1. Continuous
Quality
Improvement
Learning Contract
Management & Planning II
Sue Roh
4/28/2014

2. Continuous Quality
Improvement/CQI

3. Contract Activity 1: How does CQI fit into DHS’s IOC initiative?
IOC Framework
 Single Case Management provided
by CUAs to promote consistency
and accountability
 DHS Safety Model of Practice
applied to all service home settings
 Family-Centered Services to ensure
continuous focus on maintaining
family and individual integrity
 Community Engagement where
child welfare services are enmeshed
in the specific community served
 Family Team Decision Model
applied to the entire case process
where the family, service providers,
and system partners are included in
case planning activities,
(Department of Human Services,
2014)
CQI Framework
 Acknowledges and treats those
closest to the work (staff, children,
youth, families, and stakeholders) as
the true “experts” in the work
 Creates an environment in which
these experts are also actively
engaged in assessing the outcomes
of practices, programs, and policies,
and making improvements based on
those assessments
 Transforms organizations that are
compliance-focused into true
learning organizations that rely on
their mission, vision, and values to
constantly improve their practices,
(Casey Family
Programs & National Child Welfare
Resource Center, 2005, p. 2)

4. Contract Activity 2: Review available evidence-based
research related to CQI approaches in child welfare
program development
 CQI is the complete process of identifying,
describing, and analyzing strengths and problems
and then testing, implementing, learning from, and
revising solutions
 Relies on an organizational culture that is proactive
and supports continuous learning
 Dependent upon the active inclusion and
participation of staff at all levels of the agency,
children, youth, families, and stakeholders
throughout the process,
(CFP & NCWRC, 2005)

5. CQI: Background
 Started in the Japanese and
American business community
to improve products and
services to gain higher customer
satisfaction and retention
 QI principles, tools, and
techniques: meets/exceeds
customer needs/expectations,
aims to getting it right every time
instead of meeting
quotas/numerical goals
*have been found to work
effectively for 40+ years
 QI has been adopted by human
service industries (healthcare,
education, and child welfare)
over the past three decades,
(Council on Accreditation,
n.d., p. 2)

6. Contract Activity 3: Advice from influential program leaders at
various levels of CQI implementation
Feb. 2005- Casey Family Programs and the Nat’l Child Welfare Resource Center for Organizational
Improvement convened 28 child welfare CQI experts (administrators, supervisors, & workers; service
recipients– caregivers & youth; researchers, academics, & policymakers)
Resulting Key Principles (all interrelated and equally important):
 Quantitative & qualitative data, seeking input from all available systems, valuing those
involved with and in the system
 Purpose of data, measurements, and analysis is to guide & improve child welfare
practice and policies
 Staff and the system that supports them make improving outcomes for children and
families a priority
 There is always room for improvement, never wait to act until a problem arises
 CQI emphasizes continuous learning about practice and outcomes beyond basic, but
expected, compliance
 CQI is dependent upon the meaningful and active engagement of staff at all levels,
children, youth, families, and stakeholders
 CQI implementation should be agency-wide, support must be consistent and come from all
levels of the agency,
(CFP&NCWRC, pp. 2-3)

7. Program Stand-Outs
CQI
 Call Management Initiative with a single 1-800
number available 24 hours a day, follow up
protocol, monitored by Consumer Affairs
Tracking System,
 “Secret shopper” visits to agency waiting
rooms observing interactions between workers
and make service calls to assess services at all
levels
 Peer record reviews using a protocol that
allows workers to identify strengths and
challenges of a particular case record --
completed mainly by frontline workers
(Center for the Study of Social Policy,
2007).

8. Contract activity 4: Compile & synthesize findings, as they
apply to Community Umbrella Agency (CUA) program
development
CUA Region 6 provider, Tabor Northern Community Partners (TNCP), CQI
implementation plan includes an ongoing process of design, measure,
assess, and improve, and control (DMAIC)
Information from performance management activities collected and
aggregated by CQI Team, quarterly.
Along with using data and measurements to guide services, aggregated
scores will determine program element effectiveness.
Summary reports and subcontractor scorecard will provide DHS required
performance measures reports.

9. Contract activity 4, cont.
Under the direction of the CQI Department, performance measures will be
developed as part of an ongoing process that ensures the following:
 Treatment services incorporating evidence-based best practices are
appropriate to the consumer’s specific needs are readily available;
 Consumers’ specific goals, needs and expectations are sought, respected
and incorporated into treatment planning to promote a higher level of
functioning;
 The concepts and essential elements of quality-based treatment will be
highly valued;
 Service excellence will be pursued through CQI activities and functions
based upon the DMAIC model;
 Consumers and their community-based support system will be encouraged
to exercise their right to participate in decision making about the
therapeutic services provided and treatment modalities utilized;
 Procedures, treatments and services are provided with sensitivity and in a
compassionate manner across all phases of care; and
 Consumer and stakeholder feedback and satisfaction are key elements of
the CQI process

10. Contract activity 5: Action plan where CQI methods could be
applied with TNCP CUA
 Exploration level activities: Identify need, according to IOC requirements (personnel skills/responsibilities,
technology); Define required data; Assess for additional data to meet organizational standards, according to
stages of growth; Identify stakeholders and their requirements; Define the system/process for improvement
 Installation level activities: Obtain related resources; Design criteria-based instruments; Redesign work
processes accordingly; Design personnel education/feedback activities and determine timeline
 Initial Implementation level activities: Test theories using CQI tools for patterns and trends; Measure results to
evaluate effectiveness; Monitor change effects on service delivery; Resort back to Design, if necessary
 Full Implementation level activities: Collect and assess data; Make recommendations for improvement; Ensure
improvements are positively affecting outcomes; Standardize improvements; Resort back to Design, if
necessary
Based on Implementation Science as they apply to IOC, (Metz & Bartley, 2012)

11. To conclude: Traditional Organizational Structure
Primary Staff
Goblin Valley (Utah), known for
mushroom-shaped rocks, formed
over millions of years

12. CQI-Driven Organization Structure
 Built around core elements of perpetual
collective feedback, assessment and
response; therefore revised where and
when needed
 Conceptual elements engrained in all
operations shape the resulting structure
 Not within prescribed organizational
structures, which are often dated and
not applicable to human welfare
services

13. References
Casey Family Programs and the National Child Welfare Resource Center for Organizational Improvement. (2005,
May 17). Using Continuous Quality Improvement to Improve Child Welfare Practice: A Framework for
Implementation, [Electronic version]. Retrieved from:
http://muskie.usm.maine.edu/helpkids/rcpdfs/CQIFramework.pdf
Center for the Study of Social Policy. (2007, February). Customer Satisfaction: Improving quality and access to services
and supports in vulnerable neighborhoods, [Electronic version]. Retrieved from: http://www.cssp.org/
publications/constituents-co-invested-in-change/customer-satisfaction/customer-satisfaction-framework-
improving-quality-and-access-to-services-and-supports-in-vulnerable-neighborhoods.pdf
Council on Accredidation. (n.d.). Quality Improvement: A Key to Success. Retrieved from: coanet.org/standards/pa-pqui/
Department of Human Services. (2014, Feb 10). The Improving Outcomes for Children Initiative Community Umbrella
Agency Practice Guidelines. The City of Philadelphia Department of Human Services. Philadelphia,
PA.
Metz, A., & Bartley, L. (2012, March). Active implementation frameworks for program success: How to use
implementation science to improve outcomes for children. Zero to Three. Nat’l Implementation Research
Network. Chapel Hill, NC.