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.

Characteristics

  • Some employees have a high level understanding of QI but do not possess the knowledge, skills, and abilities (KSAs) necessary to undertake QI.
  • Select employees (e.g. QI champions, Accreditation/QI Coordinator) have received some QI training. QI trainings, resources, or mentors are not readily available to employees.
  • Employees are resistant to QI out of fear of punishment and lack of QI skills, and do not understand its value in public health.
  • Performance measures may exist in some or all parts of the agency, but are not used by employees to monitor/improve their individual work.
  • No financial resources and minimal staff time are devoted to QI.

Transition Strategies

  • Develop a training plan for building appropriate levels of performance management and QI KSAs for every level of staff.
  • QI champions engage in training opportunities to enhance ability to lead QI efforts and offer coaching to staff.
  • Leaders assess the source of staff resistance and develop strategies to counter resistance through effective messaging, training, and incentives.
  • Communicate information around agency strategy and performance improvement information (e.g. agency mission, vision, strategy).
  • Enable staff participation in improvement activities through feedback systems and inclusive problem solving.

Characteristics

  • Teams are rarely or never formed for the purposes of problem solving, improvements, or innovation.
  • Existing work teams may have defined roles, objectives and metrics for success, but team performance is likely not tracked for progress and accomplishments.
  • Peer sharing and learning across divisions, departments, programs, etc. is infrequent.

Transition Strategies

  • Ensure that teams throughout agency have clearly defined roles and expectations.
  • Create templates for setting the direction and processes for teams (e.g. team charter, agendas, work plans).
  • Begin to introduce use of tools/techniques to facilitate collaboration and sharing across the agency.
  • Actively participate in existing external QI learning communities and conferences, and share lessons learned with all staff.

Characteristics

  • Some leaders have received training in quality management principles and/or QI but do not demonstrate buy-in for QI.
  • Executive leaders do not dedicate or seek out resources for QI.
  • Data and quality are not incorporated into agency decision making.
  • Executive leaders have not set expectations for staff to engage in QI.

Transition Strategies

  • Leaders begin to seek out and dedicate additional human and financial resources for QI.
  • Leaders incorporate QI into the organization’s value statement and guiding principles.
  • Leaders work with PM/QI Council to develop a plan for change management including timelines, costs, short- and long-term goals, communication and training plans, and implications for staff and stakeholders.
  • Leaders actively communicate about the importance of QI and staff expectations, and continue to alleviate staff resistance.
  • Introduce QI to the local governing entity (LGE) and actively garner buy-in.

Characteristics

  • No formal process to identify internal and external customers of the agency exists.
  • Customer satisfaction data may be collected in some parts of the agency, but is not consistently used.
  • Customer needs are not considered in decision making processes.
  • Performance measures related to customer satisfaction are not used.
  • Staff are not empowered to resolve customer concerns.

Transition Strategies

  • Identify the agency’s customers and stakeholders to determine where customer satisfaction should be assessed. (These individuals may have been previously identified as a part of a strategic planning or health improvement planning process).
  • Begin to identify existing customer satisfaction data and data needs for all programs and services. Prioritize programs and services to assess for, and improve, customer satisfaction.
  • Develop plans and actions for how the agency will use customer data in performance management, strategic, and improvement planning.

Characteristics

  • A PM/QI Council exists but is still not fully functional.
  • No agency plans or policies address quality.
  • A current agency strategic plan likely does not exist or is not being implemented.
  • Existing performance measures are used for purposes of grant reporting (often “widget counting”) and are not linked to strategic goals.
  • Improvement efforts are implemented in the absence of performance data.

Transition Strategies

  • PM/QI Council assumes ownership of all QI efforts, and reports to agency leaders as appropriate.
  • Identify aspects of core operations and program areas for which performance is already being measured and data are being collected or are available.
  • PM/QI Council develops a plan for establishing clear performance measures and objectives
  • PM/QI Council drafts a QI plan with time-framed and measurable goals and objectives.

Characteristics

  • Agency processes are not clearly defined, unnecessarily complex, and consist of redundancies and variations through the agency.
  • Problems are inconsistently addressed and often rely on opinions or a “hunch,” over facts and data.
  • Problems are addressed in a reactive rather than proactive manner, and usually result in a temporary fix.
  • Staff are generally satisfied with the status quo and resistant to changing processes through QI.

Transition Strategies

  • Explore the different models for QI projects (e.g., Lean, Six Sigma, Rapid Cycle Improvement) and determine the best fit for the agency. For PHAB documentation requirements on use of a formal improvement process, see PHAB Measure 9.2.2.)
  • Develop criteria and a process for nominating and selecting QI projects.
  • Explore options for a “winnable” QI project(s) and lead the planning and implementation of these projects.