for Organizational Improvement
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Use Your PIP to Help Transform QA to QI (Winter, 2004)
OK, I admit it. I've been lazy with my language in the past couple of years. Because I got used to using the term "Quality Assurance" long ago, I doggedly stuck with it despite the growing movement in the field towards using the term "Quality Improvement." Beginning today, we'll be calling this article and section of the website the "QI Corner" to reflect the focus on improving outcomes for children and families.
A quick review of many state Program Improvement Plans (PIPs) reveals a shift in emphasis from traditional, compliance-based QA programs to outcome-based, QI approaches designed to improve practice. At their most developed, these QI approaches use a mixture of quantitative and qualitative data and information to measure and evaluate outcomes. Then they provide regular analyses to agency staff at all levels who use the results to make improvements.
As states like Vermont and Oklahoma (both profiled in this issue of Managing Care), demonstrate, implementing a successful PIP depends in part on developing or adapting a quality improvement approach. Therefore, state child welfare staff focused on quality should look at PIPs as opportunities to move their agencies towards more comprehensive QI approaches. In order to take advantage of the opportunity, QI staff should consider the following lessons based on other states' PIP experiences:
Get involved from the beginning. Sometimes, states assign too much of the PIP development responsibilities to a small group of people. QI staff with a working knowledge of data, information and broad quality initiatives must be involved to ensure a workable measurement strategy. Among the most critical elements are realistic goals, benchmarks and baselines that will reinforce the programmatic strategies in the PIP as well as meet federal reporting requirements.
Crosswalk current data and information sources to the Child and Family Services Review (CFSR) instrument. QI staff should assess their state's capacity to measure CFSR-related outcomes and items with existing data and information. Where gaps exist, new approaches or data sources may have to be developed as part of the PIP implementation.
Consider implementing a qualitative review process. Qualitative reviews, while time consuming to manage and operate, shift the primary focus from compliance to improving outcomes for children and families. Review results will provide targeted information to staff about their practice and data to the state on PIP progress. Also, the review process will provide a mechanism for involving all staff and stakeholders in the overall QI process.
Include a QI section in the PIP narrative. Summarizing the QI approach in the narrative will clarify the state's overall PIP measurement strategy for federal and state staff. In addition, a QI section signals the importance of QI to the agency-wide effort to improve child and family outcomes and provides a vehicle for QI communication.
Create baselines that reflect the state's data sources. States should use the CFSR final report results for their baseline measures only if they have a qualitative review process, or plan to implement one, that will yield comparable information to the CFSR. If not, states should set baselines with data and information sources they will use to measure PIP progress for the various CFSR Items.
Develop a proactive reporting strategy. States must provide quarterly reports on PIP progress to the federal government. QI staff should adapt these for communicating with the entire agency. Proactive reports that explain progress and results to all staff in the agency can become a dynamic part of the QI process, particularly if agency leadership uses the reports and sets the expectation that PIP progress is critical to its overall goals.
These are just a few examples of the way QI staff can support the PIP development and implementation process and shift their approach towards quality improvement. As always, please contact me for more specific information and/or examples if that would be helpful in your work.
Thanks, Peter
• (207)228-8330
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)
Child Welfare Leadership
and Quality Assurance (Spring, 2003)
Developing and piloting qualitative case review
systems (Winter, 2003)
