1. Leadership QI Self-Assessment: Group Discussion and Scoring
Talking points:
Now that we know what we mean by a culture of quality improvement, we need to assess where we currently fall on the QI Roadmap so we can identify strategies for moving this work forward.
We will spend the next few minutes discussing our process for conducting a QI self-assessment, staff roles in this process, and how this will inform our agency QI plan.
Facilitator Instructions:
Slides describe the NACCHO Organizational Culture of Quality Improvement (QI SAT) and provide a space for presenting your agency’s process for conducting the assessment. Tailor these slides to reflect your process.

2. Objectives Outline a process for assessing our QI culture
Engage in facilitated group discussion around our culture of quality
Administer the QI SAT through group scoring
Talking points:
Briefly discuss the objectives
Facilitator Instructions:
Identify the objectives that best meet your agency’s needs and select the slides that will meet those objectives.

3. Organizational Culture of Quality Self-Assessment Tool (SAT)
Comprehensive assessment
Based on the 6 foundational elements (14 sub-elements)
Aligned with QI Roadmap
Links results with transition strategies
Scoring Summary Sheet
Talking Points:
NACCHO also offers a formal Organizational Culture of Quality Self-Assessment Tool, referred to as the QI SAT from this point forward, to conduct an in-depth and objective assessment of QI culture across all six foundational elements.
This is one of the most comprehensive QI assessment tools designed specifically for health departments and assesses culture across the 6 foundational elements we just discussed, and 14 sub-elements which offer a deeper dive into the foundational elements.
It was designed to align with the QI Roadmap, results in a numerical scores for each foundational element and one overall score for the agency. This score identifies in which phase of the QI Roadmap we fall.
We are using the NACCHO QI Self-Assessment tool in order to have a standard way to measure ourselves against standards for the six foundational elements.
Once we have a score, the SAT provides a menu of transition strategies that we can use to move us from our current stage to the next stage. We will share our scoring summary with the whole staff when it is completed, along with the strategies we have chosen to move us to the next phase.
Facilitator Instructions:
If you are using an abridged version of the SAT tailor this slide, or add another slide, to describe the abridged tool and how it was adapted from the QI SAT.

4. Talking Points:
The QI SAT includes an overview page of each foundational element which includes a definition of terms that are referenced in the diagnostic statements.
Be sure to reference these as you are taking the assessment.

5. Talking Points:
To give you a sense of how the QI SAT is structured, here is a snapshot of one of the diagnostic statements for one of the sub-elements.
You can see that each statement should be rated against a 6-pt scale ranging from strongly disagree to strongly agree. At the bottom of each set of statements is a hyperlink to a set of transition strategies. Based on our scores, we will select various transition strategies across the foundational elements to advance our QI culture.

6. Talking Points:
The QI SAT also offers a scoring summary sheet which the QI Committee will use to average all of the scores submitted by staff.
We will share the final scores with staff.
Facilitator Instructions:
Adapt this slide based on its relevance to your specific assessment process.

7. SAT Scale Interpretation
Interpreting the Leadership SAT Scale
Roadmap Phase
SAT Scale Rating
SAT Scale Interpretation
Phase 1: No knowledge or awareness of QI 1
The respondent feels that the statement never occurs in the agency.
Phase 2: Not Involved in QI Activities 2
The respondent feels that the statement rarely occurs in the agency.
Phase 3: Informal or Ad Hoc QI 3
The respondent feels the statement occurs inconsistently or on an informal or ad hoc basis in some areas of the agency.
Phase 4: Formal QI in Specific Areas of the Agency 4
The respondent feels the statement occurs informally in some areas and formally in other areas of the agency.
Phase 5: Formal Agency-wide QI 5
The respondent feels the statement occurs formally in all areas of the agency.
Phase 6: QI Culture 6
The respondent feels the concept in the statement is fully integrated into the agency culture.
Talking points:
Let’s discuss the rating scale to ensure that we are all interpreting the scale properly and consistently.
The leadership scale is intended to measure the spread of QI across the entire agency and the formality of QI activities.
Note that our scale is different that the staff version which measures staff perceptions of QI activities from their personal experiences at the work unit level using an agreement scale.
Discuss each of the 6-pts on the rating scale, as presented on the slide.
Facilitator Instructions:

