How a pandemic makes QI more relevant than ever (but also a little tricky)

This blog is part of the Learning and changing with quality improvement blog series. It explores the role of quality improvement in helping to redesign and enhance the services and systems that support children and families.

Since 2016, the Centre for Community Child Health has been engaged by the Victorian Department of Education and Training’s Best Start program to maximise participation in Maternal and Child Health and kindergarten services through the use of quality improvement. Together with Best Start facilitators and departmental staff, we continue to learn about how to best adapt this methodology to the community setting and its ability to deliver improvements.

This blog series is authored by Lauren Heery, Senior Project Coordinator in the Service Systems Innovation Team at the Centre for Community Child Health.

The emerging impacts of COVID-19

In Victoria, towards the end of March this year, the impact of COVID-19 was becoming real. Best Start facilitators found themselves working from home, separated from the people and organisations they support and work with. Their partner services, including kindergartens and the Maternal and Child Health service, were also significantly affected by new social distancing measures. Best Start, along with all early childhood initiatives, was suddenly operating in very different environment.

To support Best Start facilitators to transition to this new context, the Centre provided two online opportunities in April and May for all 30 facilitators to come together. These sessions allowed facilitators to reflect on the impact of COVID-19 on their practice and identify responses to these impacts. In these sessions, it became clear that the pandemic was creating both opportunities for and challenges to the use of quality improvement (QI). In some instances, engagement with and understanding of QI was enabled by the new pandemic context. Equally, for some, COVID-19 was creating barriers to the use of QI. Here (in figure 1) I share the ways in which the pandemic has both enabled engagements with QI and created barriers, as identified by Best Start facilitators.

Figure 1: Enablers and barriers of using QI during COVID-19

Four ways COVID-19 has enabled engagement with QI

The initial need to adapt meant that QI was suddenly very relevant

At the end of March, kindergartens, supported playgroups and the Maternal and Child Health service suddenly needed to adapt to remote service delivery. In some cases this was because of government direction and in others it was due to the preference of families. Either way, it provided the perfect opportunity for Best Start facilitators to engage services in using QI, in particular, Plan-Do-Study-Act (PDSA) cycles. Services who hadn’t before used or seen the value this systematic experimental approach to adaptation, were willing to give it a go when they could see how it could help them adapt to a pandemic environment.

The ongoing need to adapt further reinforces QI’s value

In late May, restrictions initially began to ease in Victoria. For some services this meant resuming some face-to-face contact while continuing to offer remote delivery. For Best Start facilitators, it provided another opportunity to engage services in the use of PDSA cycles, as a way of adapting to yet another service delivery model.

The shift to online meetings has enabled participation in QI meetings

‘Doing QI’ means bringing people together on a regular basis to share and determine what is being learnt about how to improve. This aspect of QI is sometimes a challenge for early years services as it requires practitioners to find time in their schedule to step away from service delivery to participate in meetings. However, in the COVID-19 context, when all meetings had moved online, many Best Start facilitators found that attendance at their meetings was higher than usual. The reason? In some cases, practitioners had reduced client contact hours, and in all cases, they didn’t need to factor in commute time.

The use of online meetings has promoted the use of smaller action-oriented team meetings

The requirement to hold all meetings online also shifted the way many facilitators conducted their meetings. Facilitators found that the large group meetings they typically ran in a face-to-face context didn’t work so well in an online environment. Engagement and participation was trickier for a large group when meeting via videoconference. This led to some sites opting to instead run several smaller group meetings, which enabled greater interaction and greater buy-in to testing ideas (through PDSA cycles) outside of the meeting.

Three ways the pandemic makes QI trickier

While adaptation is necessary, it is also overwhelming

Just as the need to adapt to COVID-19 conditions encouraged some services to embrace QI methods, for others, the sudden and unprecedented need to quickly adapt was overwhelming and a barrier to engaging in QI practices. This resulted in changes being made without an understanding of whether they were helpful or not.

It should be noted however that many Best Start facilitators were working with services in this situation to help them come back to QI. Quick changes will always be made in crisis situations, but the opportunity is there for the QI facilitator to engage services in an intentional learning process after the fact. This helps the service to understand whether their ‘quick change’ should be sustained.

Less incidental contact with colleagues means fewer opportunities to identify QI work

Best Start facilitators note that many of their opportunities to engage a service or program in QI work happens through informal connections. The shift to working from home for Best Start facilitators and many of their colleagues meant that incidental contact happened far less frequently. As a result, there were fewer of these opportunities to identify QI work.

Engagement and interaction for online meetings of large groups is reduced

Engagement and interaction in meetings involving large groups of people is trickier online. This did present the opportunity to redesign meetings, leading to the creation of smaller, action-oriented groups. However, in some cases, a large group meeting was still required, such as a quarterly meeting of the site’s entire partnership. Best Start facilitators noted that they were challenged by designing and running these meetings in a way that kept all participants actively engaged.

While our working and home lives are still currently very much affected by the pandemic, there are certainly lessons to pull from these insights about how to best use QI to support service improvement. For example:

Services are likely to be interested in using QI when they are in a position of needing to change. This doesn’t necessarily need to be in response to a crisis – it may be a directive from management, evaluation findings, or client feedback.
There’s value in engaging people in QI even if they’ve already implemented changes. QI can help them learn if the initial changes should be sustained, or different changes are needed.
Holding QI team meetings online into the future, whether needing to physically distance or not, is likely to enable better participation by busy practitioners.
Bringing smaller groups of people together to focus on the planning, results and next steps of PDSA cycles is likely to result in more interactive and action-oriented discussion.

Access all blog posts here:

Learn about the blog series

Reflections

Are you a facilitator or coach of QI? If so, what enablers and barriers of using QI have you observed during this pandemic? Please comment below.

Are you new to QI? Has this article sparked your interest in how QI could help your program, organisation or community initiative learn and change? If so, please contact Lauren Heery.