The practices of an effective quality improvement coach

This blog is part of the Learning and changing with quality improvement blog series.

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 aims to share insights from the partnership. It is authored by Lauren Heery, Senior Project Coordinator in the Service Systems Innovation Team at the Centre for Community Child Health.

What we are learning about becoming an effective QI coach

Working alongside Best Start facilitators over the last five years, I’ve become increasingly aware of the multidimensional nature of the role. As quality improvement coaches, Best Start facilitators need to be proficient in quality improvement methods, have strong project management skills, and know-how to engage and build relationships with partners and stakeholders.

As part of the initiative’s network-wide learning and coaching programs led by the Centre for Community Child Health, Best Start facilitators have come together on multiple occasions between August 2020 and June 2021 to reflect on their practice. In these sessions, Best Start facilitators have shared insights about their role, leading to the identification of six domains of practice for becoming a more effective QI coach. These are: Shifting your mindset; Developing technical knowledge and skills; Creating buy-in; Deepening relationships; Building the capacity of others; and Practising professional self-care (see Figure 1).

Figure 1: Domain of effective quality improvement facilitation in Best Start.

1. Shifting your mindset

Facilitators identified that shifting their mindset around a few key ideas was an important aspect of becoming an effective QI coach. These included:

being curious, open to change and exploring new ideas (instead of assuming that you already understand an issue and the likely solutions)
seeing bumps in the road as opportunities for learning and not expecting things to always go according to plan (instead of labelling things as a ‘failure’ when they don’t work out as intended)
understanding that improvement happens incrementally and therefore taking small steps, setting short-term goals and accepting that that wider systems change will take time.

2. Developing technical knowledge and skills

Facilitators stated that knowing how to effectively use data, QI tools and the Best Start online reporting and data visualisation portal was pivotal to their role. Specific skills included:

developing driver diagrams for stretch goals that tease out the root causes of an issue and allow improvement teams to focus on making progress on one cause at a time
creating run charts to monitor progress on a monthly basis and sharing these on the portal with partners
teaching partners how to use the portal to report their PDSA cycles.

3. Creating buy-in

Facilitators recognised that being an effective QI coach involves engaging managers and practitioners across all kinds of organisations to become active participants. Facilitators identified the following approaches as effective for creating buy-in:

developing driver diagrams for stretch goals that tease out the root causes of an issue and allow improvement teams to focus on making progress on one cause at a time
creating run charts to monitor progress on a monthly basis and sharing these on the portal with partners
teaching partners how to use the portal to report their PDSA cycles.

4. Deepening relationships

Facilitators recognised that beyond initially engaging people, being able to deepen and maintain genuine relationships was a key factor to becoming an effective QI coach. They identified six characteristics of an effective partnership (Davis & Day, 2007) as important to their practice (see Figure 2).

Characteristic	What this looks like
Developing and maintaining genuine connectedness	Communicating in various forms: individual conversations, small group catch ups, Zoom meetings for larger meetings Acknowledging what partners are saying about their needs and capacity for involvement and responding accordingly Acknowledging all partners’ contribution
Communicating clearly	Asking partners about their best mode and time of contact Sharing a clear meeting agenda with partners prior to the meeting Following up with brief minutes (in email body so it is easily visible) with actions clearly outlined
Recognising complementary expertise and roles	Learning about everyone’s skillsets and abilities Having a good understanding of stakeholders’ current work
Sharing decision making power	Engaging partners in co-design of the work Being clear about everyone’s role Not making final decisions without everyone’s input
Fostering active participation	Creating space and opportunity for everyone to contribute Creating varied ways and opportunities for partners to share, including offline if preferred Trying virtual meetings, because sometimes they have better attendance
Negotiating disagreement	Setting mutually agreed upon goals and ways of resolving disagreements from the outset Acknowledging differences of opinions with respect and empathy

5. Building the capacity of others

Facilitators identified that becoming an effective QI coach meant building QI capacity within their partnership and improvement teams, to support sustainability of the work and enable expansion of the work across their site. Facilitators build the capacity of people to be able to ‘do the QI work’ independently, as well as identify and support emerging ‘QI champions’ who might then lead improvement teams.

Facilitators shared the following ideas for building improvement team members’ capacity:

Recognising when team members are ready to work more autonomously and letting them go
Asking team members to make recommendations about the next year’s work

Facilitators have used the following approaches to develop QI champions:

Modelling facilitation of QI activities.
Sharing facilitation of meeting activities.
Being transparent with emerging leaders about the process of building their capacity.

6. Practising professional self-care

A coach’s wellbeing and effectiveness are reliant on one another: to remain effective, coaches

should be watchful of their own morale and burnout, and seek support when necessary (Ritchie et al, 2020). Best Start facilitators have found the following helpful for supporting their wellbeing.

Making the time for regular reflection, whether that be formal supervision with a manager or less formal debriefing with peers.
Setting clear boundaries to your work by creating a work plan and blocking out time for tasks, tracking and reviewing hours to ensure it aligns with forecasts and expectations and adhering as much as possible to set work hours.
Celebrating each win no matter how small, acknowledging that the work is complex and long-term so reflecting and acknowledging progress is therefore important.

Using the learnings from Best Start

We encourage other facilitators or coaches of QI to use these insights to support their own practice improvement. To do this, you might reflect on each of the six practice domains and assess your own practice against each. You might ask yourself:

How am I tracking in this domain?
Does my practice feel strong or is there room for improvement?

Following this, we would recommend selecting just one or two domains at a time in which to build or strengthen your practice. You could lean on QI tools, such as the Model for Improvement, to:

develop a short-term goal for each domain
identify a measure for the goal
brainstorm change ideas that could support progress towards the goal (the information under each domain above can support this brainstorming)
test those change ideas.

Promising Practice in Best Start series

This post has been adapted from ‘How to facilitate quality improvement’ from the Promising Practice in Best Start series. The Promising Practice in Best Start series captures what is being learnt through Best Start about how to use quality improvement to increase participation in early years services. The series draws on insights from Best Start facilitators and is produced by the Centre for Community Child Health. The original article can be accessed here.

Learning and changing with quality improvement blog series

Access all blogs in the series:

References

Davis, H & Day, C. (2007), Current Family Partnership Model, The Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust. http://www.cpcs.org.uk/index.php?page=about-family-partnership-model
Ritchie MJ, Dollar KM, Miller CJ, Smith JL, Oliver KA, Kim B, Connolly, SL, Woodward E, Ochoa-Olmos T, Day S, Lindsay JA, Kirchner JE, 2020. Using Implementation Facilitation to Improve Healthcare (Version 3). Veterans Health Administration, Behavioral Health Quality Enhancement Research Initiative (QUERI). Available at: https://www.queri.research.va.gov/tools/implementation/Facilitation-Manual.pd