8. QI Self-Assessment Process: Next Steps
[Adapt this slide to reflect the assessment process you have designed].
Staff complete [online/paper] assessment by DATE
QI Committee will collectively complete the assessment for a leadership score by DATE
QI Committee staff will prioritize NACCHO transition strategies to select strategies for addressing QI gaps DATE
Strategies are selected and prioritized by DATE
Strategies are incorporated into QI plan and presented to staff by DATE
Talking points:
Discuss your specific self assessment process and next steps for staff.
Facilitator Instructions:
Customize this slide to reflect your timeline and assessment process.

9. Assessing our QI Culture: Leadership Group Discussion & Scoring
Talking points:
During this meeting, we will rating ourselves against the diagnostic statement in the QI SAT as a group. Prior to rating each of the sub-elements, we will have facilitated group discussion about the diagnostic statements as they pertain to our agency.
This process will provide an opportunity for all of us to rich discussion about how QI works at our agency, to develop a common understanding of the current state, and to address any questions or concerns.
This process will result in objective scoring and cross-departmental input.
Facilitator Instructions:
Slides 9-42 cover each of the 6 foundational elements and sub-elements. Each slide offers talking point to present the QI concepts covered in the respective diagnostic statements and facilitation questions to help generate group dialogue.
Following each sub-element slide is another placeholder slide for scoring the sub-element. Adapt these slides, per your process.

10. Foundational Element 1: Staff Empowerment
Staff are empowered to use QI in their daily work through:
Trainings, coaches, and resources
Clear expectations
Opportunities to implement QI
Autonomy to make improvements
Performance feedback systems
List the agency’s specific staff empowerment efforts
Talking points:
Creating a culture of quality requires all employees to regularly use QI.
It’s important that we as a health department offer training and mentorship to employees, and that we communicate clearly our expectations for each employee’s participation in QI.
We have to come to see QI as a regular part of everyone’s job, and we will get there by making sure everyone has opportunities to learn, to take on new projects, and to give feedback about the improvements you would like to see.
It is important to note that QI is not meant to be punitive or site poor performance. It is about empowering staff to continuously improve the programs and services offered to customers and the community we serve.
Facilitation Questions:
How can the agency support you with engaging in QI?
What concerns you about QI?
What excites you about QI?
Facilitator Instructions:
List workforce development activities done to date (e.g. workforce assessments, workforce development planning, and professional development opportunities like trainings done to date, scheduled trainings, and other resources available to staff, and suggested staff they can go to discuss questions, concerns or ideas related to QI.
Specify the agency’s process for staff to offer feedback.

11. Staff Empowerment Sub-Element 1.1: Enabling Performance
Have we clearly articulated expectations around QI across all staff?
Do staff have access to needed resources to do their jobs? To learn and implement QI?
Are skilled QI and other job related mentors available to staff?
Have staff been given a voice in the agency’s QI process (e.g. nominate or select projects? Authority to make improvements)?
Talking Points:
This sub-element assesses the degree to which the agency enables staff to perform optimally.
An effective performance appraisal process should be in place where expectations are clearly defined, employees have access to metrics for tracking their performance and understanding where improvements are needed, and supervisors provide periodic feedback.
Incorporation of QI related goals into performance appraisal process will ensure that all staff are working toward ingraining QI into the way work is done.
Individual successes and improved performance should be rewarded and incentivized.
Staff should have sufficient resources to enable success. This includes everything from supplies and IT to technical exerts for mentorship and guidance when needed.
Empowering staff by providing opportunities to voice improvement opportunities and granting autonomy to make improvements in work processes.
Facilitation Questions:
Have we clearly articulated expectations around QI across all staff?
Do staff have access to needed resources to do their jobs? To learn and implement QI?
Are skilled QI and other job related mentors available to staff?
Have staff been given a voice in the agency’s QI process (e.g. nominate or select projects? Authority to make improvements)?

