Phases of a Culture of Quality

Phases of a Culture of Quality

The Phases of a Culture of Quality include the following:

  1. No Knowledge of QI
  2. Not Involved with QI Activities
  3. Informal or Ad Hoc QI activities
  4. Formal QI Activities Implemented in Specific Areas
  5. Formal Agency-Wide QI
  6. QI Culture

Each tab below presents the six phases of a culture of quality including common organizational characteristics for each phase and strategies to build each foundational element and transition to the next phase. 


 
 

Follow these steps to conduct a general assessment of your organization’s culture of quality against the six foundational elements:

  1. Starting with the Phase 1 tab, select each foundational element, one at a time.
  2. Assess the organization against the characteristics under each element to determine which phase the organization currently resembles. Note that you may be further along in some foundational elements over others.
  3. Identify the transition strategies based on the phase your organization is in for each foundational element.
  4. These strategies should be considered for integration into the organization’s QI plan
  5. Visit the Resources page to identify to identify tools and trainings to assist with implementing the strategies.


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.

Characteristics
  • Employees are unaware of QI and/or mistake it for quality assurance or quality control. No Knowledge, skills, and abilities (KSAs) necessary to undertake QI exist.
  • No QI trainings, resources, or mentors are available to employees.
  • No desired set of core QI KSAs have been identified for employees.
  • Employees do not have performance measures to track performance and identify opportunities for improvement in their work.
  • No financial resources or staff time devoted to QI.
Transition Strategies
Characteristics
  • Teams are rarely or never formed for the purposes of problem solving or innovation.
  • Existing teams often lack clearly defined roles, objectives, and targets for success.
  • Peer sharing and learning across divisions, departments, programs, etc. rarely occurs.
  • Performance of existing work teams is not tracked for progress and accomplishments.
Transition Strategies
  • Explore already existing external QI learning communities at the local, state, or national level.
  • Identify methods for information sharing (e.g. social media, storyboards, “lunch and learns”).
  • Assess functionality and performance of existing teams.
Characteristics
  • Leaders do not understand QI or principles of quality, or see the value to public health practice.
  • Executive leaders do not dedicate or seek out resources for QI.
  • Leaders do not use data driven decision making to guide the agency’s strategy and activities.
  • Leaders are generally satisfied with the status quo.
Transition Strategies
  • All leaders learn about, understand, and embrace the key principles of QI from a managerial and philosophical perspective.
  • Leaders learn about strategies for championing a QI culture (e.g. change management, QI planning).
  • Leaders begin to assess the current organization culture and readiness for QI (e.g., level of QI knowledge, group dynamics, leadership, communication and decision-making styles, norms, and behaviors).
  • Leaders communicate to all staff and the governing entity the urgency for and benefits of QI, highlighting QI success stories in public health and other industries.
  • Leaders begin to identify members of a PM/QI Council to assist with leading the development of a QI program.
Characteristics
  • Internal and external customers of the agency have not been formally identified.
  • Staff are generally unaware of their own customers’ needs.
  • Customer needs and satisfaction data are not collected or used for decision making and improvements.
  • Internal agency assumptions are prioritized over customer needs/values.
Transition Strategies
  • Incorporate customer focus into agency vision and values.
  • Assess and build knowledge in concepts of customer focus (e.g. customer satisfaction, value streams).
  • Begin to identify all of the agency’s internal and external customers.
Characteristics
  • No staff are responsible for overseeing or governing quality initiatives in the agency.
  • No agency plans or policies address quality.
  • A current agency strategic plan likely does not exist.
  • Existing performance measures are used for purposes of grant reporting (often “widget counting”) and are not linked to strategic goals or performance improvement.
Transition Strategies
  • Leaders identify members of a PM/QI Council with all divisions/departments represented. This group will oversee the implementation of the QI program and/or performance management system (PM system).
  • Leaders work with the PM/QI Council to develop a team charter, outlining the mission and roles and responsibilities of each member.
  • Explore strategic plans, QI plans, and performance management systems of similar agencies, and common processes for developing each.
  • Conduct a performance management self-assessment (e.g. inventory current use of performance measures and data).
Characteristics
  • Agency processes are not clearly defined, unnecessarily complex, and consist of redundancies and variations throughout the agency.
  • Problems are often ignored and remain unaddressed for long periods of time.
  • Processes may result in lower quality products and services than what is possible.
Transition Strategies
  • Explore the different models for continuous process improvement (e.g. Lean, Six Sigma, Rapid Cycle Improvement) and determine the best fit for the agency.
  • Build knowledge on basic QI methods and tools.
  • Explore QI projects implemented in similar agencies.

