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How Do I Assess My Agency’s Culture of Quality? Practical application of NACCHO’s Organizational Culture of Quality Self-Assessment Tool
Tamara Bannan
County of San Diego HHSA
Public Health Services
Pooja Verma
NACCHO

2. Organizational Culture
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Organizational Culture
“Organizational culture is defined as the shared beliefs, perceptions, norms, values and expectations of individuals in organizations.”

3. Culture Transformation: Change Management
1. Unfreeze
Awareness
Readiness
Urgency
2. Transition
Empower
Build capacity
Build infrastructure
3. Refreeze
Institutionalize
Sustain

4. Change Management “Human” Side: “Process” Side:
How are staff responding?
Is there resistance?
Are arising issues addressed?
Is the environment “safe?”
Continually assess culture
“Process” Side:
What systems/processes must be put in place?
Do we measure performance?
Are formal plans, policies, and procedures?
Is there accountability?

5. NACCHO’s Roadmap to a Culture of Quality: www.qiroadmap.org

6. NACCHO Roadmap to a Culture of Quality
Phase 1: No Knowledge of QI
Phase 2: Not Involved with QI
Phase 3: Informal or Ad Hoc QI
Phase 4: Formal QI in Specific Areas
Phase 5: Formal Agency-Wide QI
Phase 6: QI Culture
Agency Characteristics
Transition Strategies
Resources

7. Building an Organizational Culture of Quality: 6 Foundational Elements
Quality Culture
Leadership Commitment
Employee Empowerment
Teamwork & Collaboration
Customer Focus
QI Infrastructure
Continual Process Improvement
Source: NACCHO’s Roadmap to a Culture of Quality

10. Organizational Culture of Quality Self-Assessment Tool
Comprehensive assessment
Based on the 6 foundational elements (20 sub-elements)
Aligned with QI Roadmap
Offers transition strategies based on results

14. Naccho qi Self-assessment tool
San Diego’s Approach in Using It
Presented by
Tamara Bannan, MPH

15. Overview of process
Reviewed the NACCHO Quality Improvement (QI) Self- Assessment Tool (SAT)
Obtained input from Performance Management Committee
Determined best method to implement
Conducted eight sessions with each PHS branch and administration office

16. SAT session Agenda This agenda was used at each two-hour session
Purpose and overview of NACCHO QI SAT
Instructions for completing the scoring summary
Overview of the foundational elements
Score sub-elements
Discuss next steps

17. Example from the QI SAT Sub-Element 1.1: Enabling Performance
Foundational Element 1: Employee Empowerment and Commitment
Sub-Element 1.1: Enabling Performance
Rate the following statements regarding enabling employees for success in the organization.
Strongly Disagree 1 2 3 4 5
Strongly Agree 6
Creating Expectations and Getting Feedback
Defined job and QI related roles and expectations are understood by employees. 
Employees use performance measures and targets for problem solving and improvement in their work.
Employees receive effective feedback on job performance on a regular basis.
QI related goals are incorporated into the performance appraisal process.
Employees are acknowledged and/or rewarded for their contributions and successes.
Providing Resources
Employees have the necessary resources (information and materials, supplies, IT infrastructure) to successfully perform their role.
All employees have access to a skilled practitioner (e.g., supervisor, mentor) to get help on required work.
Empowering Individuals and Teams
Leadership provides employees the authority to make decisions and take action to improve their own work processes.
Defined processes are used for addressing problems related to quality.
All employees have the opportunity to identify and nominate improvement activities and formal QI projects.

18. Foundational Element 1: Employee Empowerment and Commitment
Sub-Element 1.1: Enabling Performance
Rate the following statement in blue regarding enabling employees for success in the organization from 1 to 6 (strongly disagree to strongly agree)
Creating Expectations and Getting Feedback
Defined job and QI related roles and expectations are understood by employees.
Employees use performance measures and targets for problem solving and improvement in their work.
Employees receive effective feedback on job performance on a regular basis.
QI related goals are incorporated into the performance appraisal process.
Employees are acknowledged and/or rewarded for their contributions and successes.

19. Instructions provide to staff
Rate the main points shaded in blue from 1 to 6 (strongly disagree to strongly agree)
Supporting statements alternately shaded below will be used as guidance
Performance Management Core Team will average the scores for each sub-element across the entire PHS division and gather an overall score for the foundational element
Scores will be used to determine the appropriate next steps for continuing to build a culture of quality

20. Screenshot of scores

21. Next steps Based on finding from the Self-assessment
Finalize QI Plan to meet PHAB requirements and use data in its development and revisions
Develop specific goals for QI activities with SMART objectives
Provide more learning opportunities
Support collaboration across programs
Include customer-focused data collection for improved service, especially for those with internal customers
Include QI competencies in Workforce Development Plan
Train and develop leadership in performance improvement