12. Staff Empowerment Sub-Element 1.1: Enabling Performance
[Placeholder slide to facilitate scoring of Sub-Element 1.1: Enabling Performance.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

13. Staff Empowerment
Sub-Element 1.2: Knowledge, Skills, and Abilities (KSAs)
To what extent are our workforce development processes and plans addressing gaps in performance and workforce competencies and KSAs?
Are sufficient employee performance tracking or appraisal processes in place to support meaningful growth?
Are sufficient QI and other workforce training opportunities and resources readily available to all staff?
Talking Points:
This sub-element is about assessing QI and public health KSAs, implementing plans to address gaps, and provision of training and resources to grow staff KSAs.
Workforce assessments are conducted against core public health and QI related competencies and inform a workforce development plan to address gaps.
Employee KSAs are improved through a variety of training methods and tracked through individual performance plans.
Facilitation Questions:
To what extent are our workforce development processes and plans addressing gaps in performance and workforce competencies and KSAs?
Are sufficient employee performance tracking or appraisal processes in place to support meaningful growth?
Are sufficient QI and other workforce training opportunities and resources readily available to all staff?

14. Staff Empowerment
Sub-Element 1.2: Knowledge, Skills, & Abilities (KSAs)
[Placeholder slide to facilitate scoring of Sub-Element 1.2: Knowledge, Skills, and Abilities.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

15. Foundational Element 2: Teamwork and Collaboration
Create effective team performance by:
Defining team expectations
Carefully selecting team members
Holding teams accountable
Break down silos through:
Communication of lessons learned
Formal/informal learning and problem solving groups
Eliminating redundancies and creating alignment
List opportunities for collaboration in the agency.
Talking points:
This element recognizes that a health department must be able to form and support effective teams capable of taking responsibility for completing tasks and sharing results.
High functioning teams have clearly defined performance expectations and gather routinely to brainstorm, solve problems, improve their work, and share lessons learned.
An openness to collaborate and work across departments is critical to spreading a culture of quality throughout the agency, sharing lessons learning, reducing redundancies or waste, etc.
Facilitation Questions:
How many of you are on multiple teams in the agency? Which ones and how do members exhibit good teamwork and collaboration?
Who is on a team that has collaborated with other teams in the agency?
Facilitator Instructions:
List examples of cross-departmental collaboration in the agency or opportunities/forums for learning and collaboration (e.g. learning communities or learning circles, brainstorming sessions, online forums for sharing)

16. Teamwork & Collaboration
Sub-Element 2.1: Collaborative Sharing and Improvement
What formal or informal mechanisms exist for staff to collaborate and share successes and lessons learned across teams?
What external opportunities are staff engaged in to enhance knowledge and expertise around QI other job functions?
Talking Points:
This sub-element looks at the degree to which there is a learning culture in the organization through sharing and collaboration.
It is critical to collaborate where appropriate and share knowledge and lessons learned between individuals, teams, and even organizations. Internal and external learning communities should be available and promoted to staff.
Learnings from conferences, trainings, workshops, and learning communities should be applied and shared with others.
Improvements resulting from QI projects in one department should be spread throughout the agency, breaking down silos.
Facilitation Questions:
What formal or informal mechanisms exist for staff to collaborate and share successes and lessons learned across teams?
What external opportunities are staff engaged in to enhance knowledge and expertise around QI other job functions?

17. Teamwork & Collaboration
Sub-Element 2.1: Team Performance
[Placeholder slide to facilitate scoring of Sub-Element 2.1: Collaborative Sharing and Improvement.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

18. Teamwork & Collaboration
Sub-Element 2.2: QI Team Performance
Do teams have processes in place to support success (e.g. effective communication mechanisms, opportunities to meet, methods for tracking goals)?
What accountability mechanisms are in place to ensure that teams meet their goals?
Are QI teams being held accountable and prioritized in daily work?
Talking Points:
This sub-element looks at the functionality and accountability of QI teams and work teams.
Teams should have clearly defined visions, goals and objectives which are understood by all members.
Staff are put on teams based on their relevant KSAs to most optimally accomplish goals and objectives
Teams have standard procedures for accomplishing work including use of performance data to drive improvements, conducting team meetings, accountability mechanisms for members, and communication methods.
Facilitation Questions:
Do teams have processes in place to support success (e.g. effective communication mechanisms, opportunities to meet, methods for tracking goals)?
What accountability mechanisms are in place to ensure that teams meet their goals?
Are QI teams being held accountable and prioritized in daily work?

