The project manager is responsible for ensuring that participants receive high quality services, participants’ health and social service needs are met, and benchmarks are achieved. This requires the project manager to implement quality improvement policies and practices to monitor project performance and take corrective action, as indicated.
Healthy Start Specifics
Quality improvement (QI) is critical to all healthcare, public health, and social services providers. Stakeholders–participants, community partners, and funders–demand quality services. Your program has a key role in strengthening families and creating the foundation for optimal infant and young child health and development in your community. Improved data monitoring and performance will help your program to improve participant outcomes. However, these high-level goals require time to show improvement. QI efforts target efficiency and effectiveness in delivering services, and focus on performance improvements in the shorter term that lead to long-term outcomes.
As the program manager, you have a critical role in establishing a tone that communicates QI as an important part of everyone’s job. This empowers frontline staff to complete tasks and sustain improvements over time. You can demonstrate your endorsement of QI efforts by building time into your staff’s workload to attend to team meetings, ensuring the availability of space and other resources needed to support a team’s work, showing interest in QI processes and outcomes, and supporting indicated changes.
QI is a systems approach that mobilizes both data and team knowledge to improve decision-making. QI results in measurable improvements in efficiency, effectiveness, performance, accountability and outcomes, Quality improvement:
- Starts with an understanding of the system
- Examines program components and processes rather than individuals
- Includes and encourages staff involvement and a team approach
- Is data driven
- Centers on the participant
- Is part of an ongoing process
Focus on Systems
QI targets systems rather than individuals, but requires direct engagement of frontline staff in identifying problem areas, developing improvement strategies, and determining whether improvement has occurred. Intentional systems change requires a fundamental understanding of your program. An effective assessment tool will allow you to capture information about your program from many perspectives. A basic understanding of your program can identify broad areas for improvement, or can help you to focus in on a specific activity such as depression screening or set of services, such as prenatal services.
QI is a Team Activity
The team approach fosters ownership of the improvement processes and adopted solutions. The successful QI team will include an individual with the explicit role of guiding team members and moving the process forward, a staff person with administrative or operational authority to make decisions when the team identifies changes, and most importantly, frontline staff directly engaged in the processes you are trying to improve. The team may also include a participant. It is not essential that you as the program manager lead the QI team. When someone other than the formal leader assumes leadership of the team, more creative assessment and problem solving ideas may arise.
QI is data-driven. Using data separates what is thought to happen from what really happens, helps to identify problems and opportunities for improvement, provides information about root causes of problems, and enables comparison of measures over time to tell you whether changes have actually resulted in improvement. Useful data may be quantitative or qualitative, and can come from a range of sources. While quantitative data provide hard numbers for measurement, qualitative data can be valuable for understanding why a problem occurs, or for revealing possible approaches for improvement. Your program’s Capacity Building Assessment provides a place to start identifying improvement opportunities.
The Improvement Process
There are many QI approaches and models All QI approaches employ a systematic process of planning, trying out your plan, examining what happened when you tried it, and basing next steps on what you learned from your trial (this is the Model for Improvement adopted by the Institute for Health Care Improvement). QI starts with three basic questions:
- What is your team trying to accomplish?
- How will you know that you were successful?
- What changes can you make to get there?
Once you answer the three questions, the Plan-Do-Study-Act (or PDSA) cycle kicks into gear. It’s simple: design a plan to accomplish the desired improvement (based on data), put it into action, collect data about your intervention documenting what you learn along the way, examine the results of your trial (data), and determine how to move forward based on what the data show.
Where Do Change Ideas Come From?
Ideas for improvement come from many sources, including evidence-based practices and guidelines, expert opinion, brainstorming and creative thinking among staff members. Most changes will fall into one of three areas: improving workflow, enhancing participant-staff relationships, and standardizing processes that work well. Maintaining a focus on your services, keeping participants at the center, and tapping the knowledge of your staff will result in new ideas for improvement that ensure the quality of your program.
Ongoing Iterative Process
Small-scale changes are easier to manage, and allow your team to refine new processes, demonstrate their impact on practices and outcomes, and build support by stakeholders. QI is an iterative process. Your team will likely make frequent corrections along the way as they learn from each step and identify other actions to. Be prepared to refocus your aim. Any learning is forward progress–even if it is only learning about what does not work!
Encourage Reflection and Celebrate Successes
Celebration is an essential component of performance improvement. QI is challenging work. When progress is incremental, as it often is with QI, your staff may feel it is accomplishing little. A celebration acknowledges that something positive occurred. Sharing and celebrating success 1) fosters professional development, 2) highlights the work of the team and program, and 3) enables spreading of what works to other settings.
- Institute for Healthcare Improvement (IHI): IHI offers a wide range of resources and teaching tools to help health care professionals lead effective improvement efforts, enhance clinical outcomes, and reduce patient harm.