This is the first post of a multi-part series on Collaborative CQI (Continuous Quality Improvement)

Part 1: Creating Trust and Positive Impact

by Nathaniel Israel

Health and human service systems are composed of people. People make important decisions which shift the likelihood that children and families will meet their health and wellness goals. Having a common framework for understanding and improving decision-making is critical to system adaptation and child and family success. Responsibility and empowerment to make decisions cannot be left up to people at only one level of the system. Multiple lines of evidence indicate that alignment in decision-making at every level of the system is crucial to a system’s ability to perform. By alignment we mean that decisions are transparent at every level of the system, and serve the same end goal: improving the well-being of children and families.

Even when decisions are aligned and transparent, this does not mean that exactly the same data have the same meaning for decision-making for all stakeholders. Data must be aggregated at each level of the system in order to have meaning for persons making decisions at that level. This means that families most need data about their own progress. Front line staff need data about individual families’ progress and about the group(s) of families whom they serve. Supervisors need data about individual children and families, aggregate data about the children and families served by each supervisee, and aggregate data about all of the children and families served by all of the front line staff whom they supervise. This pattern repeats at every level of the system. Stakeholders need data at the level of the system for which they are responsible, as well as the ability to drill down to each of the levels below. Once such reports are designed, there must be continuous feedback on the effectiveness of decision-making. This feedback allows people at every level to identify and perpetuate successful decisions. Continuous feedback at every level also allows for the rapid detection and improvement of inappropriate or ineffective decisions. This begs the question-Which decisions should we focus on in an aligned, learning system?

The matrix provided below identifies key decision-points in care common to the experience of persons served in health and human-service systems. These decisions points are distillations of service processes. These processes are not limited to the sequence below, but commonly become important in this sequence. For instance, determination of system eligibility (access) commonly precedes collaborative assessment (engagement) and treatment processes. Using these decision points as a framework for multi-level alignment allows people at every level to see how important decisions about care are being made at each level of the system (transparency). Automated reports at each level of the system empower people to see the connection in real-time between actions at each service process and at each level of the system. In this way, people at every level of the system can see how they contribute to the success of children and families, and how they can improve the efficiency and effectiveness of their work with children and families.


Click this link to view the an expanded Table

Interested in developing an integrated feedback system which allows people at all levels to experience trust, growth and success? See the next briefs in this series, ‘Developing a Social Infrastructure for Collaborative CQI,’ and ‘Developing a Technical Infrastructure for Collaborative CQI.’ 

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