1. Seizing the CQI Opportunity
Peter Watson
August 15, 2014

2. CQI Framework and Definition
NRCOI/Casey CQI Framework (2005)
Developed by broad range of stakeholders
Presented CQI definition
Key CQI components
Cited in Children’s Bureau Information Memorandum on CQI, August, 2012

3. 8/5/2009
One Definition of CQI
CQI is the complete process of identifying, describing and analyzing strengths and problems and then testing, implementing, learning from and revising solutions…

4. One Definition of CQI (cont.)
8/5/2009
One Definition of CQI (cont.)
It relies on an organizational culture that is proactive and supports continuous learning. CQI is firmly grounded in the overall mission, vision and values of the agency…

5. One Definition of CQI (cont.)
8/5/2009
One Definition of CQI (cont.)
Perhaps most importantly, it is dependent upon the active inclusion and participation of staff at all levels of the agency, children, youth, families and stakeholders throughout the process.

6. Visual from the NRCOI/Casey CQI Framework.
8/5/2009
Visual from the NRCOI/Casey CQI Framework.
Developed by working session participants.

7. Children’s Bureau CQI Components
Foundational Administrative Structure
Quality Data Collection
Case Record Review Data and Process
Analysis and Dissemination of Data
Feedback to Stakeholders and Decision- makers and Adjustment of Programs and Processes

8. What is driving CQI in child welfare?

9. Past Pressures to Implement CQI
8/5/2009
Past Pressures to Implement CQI
Change focus from compliance to outcomes
CFSR process began in 2001
Quantitative and qualitative data
PIPs focused on systemic changes
Lack of measureable progress in many states
Accreditation efforts in some states
Lawsuits/settlement agreements
Heightened accountability expectations

10. Recent Pressures to Implement CQI
8/5/2009
Recent Pressures to Implement CQI
Children’s Bureau Information Memorandum on CQI—August, 2012
Program Instruction on Child and Family Services Plan (CFSP)
Child and Family Services Review (CFSR) Round 3 process and data measures
CFSR On-site Review Instrument

11. The Eureka Moment

12. Turning Pressure into Opportunity
8/5/2009
Turning Pressure into Opportunity
Some agencies have stepped back to assess and improve their CQI systems
Target resources to CQI to move agency into “learning/assessment” mode
Daily question: “What can we learn from this?”
Viewing CQI as an organizational shift may be LESS overwhelming than trying to implement a series of technical components

13. What are Agencies Doing?
8/5/2009
What are Agencies Doing?
CQI system assessments
Engaging more staff and stakeholders in CQI
Reconsidering case review approaches
Linking data from multiple sources
Building data analysis skills at all levels
Focusing on action planning
Participating in the National CQI Academy
Finalizing CFSPs submitted in June, 2014

14. What are Your Pressures?
8/5/2009
What are Your Pressures?
What pressures are you experiencing to implement a CQI system?
How might the different pressures on your management team impact your work together?
May need to understand these more to make progress

15. Lessons learned from State CQI Assessments

16. NRCOI’s CQI Assessment Process
Child Welfare Matters issue has details
Thank you to MN, OK, NM, FL, WI, IN and VA!
Pre-work: interviews, surveys, review current system elements, identify meeting participants
Meeting elements, including voting
Post-meeting
Mirror CQI action planning and implementation

17. Lesson 1: Develop Clear CQI Vision
CQI is more than just a set of activities
What are we trying to achieve through CQI?
If CQI were working optimally, what would be different in your work, the work of others, the response of stakeholders?

18. Shared Vision for a Learning Organization
A genuine mission and sense of “WE” and what “WE” are trying to achieve.
The vision drives curiosity and information seeking.
The vision is independent of leadership changes.
What is your vision for CQI?

19. Evolutional Direction for a CQI/QA system
A focus on effort: Datasets and reports on # served, caseloads, # with goals, % doing ___; % compliance ____.
to a focus on outcome: Data that can be mined for information on children/cases achieving and not achieving a goal. Drives change toward results.
and ultimately to a focus on impact: Data that pairs what happens or is done in cases to the results achieved.
Hodges, K. & Wotring, J. (2012). Outcomes management: Incorporating and sustaining processes critical to using outcome data to guide practice improvement. Journal of Behavioral Health Services & Research, 39 (2),

20. Lesson 2: CQI Leadership
Engage agency leadership in CQI
Varied commitment level across states/counties
Strategies for engaging and managing up
Building relationships to gain influence
Leading up, down, and across the organization (critical for CQI staff)
Continuously looking for ways to show CQI value

21. Lesson 2: CQI Leadership (cont.)
What are the unexpected leadership challenges of CQI?
How can we help each other anticipate and address them as we go forward?

22. Lesson 3: Challenges with Case Reviews
CQI = case reviews in many agencies
Many states have invested significant CQI resources in case reviews
Strong CQI systems use data from many sources
Third round of CFSR and expectations for states going forward

23. Current State Case Review Processes (Red = CFSR based; Blue = QSR;; Yellow = OtherWA ME MT ND VT OR MN NH ID SD NY MA WI CT WY MI RI IA PA NE NJ NV OH DC DE UT IL IN MD CO CA WV VA KS MO KY NC TN AZ OK NM AR SC AL GA MS TX LA FL AK HI
500 Miles
500 KM
AK & HI not to scale

24. Variations in Case Review Processes
8/5/2009
Variations in Case Review Processes
Frequency of reviews
Sample sizes and stratification
Interviews with case participants
Training and support for case reviewers
Use of staff and stakeholders as reviewers
Use of results
Link to broader CQI activities

25. Lesson 4: Turn Data Into “Information”
Create common understanding to spark discussions and inform action planning
Review data regularly and share broadly
Train CQI staff to prepare, present and facilitate the use of data
Working paper on this topic:

26. Lesson 5: Support Action Planning
Move beyond just collecting and analyzing data
Set expectations AND support efforts to use data to adjust practices and systems
Actively engage stakeholders in action planning
Start with small, doable solutions rather than grand solutions
Follow up and adjust!
Model action planning during CQI assessments

27. Lesson 6: Implementing CQI is a Challenge!
Difficulty of implementing CQI Action Plans
Confront idea that CQI conflicts with other priorities
Build relationships (up, down, and across the organization) to strengthen credibility
Prepare to be in “learning” mode throughout implementation to lessen frustrations when change is continuously required…flexibility is an absolute must!
Reference NIRN statements that “change is messy” especially during initial implementation. Let people know this ahead of time so they expect it and understand that adjustments will be made based on learning.

28. Eureka!

29. CQI Should Help Promote Insight
CQI not just a technical approach
Create an environment where staff and stakeholders can make connections and try new approaches
“The Eureka Hunt,” by Jonah Lehrer The New Yorker, July 28, 2008.

30. Please Contact Me With Questions and Ideas
Peter Watson
Director, National Child Welfare Resource Center for Organizational Improvement
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