QI Q & A

Quality Improvement Plan "Buy-In"
January 2002
By: Linda M. Longo

Question:
Our agency began implementing a CQI plan about a year and a half ago and we still struggle with "buy in" at all levels. I'm wondering what people are doing in their own agencies to make CQI efforts more visible and accepted.

Answer:
I struggle with this all the time! I'm at a residential treatment center and it has been 1 year / 2 months since we introduced a CQI Plan here. I have no real answer but will share some things we've tried to introduce continuous improvement to the agency culture:

1. Review the plan every 6 months and invite all direct staff members to participate in the review. Ensure (ahead of time) that administrators/managers free or reserve time for their staff members who want to participate in the review - even if it means paying some overtime! This open invitation - with accommodations - has started to help people "believe" that improvement is a process, not an event or simply a written plan, and that they can have a voice. It also reinforces that there are "no secrets" - everyone is equally aware of the direction the improvement processes are taking, helping keep administrators connected to line staff and vice-versa ("I only know what you know"). We utilize an ongoing "committee structure" and have written policy about participation in the structure (basically, participation is a part of your job if you'd like it to be, with parameters) and included a statement of encouragement in the General Personnel Handbook. This has helped integrate the improvement process into our agency culture.

2. CHEERLEAD, CHEERLEAD, CHEERLEAD! I view this as one of the most important parts of my job. "Hand pick" and encourage people at your agency who are motivated & positive to join a work team/committee (whatever your structure). Empower these people - concrete, achievable, and visible tasks / projects are best because you hope that their "word of mouth" about a positive outcome will encourage others to join. Anything generated by a committee or committee recommendation is put out with that heading - even little things like "Winter Reminders From the Safety Committee", or larger reports generated state who / where and why it's being done. This has helped people understand more about what the committees actually do, as well as some of the more "tedious" work that goes on in the background. The more people understand, the more we've found people making suggestions of what they want to see reviewed, changed or improved. There is still some resistance, which can be very frustrating at times, but I find focusing on the positives - the motivated participants, the small changes, the step closer to a middle ground, you find yourself more motivated (and a better cheerleader), which leads to more productive processes!

3. We started a CQI Committee focused on employee incentive / recognition and team building / strengthening communication between departments. It's basically a "fun" group - they publish a monthly staff newsletter welcoming new employees, reporting on happenings in each department, spotlighting local shopping areas, brainteasers / contests and so on. They also started a "Starfish Award" program, allowing colleagues to recognize each other with a simple handwritten award. Sometimes we have up to 30 Starfish Awards distributed over the course of a month - someone thanking a colleague for staying late to help meet a deadline, someone saying thanks for covering a shift on short notice, etc. This committee even published a professional Cookbook with recipes from staff in all departments, board members, friends - sold them - and now have their own small budget use for random drawings, contests in the newsletter and sponsoring coffee hours. This group has done a lot in terms of getting people talking to each other - if even socially at a "Coffee Hour". The committee has been extremely helpful in showing others that the improvement process is a part of our culture - because people see what they do. It's harder to have people buy into what they don't see as often (or something that's not as "fun" to see such as a record audit report or a referral report). So this committee has done wonders to get people at least talking about improvement and I believe it trickles through the agency.

4. Management / Supervisors have to buy in to the improvement process...We started with the Board first - secured their full support and then introduced the plan and structure to the Administration. Knowing that the Board supported continuous improvement went a long way with the administration - but it is a constant struggle. Understanding that the improvement process can feel very threatening at this level ("Am I going to loose power to a committee?") and understanding that people may feel, "The old way was my way and now you're telling me that I was wrong?" is critical - I fall back on the social work skills! You have to listen to what people want (both direct staff and management) and somehow come up with creative ways to SLOWLY move them a little closer to the same space.

5. A last little thing I do is put out quarterly "Updates" on what CQI Committees have been doing, what reporting has been done, etc. I do it as a flyer / seasonal type format rather than a memo - something that will catch people's eye to encourage them to read!

Best of luck to you!

Linda M. Longo

Linda Longo is the CQI Coordinator for Harmony Hill School in Chepachet, Rhode Island.  This article was taken from the QLN Discussion forum and republished here with permission.  E-mail: rid02034@ride.ri.net.