Seizing the CQI
Opportunity
Peter Watson
August 15, 2014
CQI Framework and Definition
• NRCOI/Casey CQI Framework (2005)
• Developed by broad range of
stakeholders
• Presented CQI definition
• Key CQI components
• Cited in Children’s Bureau
Information Memorandum on CQI,
August, 2012
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One Definition of CQI
CQI is the complete process of
identifying, describing and analyzing
strengths and problems and then
testing, implementing, learning from
and revising solutions…
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One Definition of CQI (cont.)
It relies on an organizational culture that
is proactive and supports continuous
learning. CQI is firmly grounded in the
overall mission, vision and values of the
agency…
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One Definition of CQI (cont.)
Perhaps most importantly, it is
dependent upon the active inclusion
and participation of staff at all levels of
the agency, children, youth, families and
stakeholders throughout the process.
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Visual from the
NRCOI/Casey
CQI Framework.
Developed by
working session
participants.
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Children’s Bureau CQI Components
I.
II.
III.
IV.
V.
Foundational Administrative Structure
Quality Data Collection
Case Record Review Data and Process
Analysis and Dissemination of Data
Feedback to Stakeholders and Decisionmakers and Adjustment of Programs and
Processes
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What is driving
CQI in child
welfare?
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Past Pressures to Implement CQI
•Change focus from compliance to outcomes
•CFSR process began in 2001
•Quantitative and qualitative data
•PIPs focused on systemic changes
•Lack of measureable progress in many states
•Accreditation efforts in some states
•Lawsuits/settlement agreements
•Heightened accountability expectations
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Recent Pressures to Implement CQI
•Children’s Bureau Information
Memorandum on CQI—August, 2012
•Program Instruction on Child and Family
Services Plan (CFSP)
•Child and Family Services Review (CFSR)
Round 3 process and data measures
•CFSR On-site Review Instrument
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The Eureka Moment
Turning Pressure into Opportunity
• Some agencies have stepped back to assess and
improve their CQI systems
• Target resources to CQI to move agency into
“learning/assessment” mode
• Daily question: “What can we learn from this?”
• Viewing CQI as an organizational shift may be
LESS overwhelming than trying to implement a
series of technical components
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What are Agencies Doing?
•CQI system assessments
•Engaging more staff and stakeholders in CQI
•Reconsidering case review approaches
•Linking data from multiple sources
•Building data analysis skills at all levels
•Focusing on action planning
•Participating in the National CQI Academy
•Finalizing CFSPs submitted in June, 2014
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What are Your Pressures?
•What pressures are you experiencing to
implement a CQI system?
•How might the different pressures on your
management team impact your work
together?
•May need to understand these more to make
progress
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Lessons learned
from State CQI
Assessments
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NRCOI’s CQI Assessment Process
• Child Welfare Matters issue has details
• Thank you to MN, OK, NM, FL, WI, IN and VA!
• Pre-work: interviews, surveys, review current
system elements, identify meeting participants
• Meeting elements, including voting
• Post-meeting
• Mirror CQI action planning and implementation
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Lesson 1: Develop Clear CQI Vision
• CQI is more than just a set of activities
• What are we trying to achieve through CQI?
• If CQI were working optimally, what would be
different in your work, the work of others, the
response of stakeholders?
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Shared Vision for a Learning Organization
•A genuine mission and sense of “WE” and
what “WE” are trying to achieve.
•The vision drives curiosity and information
seeking.
•The vision is independent of leadership
changes.
•What is your vision for CQI?
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Evolutional Direction for a CQI/QA system
1. A focus on effort: Datasets and reports on # served,
caseloads, # with goals, % doing ___; % compliance ____.
2. to a focus on outcome: Data that can be mined for
information on children/cases achieving and not achieving
a goal. Drives change toward results.
3. and ultimately to a focus on impact: Data that pairs what
happens or is done in cases to the results achieved.
Hodges, K. & Wotring, J. (2012). Outcomes management: Incorporating and sustaining processes critical to using outcome
data to guide practice improvement. Journal of Behavioral Health Services & Research, 39 (2), 130-143.
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Lesson 2: CQI Leadership
• Engage agency leadership in CQI
• Varied commitment level across states/counties
• Strategies for engaging and managing up
• Building relationships to gain influence
• Leading up, down, and across the organization
(critical for CQI staff)
• Continuously looking for ways to show CQI value
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Lesson 2: CQI Leadership (cont.)
• What are the unexpected leadership challenges
of CQI?
• How can we help each other anticipate and
address them as we go forward?
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Lesson 3: Challenges with Case Reviews
• CQI = case reviews in many agencies
• Many states have invested significant CQI
resources in case reviews
• Strong CQI systems use data from many sources
• Third round of CFSR and expectations for states
going forward
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Current State Case Review Processes
(Red = CFSR based; Blue = QSR;; Yellow = Other
WA
ME
MT
ND
VT
OR
MN
ID
NH
SD
MI
WY
NV
PA
IA
NE
NJ
OH
IL
UT
DC
IN
MD
CO
CA
WV
KS
MO
VA
KY
NC
TN
AZ
OK
NM
AR
SC
MS
TX
AL
GA
LA
FL
AK
HI
0
0
AK & HI not to scale
MA
CT
RI
NY
WI
500 Miles
500 KM
DE
Variations in Case Review Processes
•Frequency of reviews
•Sample sizes and stratification
•Interviews with case participants
•Training and support for case reviewers
•Use of staff and stakeholders as reviewers
•Use of results
•Link to broader CQI activities
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Lesson 4: 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
• Working paper on this topic:
http://www.nrcoi.org/rcpdfs/CQIdataintoinformation.pdf
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Lesson 5: 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 solutions rather than
grand solutions
• Follow up and adjust!
• Model action planning during CQI assessments
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Lesson 6: Implementing CQI is a Challenge!
• Difficulty of implementing CQI Action Plans
• Confront idea that CQI conflicts with other
priorities
• Build relationships (up, down, and 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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Eureka!
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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
and Ideas
Peter Watson
Director, National Child Welfare Resource
Center for Organizational Improvement
pwatson@usm.maine.edu
207-228-8330 (o)
207-632-0892 (m)
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