Teaching Quality Monitoring

Teaching How to Monitor for Quality

Monitoring is not a word always embraced in the quality field. To some, it evokes images of Big Brother in the workplace. To others, the word feels paternalistic. Dad is keeping a watchful eye out on things. To others, especially those in the health services realm, it seems old-fashioned. The quality world in health has moved beyond quality assurance to the more glitzy world of quality improvement.

Sunshine dashboardBut ask social service administrators or board members these questions, as I have.

“Would you like this agency to become more data-driven?”

“Would you like to be able to see, in metrics, how your agency programs are performing?”

“Would you like to be able to spot trends over time, in how they perform?”

The answers are almost always, Yes, please.”  They are tired of describing their work in terms of numbers served. I tentatively started down this road professionally a few years ago, when a public agency administrator I respect told me, “Curtis, I think my employees would respond very well to data. I’d love for us to be a data-driven agency, but I have no idea where to start.”  At that time, I myself had only vague ideas about how to help. As a social service researcher, this sounded like something I should know.

This year, I am teaching, as a pilot effort, a course in a school of social work called, Quality Monitoring and Improvement in the Social Services. The students are second year masters students, evenly split between those who want careers in direct practice and those who want careers in social service administration. We have completed the quality monitoring portion of the class and I thought I’d report on how it went, the challenges I faced and how the students fared on their major assignment related to monitoring. I finished this teaching module convinced more than ever that quality monitoring activities are a vital agency function and the skills associated with these tasks are important ones for agency-based quality professionals to possess.

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Take charge of your own training

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John Priebe, who blogs on the quality profession, argues this week that it is up to the quality professional to take charge of his or her own training. This resonates strongly in the social services. In only rare exceptions does the leadership of social service organizations know what it is that their quality professionals don't yet know. Maybe they worry about training their front line staff. Maybe they worry about training their supervisory staff. But they don't stay up nights worrying that their quality professionals don't know how to do their jobs.

In the professional model of practice, part of being a professional is being responsible for keeping yourself up to date on professional practice. Think about your physician. You expect her to go to continuing education events, to read medical journals at breakfast, to learn what she needs to know to serve you and your family. It comes with the autonomy given to professionals.

In my book, quality professionals in the social services don't just get to complain that they are untrained and no one is stepping forth to train them. If they recognize they are untrained, they need to find ways to get themselves skilled up. There are resources out there -- web sites to visit, books to read, even free courses to take -- to learn the quality sciences behind modern quality monitoring and improvement. And this training is not necessarily one-shot. Professional training by its nature is prolonged and specialized.

Social service clients deserve quality service. Quality professionals won't argue this point. Social service agencies deserve quality professionals who know not just the service they monitor and work to improve, but who know how best to monitor and improve service. If you are in a professional quality role in the social services, it is time to get yourself trained in the methods of the quality profession.

Check out our resources page to get started.






What to teach social workers about quality?

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If we are going to move the practice of quality monitoring and improvement into social service agencies, then schools of social work will need to get in the game of educating their students about quality tools, concepts and management. As part of the Scholar Network to Advance Quality Service (SNAQS), I am working to bring materials about quality to the attention of my profession in the hopes that social work programs will begin teaching these materials to their students.

Starting September 30, I will teach a course on quality to students in the second year of a two year masters degree program in social work. This is a pilot to see how students respond to the content, with the hopes of being able to use the course as a potential platform for spread (shared syllabi, website, materials, etc.). The course is ten weeks long (on a quarter system), with ten 3-hour hour class sessions. There are lots of decisions to be made about what is taught and what is not.

Here are my current thoughts on topics that are "in." Four foci: the quality profession as it relates to social services; monitoring (measuring) for quality; improving quality; and workplace cultures that support quality. Here is a more detailed view:

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Toyota Kaizens the Food Bank

So I went out of the country and avoided the news media and the New York Times sports a piece on quality improvement in the social services, about how the Toyota corporation ran improvement events (Kaizen events) for the New York City Food Bank. Sorry I missed it. I have so many things to say related to this post that I will have to limit myself to threecanstockphoto10704629.

1. Improvement events. Kaizen events. These are words I rarely hear in the social services, even from quality improvement people. When the corporate world recognizes it has a quality problem it strives to bring together the right data and the right people to solve the quality problems. These problem solving sessions can be called Kaizen events. The point here is that they are events, chartered events, with direct marching orders on what is supposed to get fixed, with a charter sponsor, an executive who has owned the problem and is calling for a solution. (You can find an excel template for a charter here). People are expected to drop other duties, come together and spend a 3-4 days understanding the problem and working out and testing out solutions that are implemented soon (as in the next Tuesday). These meetings are often (or at least at first) facilitated by quality experts, using some set protocols and sets of potential domains of solutions.

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Common Quality Metrics in the Social Services


The graphic to the right shows the most common metrics used in quality work in manufacturing and service industries across the globe, according to the Global Quality Survey administered by the American Society for Quality. (The full report is available here, but it will cost you your email address so ASQ can market to you).

In both sectors, the most common metric was customer satisfaction. In the service sector, employee satisfaction and the percentage that services were compliant with some standard were also common metrics. In manufacturing, on-time delivery was also measured most commonly.