19. Teamwork & Collaboration
Sub-Element 2.2: QI Team Performance
[Placeholder slide to facilitate scoring of Sub-Element 2.2: Strategic Planning.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

20. Foundational Element 3: Leadership Commitment
Dedicate financial and human resources to QI
Communicate the vision and urgency for QI
Empower staff to engage in QI
Hold staff accountable
Exhibit visible support for QI
Add leadership commitment to date (e.g. dedicated resources, $$, QI committee)
Add leadership expectations of staff
Talking Points:
Leadership’s commitment is vital for the success and sustainability of a QI culture. The Health Official and senior leaders should initiate and lead the process for transformational change, dedicate financial and human resources to QI, communicate progress, and exhibit lasting support for QI.
All leaders, including anyone who directs the work of others, are critical to executing the QI directions and actions as they must address both the resourcing and technical side of change (e.g., building the infrastructure, processes, and systems needed for effective QI) and the human side of change (e.g., alleviating resistance, maintaining transparency, meeting training needs, attaining team support).
Facilitator Instructions:
Add content around commitment leadership has shown to date (e.g. hiring QI coordinator, budgeting for QI, adopting a policy), and what current leadership expectations are of staff.
If in the room, ask senior leadership to say a few words about the vision for a QI culture at the agency.

21. Leadership Commitment
Sub-Element 3.1: Culture
Has leadership defined and communicating a clear and inspiring vision for QI and its urgency?
How has QI been integrated into agency policy, plans, and procedures?
How do leaders model behaviors in support of QI, as they expect from staff?
Talking Points:
This sub-element assesses the degree to which leaders are actively creating an agency environment conducive to QI.
Senior leadership must clearly define the QI vision and expectations, regularly communicate it to staff, and adopt agency policies and plans that promote QI.
Leaders, including middle management and supervisors, are trained in QI and actively participate and engage in QI efforts. They also encourage their staff to participate and address any barriers and resistance that may arise among staff.
Facilitator Questions:
Has leadership defined and communicating a clear and inspiring vision for QI and its urgency?
How has QI been integrated into agency policy, plans, and procedures?
How do leaders model behaviors in support of QI, as they expect from staff?

22. Leadership Commitment
Sub-Element 3.1: Culture
[Placeholder slide to facilitate scoring of Sub-Element 3.1: Culture.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

23. Leadership Commitment
Sub-Element 3.2: Resourcing & Structure
Does the agency have sufficient funding and resources allocated for QI?
Does the agency have a high functioning QI Committee?
Do leaders have the necessary KSAs necessary to drive and sustain QI?
Talking Points:
A critical role for leaders is to seek out and provide resources and structures to support, drive, and sustain QI in the agency.
This involves budgeting for QI, seeking out resources to sustain FTEs for QI, and allowing for in-kind support.
A functioning QI governance structure oversees the QI program
Leaders have the necessary training to drive QI culture transformation in agency (e.g. leading QI efforts, change management).
Facilitator Questions:
Does the agency have sufficient funding and resources allocated for QI?
Does the agency have a high functioning QI Committee?
Do leaders have the necessary KSAs necessary to drive and sustain QI?

24. Leadership Commitment
Sub-Element 3.2: Resourcing & Structure
[Placeholder slide to facilitate scoring of Sub-Element 3.2: Resourcing and Structure.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

