Informal or Ad Hoc QI activities

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.

Characteristics

  • QI champions exist and have basic knowledge, skills, and abilities (KSAs) to lead QI projects and mentor staff.
  • Basic QI training/resources are available, but opportunities for application are limited.
  • Employee QI KSAs are assessed and gaps are incorporated into workforce development and QI plans.
  • Employees remain resistant to QI and may view it as a passing phase and added responsibility. QI is avoided due to competing priorities.
  • Employees are engaged with developing and understanding performance measures related to their work and how they connect with the agency mission.

Transition Strategies

  • Celebrate and incentivize QI successes.
  • Encourage staff to engage in QI projects and create opportunities to apply QI knowledge, skills, and abilities (KSAs).
  • All staff attend training on an organization-wide performance-management process including how to develop performance measures, input and access data, identify performance gaps, and report methods and frequency.
  • Encourage employees to use performance data to evaluate and improve individual performance.
  • Mentor employees and provide advanced QI training to those that need it, including advanced tools of quality, statistical and data analysis, and more complex models for QI, as appropriate.

Characteristics

  • Groups of employees may meet on an informal or ad-hoc basis for the purposes of problem solving or innovation.
  • One or two teams may have convened to implement formal or informal QI projects.
  • Team performance may be monitored for progress against objectives but targets and commitments are not consistently met.
  • Some employees may participate in formal external learning communities to improve work.
  • Peer sharing and learning is occurring on an informal basis but no formal methods for sharing and collaboration exist within the agency.

Transition Strategies

  • All staff increase use of collaborative QI techniques for problem-solving including group brainstorming sessions and discussions.
  • Encourage employees to participate in internal and external QI learning communities.
  • QI champions lead functional QI teams in implementing discrete projects sponsored by the PM/QI Council.
  • Leaders provide staff the opportunity to share results achieved through various mechanisms (e.g., staff meetings, storyboards on display).
  • Hold teams accountable to performance goals.
  • Create and disband teams, as appropriate.

Characteristics

  • Executive leaders understand QI and its value to the agency’s work. Middle managers/supervisors may still demonstrate resistance.
  • Executive leaders communicate to employees about the agency’s QI goals on an inconsistent basis.
  • Executive leaders have dedicated some resources (training, FTE, etc.) but do not actively seek out additional resources or funding for quality initiatives.
  • The local governing entity (LGE) is informed about agency QI initiatives and goals.

Transition Strategies

  • Leaders continuously communicate updates on QI progress and future plans, maintaining an inclusive and transparent process.
  • Leaders continue to communicate to employees key messages including: (1) QI is not about placing blame or punishment; (2) QI is a way to make daily work easier and more efficient; (3) QI is within reach of all staff and will get easier with practice.
  • Leaders continuously assess the culture of the agency including staff commitment and engagement and sustainability of progress toward building a QI culture.
  • Leaders regularly update and engage the governing entity around QI.
  • Leaders role model QI behavior and values with employees, customers, and partners.

Characteristics

  • The agency’s internal and external customers and stakeholders have been formally identified.
  • Some parts of the agency use customer satisfaction data to implement improvements (typically clinical).
  • The development of performance standards and measures related to customer satisfaction is informally occurring in some parts of the agency.

Transition Strategies

  • Identify existing customer satisfaction data and data needs.
  • Develop customer satisfaction performance measures throughout the agency. Include measures related to accessibility, courtesy, value, quality, timeliness, and helpfulness.
  • Identify customer satisfaction data sources and develop data collection instruments.
  • Develop a process for monitoring and reporting on customer satisfaction data, and incorporate into the performance management process.

Characteristics

  • A draft QI plan may exist but has not yet been adopted and implemented.
  • One or two staff (e.g. QI Coordinator) are responsible for leading QI and PM related activities.
  • The PM/QI Council is fully functional and actively overseeing agency-wide QI and PM initiatives.
  • A strategic plan may exist but likely did not result from a process that included stakeholder engagement, environmental scanning, data gathering, etc.
  • Divisions, departments, programs have process and output performance measures but meaningful outcome measures are not used. Performance is not linked to agency strategy.
  • Some performance data exists but is not consistently used for decision making, performance monitoring, and QI project identification.

Transition Strategies

  • Implement a formal process for choosing performance standards and targets and for developing respective performance measures to manage performance around core functions (e.g., human resources, finance) and public health programs and services (e.g., MCH, customer service).
  • Develop performance standards and measures at the organization, division, and program level, measuring both processes and outcomes. Align performance standards and measures with the agency strategic plan.
  • All staff identify performance data needs and sources.
  • Leaders, PM/QI Council, and IT staff conduct a formal requirements gathering process to understand needs for  a data-collection system for storing and tracking performance data (e.g., Excel, Access, software).
  • Establish a formal process for routinely reporting progress against performance standards/targets to all stakeholders (e.g., external customers, governing entity, leaders) including methods and frequency of analysis and reporting.
  • Begin to identify areas for improvement based on a gap analysis using performance data.
  • PM/QI Council develops a formal process to evaluate and revise the QI plan annually.

Characteristics

  • A small number of processes are being improved through discrete QI projects using a formal QI model (e.g. PDCA), however, projects do not always fully align with steps in the selected model (e.g. lack of baseline data, insufficient Root Cause Analysis).
  • Basic QI tools are being used to implement informal or ad-hoc improvements or problem solving (e.g. Cause-and-Effect Diagram, Flowcharts, Brainstorming).
  • Performance data is inconsistently used as a part of improvement projects.
  • QI projects may not be resulting in significant improvements or take an excessive amount of time to complete.
  • Process improvements are not documented or monitored for sustained success.

Transition Strategies

  • All staff practice using the seven basic tools of quality in daily work to identify root causes of problems, assess efficiency of processes, interpret findings, and correct problems.
  • The PM/QI Council identifies and sponsors “winnable” QI projects using agency performance data. QI efforts are linked to strategic priorities and identified from performance data to the extent possible. (Lack of performance measures and data in this phase should not hinder initiation of discrete QI efforts as opportunities for staff to practice will facilitate learning.)