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Lean and Waste in the Social Services: Tim Wood is the Enemy


man files canstockphoto5616217Tim Wood, a middle aged civil servant sits at a metal 1963 vintage Steelcase desk. A pile of forms stuff an inbox in the upper left portion of his desk. There is not a computer in sight. In a deliberate manner, Tim Wood removes a form from the inbox, reviews it, marks it with an X in the appropriate approval box, signs it, gets up, meanders through a set of office cubicles to the elevator, where he goes two floors up, wanders through another set of cubicles to another 1963 Steelcase desk, where he deposits the form in someone else’s inbox. He heads back down to his own desk and starts the process anew.

I often think that this is how the general public views those of us in the social services. We are Tim Woods, slow, meandering bureaucrats, doing nothing but wasting tax payer money on endless, needless paperwork.

Waste. In the quality world, waste is an enemy and waste is the purview of Lean.

Skinny is in and the hip kids are all creating Lean Start-ups, full of Lean thinking and Lean events designed to create and institute Lean processes with good flow. Our social servant Tim Wood with his full inbox is not a hip kid. He is not Lean. Tim Wood is the enemy.

Tim Wood is also a mnemonic device to help Lean learners remember the key sources of waste in a process. Lean comes from the manufacturing world (thanks Toyota) and it requires some translation for the service world and even more for the social service world, where profit is not the ultimate arbiter of success. This blog post takes a look at waste in the social services, using the Tim Wood classification system.

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ASQ: Pricing the social services out of the quality game?

I think ASQ is awesome. I think it is amazing that there is an organization that wants to spread the word about quality. I am a member. I liked them on Facebook. I have bought about $500 worth of quality books from them in the past couple of years. I would love to go to some ASQ trainings. I live (in Chicago) just a short drive away from the ASQ world headquarters in Milwaukee.

But I'm thinking I won't. Let's look at the ASQ training price list for the courses I would like to take this summer.

  • Quality 101, 2 days ($1495 non-member/ $1295 member)
  • Lean for Service, 2 days ($1095/ $995)
  • The Case for Quality: Taking it to Management, 1 day  ($895/ $795)
  • Online Quality Fundamentals for Service, 4 hours ($369/ $269)

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Teaching Quality Monitoring and Improvement in Schools of Social Work

canstockphoto9741388Courses on quality improvement are all over schools of nursing and medicine, but not my field, social work. Social work has continued to teach Program Evaluation to our masters students, even when so few of our graduates engage themselves in evaluation work. A few years ago, when I took a COA sponsored training on quality improvement, the trainer begged me to start teaching such a course.

Curricular changes come hard. People like to teach what they know and what they have prepared. Program evaluation may be here for a whole lot longer. But students should have a choice, I think, between a program eval course that they might not use much, or a quality improvement course that can prepare them for their roles as practitioners in agencies where active quality monitoring and improvement work is taking place.

My fear is that students would stay away from such courses, just as many practitioners strive to stay away from agency quality improvement work. I might have sold them short. My school of social work asked students to indicate from a list what courses they would take next year if registering then. For the first time, we placed a quality course name on the list, Quality Monitoring and Improvement. Nineteen students said they would take it. This means the course will get offered next Fall and I will teach it if we can get 12 or so students to sign up. Oh, the quality revolution is taking small steps. Small steps forward.

The Behavior Change Ball

Is there is any thbehavior change ball in actioning implementation scientists like more than a fancy figure? I think not. All the most highly cited articles seem to have one.

This spring's entrance into the pageant is the Behavior Change Ball, shown here in action, in  what is surely the most dynamic illustration in the short history of the field.  It appeared in this article that appeared in April in the on-line journal, Implementation Science.

The model involves what the authors call integrated policies to address what they call wicked public health problems  existing in wicked contexts.The authors seemed most concerned with obesity, but they have nailed the proper language for the problems we social service folks tackle (think child maltreatment, juvenile violence, substance abuse) and where we tackle them (impoverished communities).

Integrated policies involve how a policy initiated at the top of a system is integrated in practice by program heads through street level actors. Their versions of these organizational levels are: strategic level, tactical level and operational level. A policy that is integrated has aligned actions through the hierarchy.

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Quality Management for the Social Services: Keeping it Simple Enough (the updated version of Keeping it Simple Stupid)

canstockphoto6741114Last year, the ASQ journal Quality Progress published an article on the 7 new quality tools, meant as an update to the 7 classic quality tools known to many quality professionals (affinity diagrams, tree diagrams, interrelationship digraphs, process decision program charts, prioritization matrices, matrix diagrams, and activity network diagrams).

Updates should make things clearer and more useful. The updated version of the seven classic tools includes one -- data matrix diagrams -- that made things less clear, less useful and points out a danger of modern QI practice. QI can get too fancy for anyone's good.

If QI and its related processes are to really take hold in the social services, we need to keep things relatively simple. The quality managers we hope to use these tools need to be able to master them. The people who supervise these professionals need to understand what they are designed to do. The audiences for these tools need to be able to appreciate them. They need to be tools that can be spread from agency to agency and team to team. If we start teaching crazy complicated tools, techniques, and statistics and present them as "this is part of what you need to know," we can kill QI before it takes root in these agencies.

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