Blog: Implementing quality improvement in your organisation
We work in an industry that is constantly moving, with new and established frameworks and practice standards to meet. We need to know why these standards are being implemented, where our organisations meet them, and what we can do to improve. In other words, quality improvement is the core business of every service provider and every set of service delivery standards.
1. Why do we care about quality improvement?
Quality management and improvement are about our organisation meeting quality standards (which we usually establish through having third parties oversee our operations and governance). This means we need sufficient understanding of our area of work, client cohort, service delivery area, and relevant standards to take remedial action in areas where we are not meeting quality standards. The measure of success for quality improvement systems is that the services provided are effective, the feedback is (honestly) positive, and quality standards are being met (or exceeded).
While we often focus on assessing our operations and governance – particularly in relation to audits – quality improvement isn’t just about audit cycles. It is also about being proactive: seeking feedback (and understanding that feedback), not only from the clients or consumers receiving services, but also from staff, board members, and the support networks of our clients. Ultimately, quality improvement systems are focused on delivering really high quality services and outcomes for every single client.
2. So, what is quality improvement?
Quality improvement (or quality management) is the name for the processes you use to make sure that you are providing high quality services. It involves continuously evaluating whether your service aligns with performance indicators in relevant standards, as well as professional values. Core quality management activities include information gathering, listening to participants and other stakeholders, understanding what is working well in in the way you are delivering services, identifying where improvements are needed, and taking action to make sure those improvements best meet the needs of participants.
3. How do we do quality improvement?
Quality improvement processes are required in most service standards. These standards detail the level of quality to be achieved and your quality improvement system needs to show how your organisation is doing this. This means that you need to both undertake quality improvement processes and document these processes and their outcomes. Let’s look at this in some detail.
The foundation – policies and procedures
You need a clear policy and set of procedures that summarise both your organisation’s commitment to quality management and the processes you undertake for continuous quality improvement. These processes must include stakeholder input and consider how this is documented (so you have evidence of how that input is integrated into the process), as well as an active methodology or process for how you identify and investigate issues and develop strategies for improvement.
Communication and action – whole-of-organisation focus
Your policy, procedures and processes must be communicated (and implemented) across your organisation. This provides for a consistent approach to quality improvement across all relevant standards. While your governing body has core responsibilities in championing quality improvement, all staff share in the responsibility for meeting standards and addressing non-compliance.
Gathering and documenting quality improvement information
We have already seen that gathering feedback from stakeholders is essential to both evidencing your compliance with standards and identifying areas for further work. Formal and informal feedback mechanisms, surveys, service reports, and other common organisational documents can provide invaluable input. Essential information also comes through reviewing service outcomes, risk assessments, and actual or near-miss incidents. It is important that you don’t rely solely on reported incidents, near-misses, or complaints, but that you proactively seek to identify issues, consider where poorer outcomes are possible, and consider actions to mitigate the risk of actual and potential harms.
It is also critical that your organisation thoroughly investigates incidents and near misses to identify their root causes. For example, while unsafe staff driving may be attributed to individual staff members’ poor behaviour, in reality it could be caused by insufficient travel time being allowed for travel between service delivery activities. In this case, trying to address the problem by focusing on individual behaviour without systemic organisational change wouldn’t provide a real solution.
This information needs to be securely documented and shared with people who have responsibility for monitoring and improving quality. We suggest using a quality improvement system. This can be as simple as an Excel spreadsheet or one of the electronic quality management systems available for purchase. It is essential, however, that this system that clearly links inputs with issues identified, remedial strategies attempted, and their outcomes.
The quality improvement cycle – plan, do, check, act
The ‘plan, do, check, act’ cycle is a great core framework or methodology for guiding quality improvement.
Step 1: Plan
Start by self-assessing against all the quality indicators or requirements of the relevant set of standards (e.g., HSQF, National Principles for Child Safe Organisations). This will help you develop a real-time understanding of your compliance status and, more importantly, will help you identify gaps and areas for improvement. Doing this regularly (e.g., quarterly or half yearly) and assessing your progress since the last review (What gaps did I identify? Where am I now?) provides a basis for a great continuous improvement process.