Phase 2: Not Involved in 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.

Phase 3: 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.)

Phase 4: Formal QI Activities 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.

Characteristics
  • Employees in certain areas of the agency have knowledge, skills, and abilities (KSAs) to complete formal QI projects
  • Basic and advanced level QI training/resources are available based on employee needs, i.e., QI training goals in workforce development and QI plans are being met. Opportunities for application exist in many parts of the agency.
  • Employee engagement in QI initiatives is incentivized and successes are celebrated.
  • Performance data are used by supervisors and employees to evaluate individual performance and implement improvements.
  • Employees understand the value of QI but may still view it as an added responsibility.
Transition Strategies
  • Staff are encouraged to identify quality concerns aligned with strategic plan and performance and implement staff suggestions.
  • Leaders grant QI champions and staff authority to make decisions regarding quality issues in their own work processes, as appropriate.
  • Make readily available beginner- and advanced-level trainings and resources to accommodate both new and experienced staff. Establish formal process to orient and train new staff in PM and QI.
  • QI champions continue to advocate for QI, mentor staff, and recruit additional champions throughout the agency.
  • Acknowledge and celebrate all successes around QI.
Characteristics
  • Informal groups are commonly formed throughout the agency for problem solving and innovation through the use of QI techniques (e.g. brainstorming, process mapping).
  • Formal QI project teams are more frequently formed in specific divisions, departments, programs, etc.
  • Teams have clearly defined objectives, performance measures, and consistently meet targets and commitments.
  • One or more formal methods for peer sharing and learning exist within the agency (e.g. learning community, storyboards, lunch & lunch).
  • Best practices and QI successes are shared but may be applied or translated to other parts of the agency.
Transition Strategies
  • QI champions and staff continue to participate in internal and external QI learning communities.
  • PM/QI Council sponsors multiple QI teams across divisions and programs to implement QI projects.
  • QI teams begin to break down silos by sharing results achieved and lessons-learned with staff from other programs or divisions.
  • Create physical space conducive to group innovation (e.g. common areas, conference rooms).
Characteristics
  • Executive leaders expect employees to be trained in QI and engage in QI initiatives as appropriate.
  • Leaders in certain parts of the agency hold staff accountable to QI initiatives.
  • Leaders consistently communicate about QI to staff to create buy-in and alleviate resistance.
  • The local governing entity receives ongoing updates around QI initiatives and progress in the agency.
  • Leaders proactively seek out resources for QI and appropriately budget for staff time, training, etc.
Transition Strategies
  • Leaders continuously provide regular updates on progress and future plans, maintaining an inclusive and transparent process.
  • Leaders continuously assess the quality culture of the agency, including employee commitment and sustainability of progress made through improvement efforts.
  • Executive leaders expect managers and supervisors to hold their employees accountable to QI. Executive leaders develop formal QI policies or procedures.
  • Leaders hold QI and performance discussions at leadership meetings in a standardized way.
Characteristics
  • Internal customers are engaged in decision making and improvement processes.
  • Some leaders consider customer needs in decision making processes.
  • Some areas of the agency have a formal process for assessing customer needs and satisfaction, reporting progress, and making improvements.
Transition Strategies
  • Standardize use of data-collection methods/instruments to multiple programs and services when possible.
  • Standardize department-wide process for assessing customer satisfaction, developing and implementing action plans to continuously improve programs/services offered, and report results. Align this process with the performance management process.
  • Empower employees to take appropriate corrective action on customer issues across the organization.
Characteristics
  • An agency QI plan has been adopted and is being implemented.
  • A formally established, cross-sectional PM/QI Council meets regularly to monitor, oversee, and lead implementation plan for formal agency-wide QI and PM efforts.
  • A strategic plan informed by key stakeholders and data from an environmental scanning process is being monitored and implemented.
  • Some parts of the agency have clearly defined process and outcome performance measures that are linked to program, department, and/or agency level strategic goals.
  • Some parts of the agency have formal processes for data collection, analysis, and reporting against pre-defined objectives and standards. No centralized system for storing and accessing data exits.
  • Data driven decision making is more common and QI projects or improvement initiatives are often identified from existing performance data.
Transition Strategies
  • Leaders and PM/QI Council implement a standardized performance management process to collect, store, monitor, analyze, and report on performance data.
  • Leaders and PM/QI Council work with staff to link the agency strategic plan, QI plan, and all operational plans.
  • Continuously assesses progress against QI plan.
  • Leaders begin to request return on investment data including costs and cost savings resulting from QI efforts.
  • Leaders request data prior to approving changes or making decisions.
  • Adopt and develop an information system for storing, analyzing, and reporting performance data (e.g. spreadsheet(s), database, commercial software) based on a requirements gathering process. Train employees on how to use the system.
Characteristics
  • A formal QI model is commonly used to improve processes in some parts of the agency, and projects are aligned with the steps in the model (e.g. PDCA).
  • Staff are increasingly comfortable with using various basic QI tools and techniques (e.g. flowcharting, Cause-and-Effect Diagram, Brainstorming) for problem solving.
  • Performance data is being used in some areas of the agency but consistency and reliability issues exist.
  • Formal QI projects are more consistently resulting in process improvements, however, successes are not always documented and monitored, or spread to other parts of the agency.
Transition Strategies
  • Hold improvement gains resulting from previous QI projects through quality-control strategies such as documenting and training staff on revised processes, continuing to measure improvements, creating checklists and reminders, and performing audits.
  • PM/QI Council uses performance data to identify and initiate multiple QI projects throughout the organization.
  • PM/QI Council monitors improvements and works with leaders to document and standardize improved processes throughout organization.
  • Identify and use evidence-based practices, when possible, and contribute to the evidence base of public health through national conferences and publications.

