Assess your Current Culture

Regular QI self-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 strategies for the QI plan. Discussion generated by completing an assessment provides significant insights into organizational performance and alignment of organization-wide initiatives.

NACCHO offers two options for assessing an organization’s current culture of quality – the Organizational Culture of Quality Self-Assessment Tool Version 2.0 (QI SAT 2.0) and QI 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. Agencies with limited experience or resources to devote to a formal assessment may choose to walk through the phases of the QI Roadmap website to conduct a high-level assessment prior to implementing a more formal and comprehensive assessment process. The Roadmap provides common organizational characteristics across the six phases to help determine the current state and references transition strategies and a library of resources to progress.

NACCHO Organizational Culture of Quality Self-Assessment Tool Version 2.0 (QI SAT 2.0)

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 QI SAT 2.0 which is organized by the six foundational elements and further divided into 14 sub-elements.  The original QI SAT was developed for NACCHO by Continual Impact LLC, and released in 2013. In 2018, NACCHO engaged in a customer driven process to revise the original instrument and create the QI SAT Version 2.0 with input from health department practitioners, QI subject matter experts, and the field at large.

Download the QI SAT 2.0 Toolkit, which contains the following resources:

  • NACCHO QI SAT Facilitator Guide- Offers resources and guidance for those leading the administration of a culture of quality assessment, drawing from health department experiences.
  • NACCHO QI SAT 2.0 Leadership Version – This instrument offers 59 diagnostic statements and is intended for agency level senior leadership (e.g., Health Director, department heads, executive team) and QI leaders (e.g., QI Committee) to assess the spread and formality of QI across the agency. Transition strategies are offered based on assessment scores.
  • NACCHO QI SAT 2.0 Staff version – This instrument includes 27 of the 59 diagnostic statements and is intended for all other staff not engaged in the leadership assessment (e.g., middle managers and frontline staff).
  • QI SAT 2.0 Scoring summary– An Excel file to input leadership and staff scores across all sub-elements

Additionally, the following slidedecks referenced in the Facilitator guide are available to help your department conduct the assessment:

  • QI Culture Staff Orientation Slides – Modifiable slides – including content, talking points, and facilitator instructions – to orient staff to the agency’s QI assessment and QI concepts covered in the SAT.
  • QI Leadership Assessment_Group Scoring Slides– Modifiable slides to assist with the facilitation of a group scoring process, including discussion questions and suggested scoring processes.

Looking for the QI SAT Version 1.0? Click here to download the original 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.