Frequently Asked Questions: Beginning CQI

Q: My team finds ways to do things better all the time—isn’t that continuous quality improvement (CQI)?

A: Not necessarily. Although finding better ways to do things is a great quality in a team, true CQI is structured, ongoing, and measurable: “Quality Improvement is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act [PDSA], which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measureable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” ^[1] CQI refers to a formal process rather than the general efforts we all make to get better at our work. It should be used to improve processes and services in a way that can be measured through the use of data.

Q: How do I get program leadership and team members to buy in to CQI?

A: When trying to build buy-in and commitment to a new CQI process, leadership and staff may wonder, “What’s in it for us?” Take this into consideration and remind everyone that CQI efforts strengthen the connection between their everyday work and measurable results. CQI can increase efficiency and effectiveness, reduce costs and redundancies, improve productivity, streamline processes, increase customer satisfaction and employee morale, and improve outcomes.

Q: How can we squeeze CQI into our already busy schedules?

A: This is a common concern, but CQI doesn’t have to take up a lot of resources. First, embrace a team approach by splitting up the work among all teammates. This approach reduces the burden on any one person while also exposing more team members to CQI and building your organization’s overall capacity. Next, rather than creating extra meetings for your team, piggyback your CQI work onto existing group or committee meetings making the most out of times that are already blocked off. Set realistic goals that focus on change that is within your team’s control and appropriate given the time and resources available. Lastly, remember that CQI projects aim to improve processes by streamlining and finding efficient ways to meet your goals. Results may not be immediate, but a commitment to CQI can translate to meaningful improvements over time.

Q: CQI is new for us. Where do we start?

A: First of all, congratulations on beginning to explore the benefits of CQI! CQI doesn’t have to be complicated, and you have a lot of resources at your disposal. To start, you’ll want to gather basic information about CQI and approach your organization’s leadership for approval. We recommend Embracing Quality in Public Health: A Practitioner’s Quality Improvement Guide. Read about how other organizations have implemented CQI on the Public Health Quality Improvement Exchange. Look to your data (including numerical data like client records, results from customer or employee satisfaction surveys, or general staff feedback) to identify an area with room for improvement. At that point, you’ve already started Step One (“Getting Started”) of the Plan-Do-Study-Act cycle. Keep the momentum going by assembling your team and continuing through the PDSA stages.

Q: What do you do if your CQI results don’t meet your expectations?

A: This can happen and is something that most CQI teams will experience at some point. Carefully selecting the measures you will use to track improvement during the “Plan” stage is a critical step towards understanding whether your project resulted in the improvement you are seeking. If you are not seeing the trend in your data that you were expecting, it could be because you haven’t tested your improvement long enough or under the right parameters (e.g., the data might change at different times of the year due to reasons outside of your control, the data are only reflective of certain employees/customers, etc.). You may need to extend your timeline or test your improvement under different circumstances. If these steps don’t help, consider tackling a different root cause or testing a new solution that will get you closer to your goal. It can take multiple PDSA cycles to see improvement. If you are trying to address a large process improvement, consider breaking it down into several smaller PDSA cycles.