The Road to Excellence

We are committed...to accreditation!
August 2001
By: Tom Kirkbride

As Director of Quality Assurance there are times when I wrestle with implementing and utilizing COA's standards in my organization. I have wrestled with the "what and how" to do it, because there seems to be a lot of added work for everyone involved. You may think that too. I have worked through the "what and how" and wanted to share my thoughts to hopefully make it easier for you. I hope this helps educate and inspire you to view Quality Assurance (QA) / Continuous Quality Improvement (CQI) a little differently. I want to examine the notion that QA/CQI is a "burden" or a "paper work exercise." I think we get stuck in the implementation and utilizing the standards and need a little redirection from time to time. QA/CQI truly needs to improve services. In addition, I want to provide some direction for change in your program, department or organization.

Organizations regularly experience change; both internally and externally. In spite of the changes, it's important to keep focused on what our business is and how it's done. All CEO's want all programs and departments across the organization to do excellent and efficient work. The children, youth and families deserve it! Besides, who doesn't want to provide excellent and efficient work?

Accreditation Means Excellence in Services

Excellence is the expectation. Excellence means meeting the needs of the child, youth or family, as the client/customer defines the need, and how the program or contract defines it, and how to do it in the most humane, nurturing and supportive manner possible. The expectation for all staff is to provide excellent service delivery in all aspects of the organization and in customer service, and to go the "extra mile" for the client/customer, do the best we can, ask how we can do it better, work hard and love doing it. To help organizations efforts all programs and departments need to have goals. Employees need to know the goals for his or her program or department, and how they are progressing toward their goals leads to excellent services.

How does this fit with COA's Standards and Accreditation you may ask? All of us want to give and do our best. The standards are the tools that help the organization obtain excellence. How? We look at what and how we do our current services. We compare what and how we do it with the COA's standards. We identify what we're not doing, and then make a plan to align the service or program according to the standards and/or contract to its stated requirements. The standards support the most humane and efficient means to give children, youth and families the best service possible. QA/CQI is a means to measure what and how we do our work. In other words, what are the processes for operations within each department? How does information flow between departments? Are clients satisfied? Can we do it better? Are we achieving good outcomes? Are the customers getting the best treatment? Are service plans followed? Are we providing best practices? Are systems in place for monitoring / recording results? These are some of the areas we must examine. It's worth the effort to work through these types of questions.

Use the Standards As a Guide, Not the Means to the End

To view what and how you do your work, as if it can't be improved would be a big mistake. There is always room for improvement. Do you see accreditation as a burden? Or, are you really involved because you really want services to improve? Are you looking at what and how you do your work or are you just going through the motions because so and so said so? Pitfalls such as these stop progress to improve quality. It's true that accreditation makes the organization "look good" and may help make it easier to get funding. However, we must remember the underlying goal for the organization is to offer excellent services.

The standards are a guide not the means to the end. The organization doesn't provide services to COA, they accredit organizations for quality services. Providing excellent services to the children, youth or family is the means to the end. Another critical factor that makes QA/CQI effective is the collective knowledge of staff and clients/ customers involved to improve service delivery. Without staff and client/ customer involvement/input the improvement process stops. I believe at times we're a little too close to our work and are not able to see what can be improved. A client/ customer or staff member may see what you can't. Input from others to improve service is critical at all levels.

Organizations need tools to help view their work a little differently. The standards provide the opportunity for proactive change. The challenge for us is to keep this perspective. I believe implementing change will be easy if we think of the standards as a guide to improve what you do well already, which may require a shift in your thinking. Beware of the attitude, "We're used to doing things this way, it works fine - don't fix or change it." COA's standards requires all levels of the organization to step back and take an objective look at what and how work is done. It requires staff to think what is and isn't necessary. It allows programs and departments to do away with the less efficient and implement the more efficient, to recognize patterns or trends, which need to be changed. It allows organizations to streamline the function and/or operations of their work and organize it in the most effective and efficient way possible.

Improvement Over Time Will Continue to Enhance Services

In order for our work with QA/ CQI to have a long-term impact on the quality of services at the organization, staff must look at what and how they do their work. The Japanese use the word "Kaizen" to describe the process for incremental change. It means improving the process for quality products incrementally. The benefits can be seen in nearly all technical and industrial sectors today, because "Kaizen" is applied, and even more efficient systems are being created from these processes. The Japanese automobile industry is a very good example of this principle. We have seen vast amounts of Japanese car sales in America - Why? They use the process of incremental change and utilize input from staff and the customer to improve product and systems quality. We need to do the same.

Incremental change in service delivery is best when planned in small steps. To make changes that are too large and too difficult will only frustrate staff or the process. QA/CQI isn't asking to make huge changes, unless someone or something is at risk or in harms way or isn't in compliance (generally an administrative/ management concern). As you review COA's standards, be careful to view them as tools to help improve service delivery, not as a task or paper project. Service delivery spans across all programs and departments, improvements will be made at all levels. What and how you provide service can incrementally change and have a profound impact on quality to the children, youth, families and staff served.

If QA teams have been established in your organization, which evaluates agency compliance with standards and the administrative systems or general service standards, and if CQI teams have been formed which are program/ departmental or site specific and focus on continuous quality improvements with customer satisfaction, outcomes, etc., then you can get on to do the work to really improve programs or departments. Establishing these groups improve systems of service, it helps the organization define the "what and how," and supports your organization establish goals across all programs and departments. If these groups are not established, it maybe the first step to an infrastructure for quality services.

Having established these groups, developing a quarterly and annual reporting system to report group progress is necessary to review their work. The main oversight group of QA/CQI in the organization should monitor all activity, and then you're well on your way to greater service delivery and improvement across all programs and departments. This system design supports the environment of quality monitoring systems for accreditation. When it is established and operational, I believe managing services at your organization will be easier, as well as be cost effective and with an environment of continued excellence for the client/customer and staff.

Suggested Steps for QA/CQI Implementation:

QA Team Focus (Administrative or Management Focus)
- Define what and how you do things now. (If you don't do this, you have no basis to improve your system of operation or service delivery.) (Better known as COA's self study, but can be done continuously)
- View the standards openly and honestly. Ask - are we really providing the service or not?
- Identify what needs to change according to the standards.
- Document your findings, and then prioritize them according to greatest or most crucial need to improved service delivery, then implement change. Report the changes to the Director of Quality Assurance.

CQI Team Focus - All Programs and Departments (Deming's - Plan, Do, Check, Act Model)
- Begin or plan one Performance Improvement Project, then propose it for improved service delivery.  If needed, get a baseline from actual data. Once approved, implement the project.
- Make necessary changes.
- Report your findings.
- Study your findings and draw conclusions. Plan more changes or experiment again.

Tom Kirkbride is the Director of Quality Assurance for Para Los Ninos in Los Angeles, CA.   He is a founding member of the Quality Assurance Association of Southern CA and holds a Master of Arts Degree in Organizational Behavior from Phillips Graduate Institute. E-mail: tomdebkirkbride@yahoo.com  Phone: 213-553-1569