Assess your Current Culture

Regular and systematic assessments are intended to provide a foundation for the development of a culture of quality by providing an understanding of the current culture, identifying strengths and areas for improvement, and prioritizing key actions to further progress. Discussion generated by completing an assessment provides significant insights into organizational performance and alignment of organization-wide initiatives. Communicating the results can help clarify organizational direction and provide a common basis and language for collective sharing and learning.

NACCHO offers two options for assessing an organization’s current culture of quality – the Organizational Culture of Quality Self-Assessment Tool (SAT) and Roadmap to a Culture of Quality website. Both tools are based on the six foundational elements of a culture of quality and assess the breadth of the components of a culture of quality.

Selecting an Assessment Tool

The approach used to assess an organization’s culture of quality should be determined based on both the level of experience staff have with quality improvement (QI) and the amount of time and resources available to conduct a self-assessment. The NACCHO Roadmap and the SAT both provide insight into an organization’s maturity across the breadth of the six foundational elements. However, those looking for a more in-depth assessment providing more detailed insight into each aspect of a quality culture would benefit from the NACCHO SAT. The following table offers guidance around selecting an approach.

Tool Features Target Audience Time Commitment Access
Roadmap to a Culture of Quality Website
  • Common characteristics and transition strategies for each phase
  • Assesses 6 foundational elements
  • Library of resources to assist with implementation of transition strategies
  • Easy to navigate website format
  • Organizations with little to no experience with QI
  • Organizations with very limited time/resources to devote to QI
2-3 hours For a high level assessment of your culture, click here for instructions on how to use the Roadmap.
Organizational Culture of Quality Self-Assessment Tool
  • Diagnostic questions for formal culture assessment
  • Assesses 6 foundational elements and 20 sub-elements
  • Scoring sheet
  • Targeted transition strategies based on scores
  • PDF & Word versions
  • Organizations experienced with QI
  • Organizations with an established Quality Committee
  • Organizations with staff time dedicated to QI (e.g. QI Coordinator)
3-8 hours
  • For an in-depth assessment of your culture,download the SAT (zip).
  • NACCHO developed a canned PowerPoint presentation that agencies can modify and use to introduce the assessment to their staff.
  • This facilitator’s guide offers resources and tips for those leading the facilitation of a culture of quality assessment, drawing from LHD experiences with completing a QI culture assessment.

Regardless of the assessment tool or approach selected, NACCHO’s Roadmap and SAT are designed to provide a comprehensive look at the breadth of the considerations that are key to both building and sustaining a quality culture. Click one of the links below to access an assessment tool.

The Phases of a Culture of Quality

The following descriptions provide an overview of each phase an organization typically goes through to reach a culture of quality. Review the following descriptions and conduct one of the assessments above to determine which phase best fits your organization’s current culture.

Phase 1: No Knowledge of QI
Executives, senior leaders, and staff are not aware of performance management and QI and their value to public health. As a result, financial and human resources are not typically dedicated to measuring, monitoring, or improving individual, team, or organizational performance. In general, leaders and staff are satisfied with the status quo and resistant to change. Staff rarely collaborate for the purposes of problem solving and innovation, and peer sharing is unusual. Decisions are not driven by data, and customer needs and satisfaction are not prioritized. Processes are undefined, complex, redundant, and varied. Problems tend to be ignored and remain unaddressed for long periods of time. Products, processes, and services might be ineffective and inefficient.

Phase 2: Not Involved with QI Activities
While some executives and senior leaders have experience with QI, staff are not expected to or provided with resources and support to engage in efforts to improve performance. However, it is possible that some QI champions exist within the organization. Performance data is not routinely collected or easily accessible. Solutions to problems are often based on opinions or hunches, resulting in reactive, temporary fixes. Staff may be aware of performance management but resistant to QI due to fear of punishment.

Phase 3: Informal or Ad Hoc QI
Executives and seniors leaders may value QI, but expectations are not consistently communicated to staff. Because some financial and human resources are dedicated to QI, a few staff have the knowledge, skills, abilities, resources, and support to lead small QI projects. Staff meet informally to solve problems and innovate, but opportunities for peer sharing are limited. Typically one or two staff are responsible for QI and performance management activities. While some performance data is collected, monitored, and shared, it is not used consistently for decision making. Staff may view QI as a passing fad or added responsibility.

Phase 4: Formal QI Implemented in Specific Areas
Executives encourage employees to engage in QI, and most senior leaders hold staff accountable to that expectation. Most teams have staff capable of leading formal QI projects as QI is included in workforce development plans and training and resources are made available as needed. Teams are commonly formed to solve problems and innovate using basic QI techniques. Efforts are made to link organizational performance measures to the organization’s strategic plan, and team performance is measured, monitored, and reported in some parts of the organization. It is possible that a formal governance body meets regularly and a QI plan has been created. However, the results of QI projects are not always documented and improvements do not always spread throughout the organization due to limited peer sharing opportunities. Leaders anticipate, explore, and address staff resistance.

Phase 5: Formal Agency-Wide QI
Executives and senior leaders hold staff accountable to expectations related to performance management and QI. This commitment is demonstrated by the dedication of sufficient financial and human resources to training, infrastructure, and support for collecting, monitoring, reporting, and improving individual, team, and organizational performance. Most staff value QI as a strategy for improving their work. QI is incorporated into job descriptions, employee orientation, and the performance appraisal process. Formal QI teams are formed on a regular basis, and the results of these efforts are consistently disseminated. As a result, processes are becoming clearly defined, efficient, effective, and standardized across the organization. A formal process for implementing, monitoring, and evaluating the QI plan is in place. Performance measures are linked to strategic goals. All teams have performance management plans, including data collection, analysis, and reporting and a centralized system for storing and accessing that data exists. Problem solving and decision making are driven by data.

Phase 6: QI Culture
Executives and senior leaders fully embrace quality and ensure the sustainability of the culture by maintaining necessary resources. Leadership turnover has minimal negative impact on the organizational culture. Performance management and QI are fully embedded into the way business is done at the individual, team, and organization levels. The use of formal and informal QI tools and methods to solve problems and create improvements is second nature to employees. Performance data drives all decision making across the organization. The organization is regarded as quality-driven and innovative. Employees are granted autonomy to fulfill their QI responsibilities. Staff understand how they contribute to the organizations overall mission, vision, and strategic plan.