25. Foundational Element 4: Customer Focus
A customer focus is part of the agency’s core values and vision
Programs understand and respond to customer needs through community engagement
Customer satisfaction data is collected
Customer data drives decision making and improvement efforts
Employees are empowered to exceed customer expectations
Add current efforts to collect and use customer data.
Talking points:
Customer focus is a core tenet of quality. Customers can be both internal or external to the health department. Key external customers to the health department include the community it serves, tax payers, and funders.
It is important for all work units to identify who all of their customers are and understand both their needs and values and the degree to which current programs/services are meeting their needs.
For programs and services that serve the community, community engagement is prevalent – working collaboratively with groups within the community to inform programs and services designed to address those needs.
This must be accomplished by authentic community engagement and ongoing collection and use of customer needs and satisfaction data.
Work units with internal customers (e.g. HR department, QI Committee) should also understand needs and satisfaction of other staff in the agency.
Customer input should be taken into account when prioritizing services to offer and when selecting areas of our agency to target for improvement through a QI project.
Facilitation Questions:
Can anyone think of ways that we involve customers in improving our programs/services now?
Facilitator Instructions:
Add current efforts to collect customer data. For example, do certain departments have feedback forms? Has the agency conducted a stakeholder analysis identifying various customers?

26. Customer Focus Sub-Element 4.1: Understanding the Customer
How well do programs and services continuously engage the community to understand needs of different customer groups?
How well do administrative work units with internal customers (e.g. Human Resources, Finance) understand needs of staff?
Talking Points:
This sub-element assesses the degree to which the agency collects and uses data on customer values, needs, and satisfaction to drive decision-making and continuous improvement.
Facilitator Questions:
How do programs and services engage the community to understand and address current and emerging needs of different customer groups (e.g. racial/ethnic groups, low-income groups)?
How well do work units with internal customers (e.g. HR dept) understand needs of staff?

27. Customer Focus Sub-Element 4.1: Understanding the Customer
[Placeholder slide to facilitate scoring of Sub-Element 4.1: Understanding the Customer.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

28. Customer Focus
Sub-Element 4.2: Meeting and Exceeding Customer Expectations
How do we collect customer satisfaction data cross the agency?
To what extent is internal and external customer input and satisfaction data used to drive improvement efforts?
How are staff empowered to resolve customer issues?
Talking Points:
Facilitator Questions:
How do we collect customer satisfaction data cross the agency?
To what extent is customer input and satisfaction data used to drive improvement efforts?
How are staff empowered to resolve customer issues?

29. Customer Focus
Sub-Element 4.2: Meeting and Exceeding Customer Expectations
[Placeholder slide to facilitate scoring of Sub-Element 4.2: Meeting and Exceeding Customer Expectations.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

30. Foundational Element 5: QI Infrastructure
Components of a strong QI infrastructure:
Alignment with strategy
Performance management system
QI governing body
QI Plan and/or policy
Talking Points:
To achieve a culture of quality, and organization must have the systems and structure in place to support QI. QI must be aligned with the organization’s mission, vision, and strategic plan and linked to organizational and individual performance. The following are components of a strong QI infrastructure:
QI Governing Body is a cross-sectional group of staff which governs the agency’s quality program, overseeing the implementation QI initiatives, supporting individual QI projects, reviewing performance data and reporting progress, mentoring staff, and recommending next steps.
The performance management system (PM System) provides a framework for measuring, monitoring, and reporting progress toward strategic organization, division, and program goals and objectives. It provides a structured, data-driven approach to identifying and prioritizing necessary QI projects. Progress against the agency strategic plan should be monitored with the PM system and work teams should link their performance goals to the strategic plan.
The QI plan outlines the agency’s QI goals and objectives, providing direction and structure for QI efforts.
We will now discuss the QI Infrastructure the agency currently has in place.
Facilitator Instructions:
Tailor the next four slides to discuss the agency’s current QI infrastructure

31. QI Infrastructure Sub-Element 5.1: Strategic Planning
How well do we operationalize an agency strategic plan?
What processes are in place to link department-wide programs and services to strategic goals?
Does the strategic plan guide resource allocation?
Talking Points:
This sub-element assess the degree to which the agency engages in a 3-5 year strategic planning process that is implemented and monitored for success against strategic goals.
The strategic planning process should include all the elements listed on this slide and the agency is held accountable for implementation of the strategic plan.
The strategic plan should be linked to QI activities. For example, strategic goals that are not being met should be prioritized as QI projects.
Facilitator Questions:
How well do we operationalize an agency strategic plan?
Does the strategic plan guide resource allocation?