- Use internal reports, previous continuous improvement information, self-assessment tools, etc., to gain an accurate understanding of current organisational practice and governance in relation to each indicator.
- Gather and synthesise input from stakeholders, as well as reports on complaints or incidents, into your self-assessment.
- Establish the goals you want to achieve and strategies (i.e., improvements to be made) to help achieve these goals.
Step 2: Do (a test)
Test your thesis and whether the goals and strategies you have identified will work in the organisational context (consider the purpose of the organisation, the client group, the broader environment, etc.).
- Consult with staff, clients, your governance body, and other stakeholders regarding your goal and strategies.
- Test the proposed changes to organisational processes and document outcomes.
- Make sure that the strategies being tested are actually implemented!
Step 3: Check
Evaluate the strategy or strategies you have implemented.
- Has it/have they delivered what was intended?
- Has it/have they improved the quality of service your organisation is delivering?
- Has it/have they reduced the risk of harm?
- What do the relevant stakeholders have to say about it?
On the basis of this evaluation, you might determine that the strategy is workable and should be implemented as is, that a tweaked version of the improvement needs to be tested, or that you need to go back to the drawing board.
When you have a workable strategy, it is time for Step 4.
Step 4: Act
Formally change the relevant policies, procedures, and processes. Once this has been done, ensure that the change is effectively communicated, that the governing body is aware of the change and has ratified it, and that all affected staff and clients (or other stakeholders) are familiar with it and know what their rights or responsibilities under the new arrangements are.
Truly continuous improvement
Step 4 is not the end of the process. Rather, the cycle re-starts. But this is easily missed: Everybody is so busy on service delivery – which is the most important thing – that quality improvement processes can be de-prioritised.
Where people simply do not have enough time to focus on quality management, we often see pinch periods – a panic three months out from an accreditation review or audit when there has been no improvement since shortly after the previous one, for example, and a scramble to make changes before the auditor arrives. This is not really a continuous improvement process and it won’t get you to where you want your organisation to be.
Community sector standards are moving towards a greater focus on continuous improvement as a theme. That is to say, there is a trend towards a reduced focus on auditing and ‘ticking off’ indicators for standard compliance and a greater interest in organisations demonstrating that they have a real continuous quality management and improvement process. By documenting thorough quality improvement cycles and outcomes, organisations can establish their commitment to the quality and safety of their service provision.
Using a quality management system
There are tools available to help you work through quality improvement processes, known as quality management systems (QMS). If you are looking to implement a QMS, it is worth taking the time to consider what a good QMS looks like for your organisation. The QMS should:
- Operate on the basis of your organisation’s core policies and procedures, reinforced by the service delivery standards you need to meet.
- Allow you to adequately document each stage of the review and strategy implementation cycle.
- Guide you through following the relevant policy for a particular issue, such as the process for investigating and responding to a hazard, incident, near miss or complaint, and to comprehensively document this process.
- Allow for collaboration to facilitate the actions of all staff and governance body members to meet their responsibilities and to have input into the identification and resolution of issues.
- Be easily accessible and easy to manage.
- Be able to generate quality reporting, not just on your compliance status against a relevant standard or indicator, but to provide snapshots of quality improvement processes and outcomes. If you have a quality framework that goes well beyond the minimum standards you need to comply with, your QMS should have the capability to report against your internal organisational standards.
Quentin Jones is a Director of Breaking New Ground (BNG), which has been helping Australian community services and health service providers streamline their standards compliance, quality management systems and organisational capacity building for over 20 years. BNG’s Standards & Performance Pathways (SPP) is a leading online standards compliance and quality improvement platform used by over 1,500 providers nationally.
QCOSS thanks Quentin for conducting the quality improvement session with the QCOSS’ Quality Collaboration Network, which provided the content for this post. Find out more about the Quality Collaboration Network here.