQI in Child WelfareA National PerspectiveA National Perspective

Key CQI functions:Key CQI functions:–– Identify data/information that are consistent with Identify data/information that are consistent with

agency mission & practiceagency mission & practice–– Gather data/informationGather data/information–– Analyze data/informationAnalyze data/information–– USE results to bring about change!USE results to bring about change!

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One Potential CQI ModelOne Potential CQI Model

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PracticePractice

Making CQI SustainableMaking CQI Sustainable

Connect CQI to the bigger picture of what Connect CQI to the bigger picture of what your agency is trying to accomplishyour agency is trying to accomplish–– Organize case practice around mission, vision Organize case practice around mission, vision

and valuesand values–– Support agency leadership priorities through CQISupport agency leadership priorities through CQI–– Assess CQI processes for relevance to the Assess CQI processes for relevance to the ““big big

picturepicture”” & eliminate those not targeted& eliminate those not targeted–– Integrate CQI with other key systems (e.g., Integrate CQI with other key systems (e.g.,

Training, HR, Service Array)Training, HR, Service Array)

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Management investment/leadership in the Management investment/leadership in the CQI process is criticalCQI process is critical–– Management must lead by example to ensure Management must lead by example to ensure

““buybuy--inin””–– Sometimes a topSometimes a top--down approach helps to down approach helps to

reemphasize central themes and programmatic reemphasize central themes and programmatic performance goalsperformance goals

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CQI must be grounded in a strong, CQI must be grounded in a strong, broader model of QA in an agencybroader model of QA in an agency–– Need access to reliable data and informationNeed access to reliable data and information–– Need to have solid accountability standardsNeed to have solid accountability standards–– Need for a Need for a ““quality continuumquality continuum”” –– some some

compliance monitoring still may be criticalcompliance monitoring still may be critical–– Should reinforce and help sustain practices Should reinforce and help sustain practices

over time that support improved outcomesover time that support improved outcomes

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There must be a clear vision and explicit plan There must be a clear vision and explicit plan for CQIfor CQI–– Have longHave long--term goals for CQI that are linked to term goals for CQI that are linked to

agency vision and to practiceagency vision and to practice–– Also have flexible, shortAlso have flexible, short--term strategiesterm strategies–– What needs to measured, monitored, reinforced?What needs to measured, monitored, reinforced?

Create a solid CQI organizational structure Create a solid CQI organizational structure (your CQI (your CQI ““househouse””) and be prepared to ) and be prepared to modify it over timemodify 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!)

Your roof?

Walls/Structure?

What do you put in first?

Foun

datio

n?

The Illinois CQI House 2002

Local Quality Teams

RQCC/N

RQCNorthern

StatewideQuality Council

RQCCentral

RQCC/C

RQCSouthern

RQCC/S

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

Your roof?

Walls/Structure?

What do you put in first?

Foun

datio

n?

Illinois DCFS CQI Structure

Statewide Quality Council

DCFS Regional Quality Councils

Site Clusters

Local QI Teams

Statewide PIP Committee

Regional PIP Workgroups

Statewide POS Quality Council

POS Regional Quality Councils

Individual POS agency internal QA/QI Systems

DCFS

The Illinois CQI Compound2009

DCFS & POS POS

Stakeholder Advisory Councils


Consider existing organizational structures Consider existing organizational structures and resourcesand resources–– Use data and information from a variety of Use data and information from a variety of

sourcessources–– Remember the goal is to provide targeted Remember the goal is to provide targeted

information and use it to make improvements information and use it to make improvements (not just to sustain multiple processes (not just to sustain multiple processes indefinitely)indefinitely)

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Plan to invest in infrastructure to support Plan to invest in infrastructure to support CQI (itCQI (it’’s necessary and worth it!)s necessary and worth it!)–– YouYou’’ll need sufficient staff to support the CQI ll need sufficient staff to support the CQI

processprocess–– Training (initial and ongoing) for CQI staffTraining (initial and ongoing) for CQI staff

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Provide responsive, understandable and Provide responsive, understandable and targeted CQI reports:targeted CQI reports:–– Too many systems produce an overabundance Too many systems produce an overabundance

of data and informationof data and information–– Narrow CQI reports to focus on core practices Narrow CQI reports to focus on core practices

and critical outcomesand critical outcomes–– Use CQI staff to support the understanding Use CQI staff to support the understanding

and use of data/reports throughout your and use of data/reports throughout your organizationorganization

–– Remember Remember -- Be flexible!Be flexible!

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

Putting Down CQI Putting Down CQI Roots Roots –– it takes time it takes time ……

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


2020

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

Email message from retiring Illinois caseworker, 2009Email message from retiring Illinois caseworker, 2009


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Getting Started Getting Started ……

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

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Getting Started Getting Started ……

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

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Contact InformationContact InformationPeter WatsonPeter Watson207207--228228--8330 (office) 2078330 (office) 207--632632--0892 (mobile)0892 (mobile)[email protected]@usm.maine.edu

Jerry MilnerJerry [email protected]@csfmail.org

Joan NelsonJoan Nelson--PhillipsPhillips312312--814814--5527 5527 [email protected]@illinois.gov

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building and maintaining a sustainable cqi process

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