32. QI Infrastructure Sub-Element 5.1: Strategic Planning
[Placeholder slide to facilitate scoring of Sub-Element 5.1: Strategic Planning.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

33. QI Infrastructure
Sub-Element 5.2: Performance Measurement and Use of Data
Is there an effective agency-wide process for developing meaningful performance metrics in all programs, services and departments?
How do we ensure a mix of meaningful process and outcome performance measures that link activities to outcomes?
Do programs, services, and work units link performance measures to agency level measures?
Talking Points:
Performance data is the backbone of QI. The performance management system should be established to identify metrics and standards against which performance is monitored.
A mix of process, output, and outcome metrics are used to understand effectiveness of programs and services and more readily identify targeted areas for improvement.
Performance standards and targets are set to assess against metrics using sources like national or state standards (e.g. HP2020), past agency performance, or peer agencies.
Data sources are defined for all metrics and responsible staff regularly collect data using an effective information system for storing and analyzing data (e.g. performance dashboard).
A schedule for frequency of data reporting to relevant stakeholder is followed.
Facilitator Questions:
Is there an effective agency-wide process for developing meaningful performance metrics in all programs, services and departments?
How do we ensure a mix of meaningful process and outcome performance measures that link activities to outcomes?
Do programs, services, and work units link performance measures to agency level measures?
How is performance data being used to identify and implement improvements?

34. QI Infrastructure Sub-Element 5.2: Performance Measurement
[Placeholder slide to facilitate scoring of Sub-Element 5.2: Performance Measurement and Use of Data.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

35. QI Infrastructure Sub-Element 5.3: Quality Improvement Planning
How is performance data being used to identify and implement improvements?
Are unmet strategic goals prioritized for QI?
How well do we operationalize our QI plan?
Talking Points:
A QI planning process should be adopted by an agency to ensure that progress is being made toward a QI culture through an adopted QI plan. This QI assessment process with inform what goes into the QI plan. Performance data should also be used to identify QI projects for inclusion in the QI plan.
The agency holds staff accountable to implementing the QI plan and a process is in place to evaluate progress against the plan and make necessary revisions.
Facilitator Questions:
How is performance data being used to identify and implement improvements?
Are unmet strategic goals prioritized for QI?
How well do we operationalize our QI plan?

36. QI Infrastructure Sub-Element 5.3: Quality Improvement Planning
[Placeholder slide to facilitate scoring of Sub-Element 5.3: Quality Improvement Planning.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

37. Foundational Element 6: Continuous Process Improvement
Also called Continuous Quality Improvement (CQI)
Common methods are Lean, Six Sigma, and Plan-Do-Study-Act (PDSA) cycles.
Elaborate on health department’s QI process here
Add how staff can nominate or get engaged with QI projects.
Talking points:
Continuous process or quality improvement is an ongoing quest to improve processes by identifying root causes of problems and making plans to address those root causes.
Performance is improved through the systematic application of proven QI methodologies that engage work team members in developing permanent changes to processes to reduce waste, improve quality of services, and increase customer satisfaction.
As our QI culture advances, CPI becomes increasingly embedded into daily improvement activities as part of normal work in addition to being applied through formal QI projects, resulting in broader and more rapid process improvement
The goal is not perfection, but continuous improvement. It involves gradual improvements to everyday processes using a defined method. We are going to illustrate how this process works with example(s) from our health department.
Facilitation Questions:
Can you think of any possible QI projects that could improve performance in your work unit or at the agency level?
Facilitator Instructions:
Customize this slide with the QI process(es) your agency uses, replacing the Model for Improvement if not relevant to your agency.
Use next 2 slides to give examples of results achieved from past QI initiatives and current projects underway

38. Continuous Process Improvement
Sub-Element 6.1: Improving Standardized Work
Do staff have access to a library of standardized work processes or procedures?
Are they consistently followed?
How well do we formally apply QI method(s) to improve work processes?
Talking Points:
Documenting and deploying standard methods of how work gets done, i.e. standard operating procedures or SOPs, so it can be effectively used to decrease variation and enable continual process improvement.
Standard work processes should exist for all work units and grounded in evidence base as the best method for accomplishing work or achieving results.
Employees are trained in standard work processes and they are consistently followed throughout the agency
Processes are in place for storing and updating standardized work processes so they are readily accessible to all staff.
Facilitator Questions:
Do staff have access to a library of standardized work processes or procedures?
Are they consistently followed?
How well do we formally apply QI method(s) to improve work processes?

