for Organizational Improvement
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Child Welfare Leadership and Quality Assurance (Spring, 2003)
The interviews with four recently departed child welfare directors in this issue of Managing Care provide an excellent jumping off point for a discussion of QA's role in supporting leadership priorities. All four directors noted the importance of using outcomes in setting agency priorities and making improvements. Their experiences highlight several lessons that QA staff in all states should consider.
Anticipate Leadership Priorities and Adjust
QA Activities
QA staff should anticipate new or modified leadership
priorities and support them through data and information collection, analyses,
and presentations. QA staff may be used to analyzing data from their automated
systems or collecting information through qualitative case reviews that
focus on certain outcomes. However, if leadership priorities in the agency
are going to change for some reason (e.g., new leadership or new priorities
for existing leadership), QA staff should reexamine their activities.
They may need to adjust some of their data collection or analyses to reflect
new priorities, or even implement new QA initiatives. If they do not take
these actions, the impact of their work will be less relevant and useful
to the agency.
For example, many states have used their Child and Family Services Review (CFSR) Program Improvement Plans (PIPs) to emphasize key leadership priorities such as reducing permanency delays or improving assessment activities. As part of the PIP development process, states often have had to adjust their QA systems to measure the impact of various PIP activities. Some state QA systems with existing qualitative review components have added questions or modified their processes. Some states without existing reviews have begun to implement them as part of their PIPs. Similarly, many states have begun to analyze and distribute data that relate to CFSR outcomes among county or local offices on a regular basis to increase local ownership of outcome achievement.
Be Proactive During Leadership Changes
The
PIP offers a timely example, but responding to child welfare leadership
changes often presents a more difficult challenge for QA staff. Leadership
commitment to quality is a critical component to QA having a positive
impact in child welfare, and QA staff may need to win support among new
leaders to guarantee this commitment. One strategic way of doing so is
to be proactive as new leadership takes over. As new leaders begin to
define their priorities for the agency, QA staff should make the case
for how existing or new QA activities, analyses and reports can support
these priorities and help staff throughout the agency achieve them. In
addition, they should provide new leadership with responsive and understandable
analyses and reports that will support them in their work. Susan Dreyfus,
the former Administrator from Wisconsin, talked about convincing governors
and legislators about the importance of quality assurance. An Administrator
who tried to do so without some clear and convincing QA reports focused
on her key priority areas would be at a tremendous disadvantage.
Help Staff Throughout the Agency Use QA Data
and Information
Another critical implication of the former directors' comments
is the importance of helping managers and staff throughout the agency
understand and use QA data and information. Too often, QA reports may
not be particularly useful to managers and staff. They may be so statistical,
outdated, or focused on high level outcomes that staff do not know how
to adjust their activities to affect them. For this reason, QA staff should
take responsibility not only for producing reports, but also for helping
staff use them.
In this role, QA staff will serve as "translators" in a child welfare agency. They should have an ongoing dialogue with staff about the content and implications of data and information presented in QA reports. Jess McDonald described presenting information on length of stay in Illinois back to field managers and asking them to help explain the numbers and create strategies for improvement. Similarly, QA staff can help county or local offices understand the results of qualitative reviews and determine systemic responses that will improve outcomes for children and families.
As translators, QA staff should consider the data collection, analysis and presentation process as an iterative one in which they engage continuously with staff throughout the agency (from the leadership to front lines). Only an iterative process will result in responsive information and reports that will help those staff improve their work and ultimately the outcomes for children and families.
As always, please let me know if you have any questions or comments.
Thanks, Peter
Other QI Corner Topics:
The Critical Role of Stakeholders
in Continuous Quality Improvement (CQI) (Fall, 2005)
Quality Improvement T/TA Planned for 2005
(Spring 2005)
Use Your PIP to Help
Transform QA to QI (Winter, 2004)
Developing and piloting qualitative case review
systems (Winter, 2003)