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.

Characteristics
  • Employees with necessary KSAs to complete formal QI projects exist in all areas of the agency.
  • An inventory of internal and external QI trainings and resources (basic and advanced) are available to all staff.
  • Employees are incentivized to engage in QI initiatives through both non-financial and financial rewards (e.g. bonus, promotions), as feasible
  • Most employees fully embrace QI and view it as a valuable tool to improve their work.
  • Employees use performance measures and data to identify and implement improvements to their own work.
  • Employees understand how they contribute to the agency’s overall mission, vision, and strategy.
Transition Strategies
  • Leaders and managers incorporate QI competencies in position descriptions.
  • Leaders and managers incorporate QI into performance-appraisal process.
  • Hold every level of staff accountable to identifying QI opportunities aligned with agency strategic plan and improving quality in own work processes.
Characteristics
  • Informal groups of employees from various parts of the agency are commonly formed for problem solving and innovation.
  • Formal QI project teams are formed throughout the agency.
  • Several formal methods for peer sharing and learning exist within the agency (e.g. learning community, storyboards, lunch & lunch).
  • Best practices and QI successes are applied and translated from one part of the agency to another.
Transition Strategies
  • PM/QI Council continues to sponsor multiple QI teams across divisions and programs to implement QI efforts.
  • Staff routinely form sharing sessions or use other mechanisms to exchange successes and lessons-learned.
Characteristics
  • Executive leaders and middle managers throughout the agency hold staff accountable to engaging in QI.
  • All leaders are knowledgeable about QI and quality principles, and are able to support staff around QI initiatives.
  • Executive leaders dedicate sufficient staff time and resources to reaching agency QI goals.
  • Leaders engage in QI initiatives and role model the level of engagement expected of staff.
  • Leaders address staff resistance or other barriers to QI on an ongoing basis.
Transition Strategies
  • Leaders continue to update employees and stakeholders on progress and future plans, dedicate resources to QI, and assess agency culture and sustainability of progress.
  • Leaders continue to role model QI behavior and values with employees, customers, and partners.
  • Select new organization leaders that exhibit QI values and dedication to continually improve.
Characteristics
  • Employees are empowered to take corrective action against customer dissatisfaction.
  • Evidence exists that the agency consistently meets internal and external customer needs.
  • Customer satisfaction performance standards and measures are standard throughout the agency, as appropriate.
  • Customer satisfaction data is actively used to improve performance.
Transition Strategies
  • Continue to monitor, assess, improve, and report on customer satisfaction for all programs and services.
  • Refine and improve the customer-satisfaction measurement process.
  • Involve both internal and external customers in improvement activities.
  • Use customer data to define new offerings and services.
  • Incorporate customer feedback into performance appraisal process.
Characteristics
  • An agency QI policy may exist.
  • A formal process for implementing, monitoring, and evaluating a QI plan is in place.
  • The PM/QI Council oversees all QI/PM initiatives, ensures sustainability of successes achieved, and takes necessary action to address barriers among quality initiatives.
  • A formal process for developing and revising performance measures that are linked to program, department, and agency strategic goals is implemented agency-wide.
  • All programs, departments, or divisions have clearly defined plans for performance data collection, analysis, and reporting against pre-defined objectives and standards.
  • A centralized information system for storing and accessing performance data allows for user-friendly performance monitoring and reporting.
  • Agency and department level decisions are always data driven. Performance data is used to identify agency QI projects.
Transition Strategies
  • All staff in all divisions and program areas continue to collect, monitor, analyze, and report performance data.
  • PM/QI Council uses performance data to identify and recommend QI efforts throughout the organization.
  • PM/QI Council continuously assesses progress against QI plan and revises annually.
  • Leaders routinely measure return on investment using cost and benefit values.
Characteristics
  • Formal QI projects are being implemented to improve processes in all departments and divisions of the agency.
  • Formal QI projects result in documented process improvements and monitored for sustainability. Improved processes are standardized and adopted agency-wide.
  • Basic and advanced QI tools and techniques are commonly used for informal problem solving and formal QI projects.
  • Reliable performance data is consistently used to assess for performance gaps, and identify and implement QI projects.
  • Many agency-wide processes are clearly defined, efficient, and standardized throughout agency.
Transition Strategies
  • Continue to hold improvement gains resulting from previous QI efforts.
  • PM/Council continues to sponsor QI projects, as appropriate.
  • Staff continue to use, and contribute to, evidence base and model practices.