39. Continuous Process Improvement
Sub-Element 6.1: Improving Standardized Work
[Placeholder slide to facilitate scoring of Sub-Element 6.1: Installing Standardized Work.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

40. Continuous Process Improvement
Sub-Element 6.2: Planning for QI Projects
Do our QI projects adhere to formal QI methods?
How clearly do we scope QI projects with Aim statements and baseline data?
How well do we investigate root causes of a problem?
Are best or promising practices considered for potential improvements to test?
Talking Points:
This sub-element assesses the degree to which we effectively follow steps in the “Plan” phase of the Plan-Do-Study-Act cycle. This includes the following:
Clearly defined improvement objectives and Aim statements which are specific and measurable?
Examination of current work process to determine root causes. For example, through the use of baseline data, flowcharts, or other Root Cause Analysis methods prior to diagnosing and solving problems?
Identification of best practices used to inform potential improvements and analysis of unintended disruptions or inefficiencies that may arise.
Detailed plans for testing the selected intervention which state the hypothesis, timeline, data collection methods, and staff roles.
Facilitator Questions:
How clearly do we scope QI projects with Aim statements and baseline data?
How well do we conduct root cause analysis (RCA) to understand the problem?
Are available best or promising practices considered for potential improvements to test?

41. Continuous Process Improvement
Sub-Element 6.2: Planning for QI Projects
[Placeholder slide to facilitate scoring of Sub-Element 6.2: Planning for QI Projects]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

42. Continuous Process Improvement
Sub-Element 6.3: Testing, Studying, and Acting on Potential Solutions
Are tests done on a small scale and gradually scaled up once improvements are demonstrated?
How are we documenting results and lessons learned from QI projects? Are standardized work processes updated accordingly?
How often do QI projects result in measurable improvements?
How frequently are we sustaining improvements?
Talking Points:
This sub-element is closely related to the ‘Do,’ ‘Study,’ and ‘Act’ phases of the PDSA cycle. It is about systematically testing and validating proposed solutions prior to implementation, in order to build knowledge and increase the likelihood of success. For every QI project:
Potential improvements are tested on a small scale in the real environment according to a test plan and results, observations, problems are documented.
Results are compared to baseline data and gaps between predicted and actual results are studied and documented
Proposed solutions are either scaled up or standardized, i.e. adopted; adapted with a revised test; or abandoned.
Facilitator Questions:
Are tests done on a small scale and gradually scaled up once improvements are demonstrated?
How are we documenting results and lessons learned from QI projects? Are standardized work processes updated accordingly?
How often do QI projects result in measurable improvements?
How frequently are we sustaining improvements?

43. Continuous Process Improvement
Sub-Element 6.3: Testing Proposed Solutions
[Placeholder slide to facilitate scoring of Sub-Element 6.3: Testing Proposed Solutions.]
Talking Points:
Based on the previous discussion, lets score ourselves on the diagnostic statements in this sub-element.
Provide instructions on scoring based on your process.
Facilitation Questions:
This slide should be used to facilitate the scoring process for this sub-element. Adapt the slide according to your process. Some options include:
Provide hard copies of the assessment, and provide the group with some time to individually score the diagnostic statements. Following the meeting, collect all the scores and calculate the agency’s final score.
Incorporate a group polling system into this presentation. Program the diagnostic statements in the system prior to the meeting. At this time, ask the group to use their hand held device to input their scores.
Facilitate a group voting process using a “majority wins” approach. Go through statement by statement, asking the group to which rating they have selected. Once the score with the majority votes is determined, ask the remaing respondents if they are comfortable with this score.

44. Next steps
[Insert next steps for scoring, selecting transition strategies, and updating the QI plan per agency’s process.
Talking points:
Discuss how the results will be used and next steps in the QI assessment and planning process.
Facilitator Instructions:
Customize this slide to reflect your timeline and assessment process.

45. THANK YOU!
Questions?