Continuous Quality Improvement (CQI) is a structured and ongoing process dedicated to enhancing activities that address community needs and boost population health. It represents a persistent effort to achieve significant improvements in efficiency, effectiveness, performance, accountability, outcomes, and various quality indicators at both state and local program levels. In essence, CQI is about making things better, constantly.
The primary objective of CQI within the Minnesota Department of Health (MDH) family home visiting program is to improve results by strengthening the capabilities of local partners. This is achieved by:
- Cultivating a CQI-focused culture.
- Developing a robust CQI infrastructure.
- Applying CQI methodologies in everyday practices.
For detailed information regarding Minnesota’s initiatives in family home visiting CQI, please reach out to [email protected].
The Importance of CQI in Public Health
CQI is recognized as a best practice within the public health sector. MDH, as a Maternal, Infant, Early Childhood Home Visiting (MIECHV) award recipient, manages funding from the U.S. Health Resources and Services Administration (HRSA) to distribute to local grantees across Minnesota for home visiting programs. HRSA mandates that MDH family home visiting establish and annually report on a CQI work plan. MDH family home visiting must demonstrate the application of CQI best practices and show measurable progress at the state program level. Simultaneously, they are tasked with assisting family home visiting programs in enhancing their ability to consistently and methodically employ CQI to improve program results. This dual approach ensures both state-level oversight and local program empowerment in quality improvement.
Who Benefits from CQI Support?
MDH family home visiting extends support to local family home visiting programs funded by federal and state resources. These programs can be administered by various entities such as local public health agencies, county health boards, tribal nations, and nonprofit organizations. The majority of programs supported by MDH family home visiting utilize evidence-based home visiting models funded by state and/or federal home visiting grants, ensuring a focus on proven methodologies and effective interventions.
How CQI Support is Delivered
A dedicated interdisciplinary team, comprising a CQI coordinator, home visiting practice consultants, research scientists, and student workers, collaborates to support local family home visiting programs in enhancing their CQI capabilities. This support is multifaceted, encompassing:
- Consultation: Providing expert advice and guidance on CQI implementation.
- Training: Offering structured educational programs to build CQI skills.
- Facilitation: Guiding groups through CQI processes and activities.
- Coaching: Providing personalized support and mentorship to individuals and teams.
- Peer learning opportunities: Creating platforms for programs to learn from each other’s experiences.
- Technical assistance: Offering specific tools and resources to aid in CQI efforts.
- Data collection, reporting, and analysis: Assisting with the crucial data aspects of CQI projects.
Core Principles of CQI
The MDH family home visiting section is deeply committed to CQI principles, advocating for their application at both state and local levels to improve the effectiveness and delivery of family home visiting services for families with young children. These fundamental principles include:
- Client-Centered Focus: Prioritizing service improvement from the client’s perspective, ensuring that changes are meaningful and beneficial to those receiving care.
- Meaningful Engagement: Recognizing that success hinges on active participation and contribution from all levels within the system, fostering a collaborative environment.
- Process Improvement Mindset: Acknowledging that every process, regardless of its current state, has the potential for enhancement and refinement.
- Continuous Learning Culture: Embracing an “all teach, all learn” philosophy, promoting shared knowledge and ongoing development among all stakeholders.
- Data-Informed Decision Making: Emphasizing the use of both data and team expertise to make well-informed decisions, moving beyond anecdotal evidence.
- CQI for Learning and Growth: Utilizing CQI data for learning and improvement, explicitly avoiding its use for judgment or supervisory purposes, thus creating a safe space for growth and development.
MDH employs a wide array of resources to bolster CQI efforts. For those starting a CQI project, several essentials pave the way for success. The family home visiting toolkits webpage provides access to a CQI toolkit with extensive information on CQI practices and essentials.
The Model for Improvement provides a structured framework for rapid testing and change, leading to tangible improvements. This model is composed of two key components: addressing three fundamental questions and implementing change tests using the Plan-Do-Study-Act (PDSA) cycle.
Langley, G.J., Nolan, K.M., Nolan, T.W, Norman, C.L., & Provost, L.P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco: Jossey-Bass. P.24.