Phase 6: Formal Agency-Wide QI

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.

Characteristics
  • All employees have the appropriate knowledge, skills, and abilities (KSAs) to fulfill their quality related role in the agency.
  • Employees are granted an appropriate level of autonomy to fulfill their quality related roles in the agency.
  • New employee orientation includes agency values and goals around quality. All new employees are trained in QI within a predefined period.
  • QI is incorporated into job descriptions and the performance appraisal process.
  • Attitudes and propensity for quality are considered in hiring decisions.
  • Employees are viewed and treated as the agency’s greatest asset.
Characteristics
  • The agency uses and contributes to the evidence base in the field. The agency is widely regarded as innovative and quality driven.
  • Informal groups are commonly formed for idea generation, innovation, and improvement. Formal teams are readily formed to implement improvements.
  • All functioning teams in the agency are structured with clear goals and targets, and consistently meet commitments.
  • An environment of peer learning and sharing is highly encouraged and prevalent with multiple venues for sharing.
Characteristics
  • Executive leaders and middle managers fully embrace quality and hold staff accountable to engaging in QI.
  • Executive leaders ensure sustainability of the quality culture by proactively maintaining resources.
  • Leaders quickly identify and address resistance or barriers to sustaining the quality culture.
  • Leadership turnover has minimal negative impact on the quality culture. Knowledge of quality principles and attitudes toward QI are considered when hiring new leadership.
Characteristics
  • Customer needs and values are central in decision making and daily operations.
  • Externally, the agency is viewed as being customer focused, and continuously meets and exceeds customer expectations.
  • Internal and external customers are proactively engaged in decision making and improvement processes.
Characteristics
  • QI plan goals and objectives are consistently met and challenge the agency to continuously strive for improvement.
  • A strong governance structure for quality initiatives exists ensuring the agency is accountable to quality related goals. Performance data drives all decision making and improvement activities in the agency.
  • Performance data drives all decision making and improvement activities in the agency.
  • An efficient and cost effective automated system for centralized data analysis and reporting is in place.
Characteristics
  • The use of formal and informal QI tools and methods to solve problems and create improvements is second nature to employees.
  • Large, agency-wide QI initiatives consistently yield significant improvements.
  • QI initiatives are occurring at all levels of the agency, on a formal and informal basis.
  • Agencies processes are standardized, efficient, and ultimately yield high quality products and services to the community.