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Continuous Quality Improvement

Continuous quality improvement (CQI) is an approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems: it focuses on “process” rather than the individual; it recognizes both internal and external “customers”; it promotes the need for objective data to analyze and improve processes.

CQI is a management philosophy, which contends that most things can be improved. This philosophy does not subscribe to the theory that “if it ain’t broke, don’t fix it.” At the core of CQI is serial experimentation (the scientific method) applied to everyday work to meet the needs of those we serve and improve the services we offer.

CQI is a concept that came out of the business industry, and which has been successfully applied in human services. CQI is a collaborative effort that enables people to work together across organizational boundaries to improve shared processes.  Rather than creating a culture of blame if things do not go well, the focus is on a team approach to improvement that rewards the group when things get better.

Core Concepts of CQI
•    Quality is defined as meeting and/or exceeding the expectations of our customers.
•    Success is achieved through meeting the needs of those we serve.
•    Most problems are found in processes, not in people. CQI does not seek to blame, but rather to improve processes.
•    Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation.
•    It is possible to achieve continual improvement through small, incremental changes using the scientific method.
•    Continuous improvement is most effective when it becomes a natural part of the way everyday work is done.

Core Steps in Continuous Improvement
•    Form a team that has knowledge of the system needing improvement.
•    Define a clear aim.
•    Understand the needs of the people who are served by the system.
•    Identify and define measures of success.
•    Brainstorm potential change strategies for producing improvement.
•    Plan, collect, and use data for facilitating effective decision making.
•    Apply the scientific method to test and refine changes.

CQI has been adapted for human services and health care in several ways. One acronym for this is FOCUS-PDCA work.

First, FOCUS on a particular issue.
•    Find a process to improve
•    Organize to improve a process
•    Clarify what is known
•    Understand variation
•    Select a process improvement

Then, move through a process improvement plan, PDCA
•    Plan: create a timeline of resources, activities, training and target dates. Develop a data collection plan, the tools for measuring outcomes, and thresholds for determining when targets have been met.
•    Do: implement interventions and collect data.
•    Check: analyze results of data and evaluate reasons for variation.
•    Act: act on what is learned and determine next steps. If the intervention is successful, work to make it part of standard operating procedure. If it is not successful, analyze sources of failure, design new solutions and repeat the PDCA cycle.

CQI is a Win-Win Process
Using a CQI process is a win for the organization and a win for the people the organization serves.  Within the organization, keeping volunteers and employees actively involved in the CQI process keeps creativity flowing, keeps our team energized and excited about the services they provide and the people they serve.  While the final decisions on what to implement may be made at the management level, every person in the organization has value to add to the process.  Each volunteer and employee brings different experiences and ideas to the process – the best idea may come from where you least expect it!

CQI is also a win for the people you serve.  They are the direct beneficiaries of any improvements you make to your processes.  And, indirectly, they will benefit from the excitement and creativity of your volunteers and employees.

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