A QI Project Charter Template (PDF), available at [/docs/communities/fhv/chartertemplate.pdf], serves as a vital document for describing and launching an improvement project, establishing a shared vision and purpose for the work.
Key indicators, or measures, are essential for evaluating performance and tracking progress in improvement initiatives. These measures are used to determine if the aims and objectives of a CQI project have been successfully achieved.
A Driver Diagram Template (PDF), accessible at [/docs/communities/fhv/driverdiagtemplate.pdf], offers a visual representation of the theory underpinning a project’s aim. It illustrates the relationship between primary drivers (direct contributors to the aim), secondary drivers (components of primary drivers), and the overarching goals. This tool is invaluable for breaking down a high-level improvement goal into manageable, logical sub-goals and projects.
The Plan-Do-Study-Act (PDSA) cycle, supported by a PDSA template form (Word) at [/communities/fhv/pdsaform.docx], is a dynamic method for rapidly testing changes. It involves developing a test plan (Plan), executing the test (Do), analyzing the outcomes (Study), and deciding on modifications (Act).
A Project Planning Form (PDF), located at [/docs/communities/fhv/projplanform.pdf], is instrumental in strategically setting smaller, time-bound goals. It aids in planning the timeline and assigning responsibilities for PDSA cycles across different project stages (test, implementation, or spread).
Engaging parents as active leaders in CQI efforts is invaluable. Their feedback and innovative ideas are crucial for enhancing services and processes. Partnering with families is key to improving services for families. The HV CoIIN Parent Leadership Toolkit, available for free download at Family Leadership Toolkit & Resources, offers resources in both English and Spanish.
For additional CQI resources and tools, the MDH Center for Public Health Practice’s Public Health and QI Toolbox is a comprehensive resource.
Collaborative Learning in CQI
A collaborative in CQI is a focused, time-bound initiative where multiple organizations, along with leaders and experts, converge to learn and develop enhanced processes within a specific area. MDH utilizes the Institute of Healthcare Improvement’s Breakthrough Series collaborative model as a guiding framework for CQI in family home visiting.
The selection of topics for these collaboratives involves both internal and external stakeholders. Chosen topics typically reflect areas of high interest at both state and local levels, and where there is potential for improvement based on national benchmarks in family home visiting performance measures. The following sections detail current and past statewide CQI learning collaboratives.
Monthly Office Hours:
MDH provides ongoing support to family home visiting program staff through monthly CQI office hours, held on the second Wednesday of each month at 10 a.m. via Microsoft Teams. Registration links for upcoming sessions are available:
In 2024, MDH supported a CQI project focused on family retention, particularly aiming to increase prenatal enrollment and reduce missing data in MIECHV performance measures.
In 2023, MDH supported a CQI project centered on family engagement and retention. The 2023 CQI Practicum Showcase highlights this project, which included participation from two local family home visiting agencies in the CQI Practicum with MDH.
Qualitative data collected in 2023 was showcased in a poster, 2023 MN Initiative: Collaborative Use of Qualitative Data in Continuous Quality Improvement Efforts (PDF), presented at the MIECHV All Grantee Meeting in January 2024.
In 2022, a CQI project supported by MDH addressed MIECHV performance measures related to early language and literacy and referrals. The project outcomes, including Dakota County’s work on implementing the Mothers and Babies curriculum to reduce maternal depression, are featured in the Showcase.
In 2018, MDH facilitated an eight-month statewide learning collaborative on family enrollment, engagement, and retention, involving 16 teams. The collaborative aimed to increase the participation of eligible, referred families by improving staff approaches to enrollment and engagement.
In 2017, MDH conducted a nine-month statewide learning collaborative on screening and referrals with 16 teams. The goals were to enhance early identification, service connection, and follow-up for families needing referrals after developmental, social-emotional, or caregiver depression screenings.
For additional materials from these collaboratives, please contact: [email protected].
MDH family home visiting evaluation staff play a crucial role in CQI initiatives by offering guidance on data collection and reporting. Guidance documents for reporting are available on the family home visiting evaluation resources page. Data reports are regularly generated to support current CQI efforts and inform future project directions. For data collection assistance, contact: [email protected].
