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’s Best Start program to maximise participation in the Maternal and Child Health service and kindergarten 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.

What is quality improvement?

Quality improvement (QI) is just one of a range of methodologies the Centre for Community Child Health uses to support organisations and communities to learn, improve and change.

QI offers a practical, step-wise approach to understanding problems and designing and testing possible responses. It empowers those on the frontline to work out how to solve the issues they face.

It originated in the manufacturing world but more recently has been applied in health and education settings.

What we are learning from organisations overseas

In November 2019 I travelled to the United States to visit three different organisations.

These were: the James M. Anderson Centre for Systems Excellence at Cincinnati Children’s Hospital, Petaluma Health Center and Zuckerberg San Francisco General Hospital. These places have been using QI for many years and I was excited to see what I could learn from them.

The organisations were different in terms of their size and the focus of their QI work. However, I noticed four common practices that helped them ‘do QI’. These were:

1. They see QI as the way to do their work

In all three organisations, people described QI as the way they did their work. It wasn’t a tool to turn to if or when something needed improving. This was made possible by coaching all staff in how to use QI. In all three organisations, QI coaches built the knowledge and skills of team leaders and senior management. Senior management were supportive of QI work. Team leaders were able to support their staff to use QI to design and test possible solutions. The QI coaches used ‘QI competency frameworks’ to work out how staff were progressing, where they needed support and when it was time to move on to coaching the next staff member.

2. They use consistent tools and schedules to help them learn

Improvement teams in these organisations used consistent tools and templates for setting up their ‘improvement projects’. Teams had a central noticeboard to keep their goals and progress in front of mind. They followed a meeting schedule to keep their learning moving; e.g. a weekly team huddle, a bi-weekly meeting for team leaders. They also used processes to feed what was learnt in each meeting up the chain. This meant that learning was shared at all levels of the organisation.

3. They involve staff and consumers in QI work as much as possible

All three organisations made it clear that it was important to include staff and consumers in their QI work. In one organisation, the QI team asked all staff to vote for their preferred QI priority. The same organisation asked a proportion of consumers each month about their satisfaction with the service. They also asked consumers to work with their staff to help them design ideas for improving their service. In another organisation, staff supported families and community members who had their own ideas for improving services to do their own Plan-Do-Study-Act tests.

4. Their QI coaches are always learning

QI coaches in the three organisations were expected to continuously build their skills. They made time to sit in on and reflect on each other’s coaching practice. They debriefed with each other. They undertook reflective practice with their managers.

In our ongoing work with Best Start, we have the opportunity to work out how we can apply these insights so as to continuously improve the way we ‘do QI’ in this setting. We are grateful to the Best Start facilitators and departmental staff who we work and learn alongside with.

Access all blog posts here:

1. 1. Four practices of effective quality improvement
   2. How a pandemic makes QI more relevant than ever (but also a little tricky)
   3. How quality improvement can help services to adapt to COVID-19
   4. Practices of an effective quality improvement coach
   5. How to increase participation in the early years: promising practices identified through quality improvement

Learn about the blog series

Reflections

Are you a facilitator or coach of QI? If so, how do these four things resonate with your practice? What’s one thing you’d like to try doing differently as a result of reading this post? 

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.