About the Quality Improvement System

DHS developed the Quality Improvement (QI) system to provide a reliable framework for improving the quality of our services across the department, with the flexibility required to address the specific outcomes for each DHS program area and within each work unit.  The QI System is results-based, meaning that all program evaluation and improvement efforts will focus on supporting the safety, health, self-sufficiency, and stability of all the children, adults, and families in Iowa, and the efficiency of the agency in accomplishing those results.  Improving outcomes for the children and families of Iowa requires diligent focus on quality, the quality of our efforts and of the consistency in the result of those efforts.

 

Quality Improvement efforts will help the agency relentlessly seek out and eliminate activities that do not create value for customers (waste), will focus on increasing value by creating efficiencies, will eliminate or reduce duplication, loop backs and double checks, and work with the staff who do the work to increase the clarity of processes and expectations, so everyone has the same understanding of the process and is able to consistently perform at best practice levels.

 

Employee-driven improvement efforts

Making processes more effective and efficient is one part of the larger goal of the Quality Improvement system. The ultimate goal of the Quality Improvement system is for DHS to become a continuously improving organization, and to establish itself as a model of effective state government.  The Quality Improvement system is supported by agency leadership, and empowers all staff to become engaged in making decisions about how to change the way we do our work.  As Chad Dahm, Social Work Administrator said, these tools have allowed staff to take control of their work rather than letting the work control them.

Being a continuously improving organization means all employees use data to measure performance and know how to use simple tools to make small improvements in the way the agency's work is done every day. To establish continuous improvement as the way we work daily, employees at all levels are being taught to use a simple, standard system of tools called the Lean which provide a framework to constantly review their processes to find, and more importantly, act on opportunities to improve.

It empowers workers to make decisions and changes in the way we do our work. In our current economic crisis, it is absolutely essential to cut out waste in our processes so we can help more people as the demand for services skyrockets.

Our staff is our only resource whose value appreciates over time.  Empowering staff to improve agency results and efficiency is changing the culture of the agency, the way business processes work and the way we engage with partners.  With the support and guidance of the Quality Improvement system we're:

  • Cutting red tape;
  • Delivering services better and faster to clients;
  • Increasing transparency and accountability; and,
  • Saving time and money

 

Quality Improvement Resources

 

QI system and activities leverage QI staff expertise in Quality Improvement techniques and change management strategies - using a simple, cyclical approach that supports continuous, small quick, incremental changes applied and sustained over a long periods, to achieve significant improvement.  The QI system is not dependent on QI staff being subject matter experts in every possible business area, but rather subject matter experts in QI.  The quality improvement staff is deployed across the state, and those QI staff work together as a team.  Activities are supervised and coordinated centrally, aligned with department business and strategic improvement priorities, and work is assigned by priority within resources available.

 

The QI system is not separate, or a stand-alone effort, but is an integrated part of all the work that is done in DHS.  QI strives to improve outcomes for those who receive services or benefits, to improve efficiency and ease of delivering those services for agency staff, and reduce the variation of both outcomes and efficiency, improving the predictability of high quality services.

 

Quality Improvement efforts will help the agency relentlessly seek out and eliminate activities that do not create value for customers (waste), will focus on increasing value by creating efficiencies, will eliminate or reduce duplication, loop backs and double checks, and increase the clarity of processes so everyone has the same understanding of the process and is able to consistently perform at best practice levels.

 

Values of Quality Improvement:

 

  • Customer Focus (is how value is measured)
  • Simplify, Streamline, Consistency (in processes, quality, geography, and results)
  • Do it Right the First Time
  • Bias for Action (avoid analysis paralysis - be nimble - simple & quick e.g. PDSA).
  • Support Continuous Learning, Creativity and Improvement in Practice
  • No Blame (problems indicate broken processes - do not blame people/groups)
  • Use cross functional teams working together across divisions, geographic areas, and work units.
  • Quantifiable Results (know what results are expected, measure, check & adjust)
  • Creating, using, measuring, monitoring and adjusting Quality Improvement Plans.

 

Quality Improvement Methods

 

  • Establishing desired outcomes and standards of expected performance.
  • Monitoring actual performance and outcomes and comparing them with expectations for performance and outcomes;
  • Analyzing discrepancies between desired and actual performance;
  • Based on analysis, setting focused goals for improvement
  • Analyzing root causes, designing and implementing focused strategies to improve, monitor results and adjust strategies when needed.
  • Creating, using, measuring, monitoring and adjusting Quality Improvement Plans.

 

Attributes of Quality Improvement

 

  • Quality Improvement serves to develop and maintain a culture of excellence.
  • Quality Improvement develops skills of all staff to recognize both quality, and opportunities for improvement.
  • Quality Improvement encourages staff to seek new experiences beyond normal duties and outside normal work areas, so they might consider additional ways of improvement they may not have previously experienced.
  • Quality Improvement demonstrates that all staff has the ability to influence quality of the work they do directly, and also through others they work with.

 

The QI system uses a variety of improvement tools, including LEAN/Kaizen.  Lean is a collection of principles and tools that improve the speed of any process by eliminating waste. Kaizen is one tool used in LEAN / Six Sigma process improvement.   Kaizen, a combination of two Japanese words meaning, change and for human good.  Kaizen refers to an approach to continuous improvement that uses the staff that do the work to clarify goals, and uses quick small, incremental changes routinely applied and sustained over a long period the results in significant performance improvements.  DHS receives support and training Kaizen from the Department of Management, see the Office of Lean Enterprise web site for more information.

 

The QI System is results-based, meaning that all program evaluation and improvement efforts will focus on supporting the safety, health, self-sufficiency, and stability of children and families in Iowa. The Department has prepared a comprehensive Guide to a Results-Based Framework that articulates the benefits of this approach, and is written to help staff throughout the Department initiate and sustain their own quality assurance efforts.

 

The motto of the QI System is Moving from Data to Action, recognizing that all QA activities must directly support active efforts to improve results for children adults and families, and not succumb to the pursuit of data for data's sake. 

 

If you have questions about the QI System, or would like more information about conducting quality assurance and improvement efforts for your program, contact the Bureau of Quality Assurance and Improvement by e-mail at qaimail@dhs.state.ia.us.

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