Roadmap to an Organizational Culture of QI

1. Roadmap to an Organizational Culture of QI Pooja Verma, NACCHO, APQI pverma@naccho.org Ty Kane, SCHD tkane@sedgwick.gov

2. Roadmap to an Organizational Culture of QI EXIT 6 EXITS 4-5 6. QI CULTURE 4. SOME FORMAL QI ACTIVITIES 5. FORMAL AGENCY-WIDE QI EXIT 3 3. INFORMAL OR AD HOC QI ACTIVITIES EXITS 1-2 1. NO KNOWLEDGE OF QI 2. NOT INVOLVED IN QI ACTIVITIES

3. Roadmap to an Organizational Culture of QI • Characteristics • Lack awareness/understanding of QI • Overwhelmed with other issues • Satisfaction with status quo • Don’t value/link QI to PH practice • Strategies for Transition • Marketing QI to leaders • Leadership & staff training • Share stories of success • Incentives for engaging in QI • Intentionally manage change • “Deselect” resistant leaders EXIT 1 NO KNOWLEDGE OF QI EXIT 1

4. Roadmap to an Organizational Culture of QI • Characteristics • Begin to embrace/understand QI • Problems are ignored/buried • Staff are viewed “hired hands” • Data are not available or not used • Strategies for Transition • Mentorship • Integrate QI in agency planning • ‘Firefighters’ to problem solvers • Task-focus to QI project focus • Membership in ASQ • Market QI thru successes EXIT 2 Not Involved With QI Activities

5. Roadmap to an Organizational Culture of QI • Characteristics • Data not routinely used • Discrete QI efforts • “Pseudo-QI” • QI not part of organization’s strategy • Few lessons learned and sharing • Anxiety of • Doing it wrong or • Finding problems • Strategies for Transition • Share stories organization-wide • Build learning communities • Performance management • Demystify QI • Celebrate all improvements • Address resistance to change EXIT 3 INFORMAL OR AD HOC QI ACTIVITIES

6. Roadmap to an Organizational Culture of QI • Characteristics • Greater reliance on data • Fewer ‘firefighter’ supervisors • People viewed as critical to success • QI is a part of the job • In-house QI TA available • Strategies for Transition • QI division or function • Sharing QI results externally • Results-sharing is the norm • More working across silos • Data use/access increases • Talk of systematic Performance Management • Draft a comprehensive QI plan • Join ASQ • Report results to local governance EXIT 4 FORMAL QI ACTIVITIES IMPLEMENTED IN SPECIFIC AREAS ONLY

7. Roadmap to an Organizational Culture of QI • Characteristics • More data-driven decisions • QI plan individualized to setting • Integration of measures into “system” • QI integrated in operational plans • QI becomes more visible • Standardization in processes • Learning/sharing culture • QI in position descriptions • Customer-focus • Demonstrate ROI • QI policies • Strategies for Transition • QI on all meeting agendas • Leadership that walks the talk • Supervisors are QI coaches EXIT 5 FORMAL AGENCY-WIDE QI

8. Roadmap to an Organizational Culture of QI • Characteristics • Distribution of results to staff, stakeholders and customers • QI champions throughout organization • Ongoing training and networking • Data and tools used daily • Customer is front and center • Integrate with strategic plan • Getting better all the time • Self-assessment • Problems are “gold” • Sustainability • Caution: Digression is easier than progression EXIT 6 QI CULTURE

9. Foundational Characteristics: The following characteristics were identified throughout every phase in the roadmap: • Selecting employees who are well-suited to learn and teach QI techniques • A Collaborative AND learning culture • QI should be integrated into strategic plan • Data analysis skills AND problem solving skills (tools) • Leadership (including governance) must be engaged and have knowledge • Theoretical vs. practical balance (50,000 ft and 5 ft view) • Flexibility in decision-making (at all levels) is seen as critical piece to success • Supervisors are expected to engage in QI and see their job not as about fighting fires but rather, improving processes • Customer focus • QI should be integrated into funder requirements (expected as program work, not “extra”)