Key Processes

The Continuous Improvement (CI) Process

Beyond change planning, effective change management relies on having in place a formal process of continuous improvement (CI). As a result, the priorities established in the change plan lead to efforts that actually make the priorities within the plan happen. CI efforts also reinforce the agency’s practice model and overall readiness for change, as they embody the principles and values of empowerment, learning by doing, innovation, and inclusion.

An effective formal CI process includes three tiers of organization: sponsor groups, continuous improvement teams, and working committees. Sponsor groups charter and authorize specific projects and initiatives and provide ongoing oversight for these efforts. Continuous improvement teams actually manage the CI process, while working committees may be formed to tackle the most complex assignments that the continuous improvement teams generate, such as designing or revamping a service, process, program or practice.

An effective CI process is systematic and includes the following general steps a continuous improvement team should follow for making improvements to areas of priority for the agency:

• Defining improvement areas and desired furture state in operational terms.  For example, "culture" is often a priority area for improvement in agencies, but an operational definition might focus on communication, decision-making, delegation and follow-through in order for the improvement effort to be concrete.  Alignment to strategy and to the priorities of sponsors is a key feature of this step in continuous improvement.
• Assessing the current state sufficiently to establish a baseline for improvement and to identify observable, measurable strengths and gaps.
• Identifying the specific sources of resistance within the agency that will impact the pace of mid and long term change initiatives.
• Identifying the root causes of strengths, gaps and sources of resistance in order to discover actionable areas for improvement that do not merely treat symptoms, resulting in the intended impact on performance, capacity and outcomes.
• Identifying “quick win” remedies to increase credibility and capacity for the change process and to build energy, commitment and consensus for longer-term remedies. Quick wins include both doing new things and eliminating things that truly need not be done.
• Identifying and planning for mid and long term remedies, taking into account:
  
  • How to enfranchise constructive forms of resistance - that which serves to improve the change effort by identifying blind spots and limitations within it (e.g., improving the communication regarding why a change effort is important)
  • How to minimize non-constructive forms of resistance (e.g., turfism, resistance based on agendas that are inconsistent with the agency mission and values)
  • What time will be required for complex changes where resources are limited
  • What the sponsors of change can and cannot currently control
• Implementing these remedies, often involves the formation of working committees, and at times, further continuous improvement team work. Establishing detailed task plans and a concurrent communication plan to help track progress and troubleshoot obstacles.
• Monitoring plan progress, actual versus expected impact, and lessons learned for further refinement of the continuous improvement process as a whole, creating a “loop” back to both additional CI work in the previous steps and to the sponsor group for adjustments to the overall charter and scope of the improvement effort.

The DAPIM™ Model and Root Cause Analysis

APHSA developed a model that illustrates this CI process as an ongoing cycle or “flywheel” that moves through five general stages of Defining, Assessing, Planning, Implementing and Monitoring (linking back to the previous steps). In its experience supporting agency CI efforts, APHSA finds that agencies often “jump” from identifying a gap to developing solutions, without taking the time needed to understand the root causes for why a gap exists. Effective root cause analysis typically requires “peeling the onion” of a gap one to three times before arriving at its root cause and related general remedy.

The DAPIM™ Model and Performance Improvement Plans (PIPs)

Agency PIPs typically define the CFSR-based performance standards, measure current agency performance against those standards, and list a set of actions for addressing any current gaps between these standards and measures. When using the DAPIM^TM flywheel technique, agencies enhance their standard PIPs by also identifying the root causes for their gaps, developing implementation plans that are more targeted and sequenced over time, and establishing mechanisms for monitoring those plans for follow through, impact, lessons learned, and adjustments to make. This is in line with the best intentions of the CFSR and PIP process.

Other Key Processes for Effective Change Management

Data Collection and Analysis
At both the micro change plan level and within targeted continuous improvement efforts, processes must be in place that yield three types of data to support them: environmental scanning and baseline assessment; monitoring agency performance and impact on children and families; and communicating with staff and stakeholders. Characteristics of these data include:

• Data to gauge the perceptions of and gather input from children and families served, staff and stakeholders
• Data that can be manipulated and analyzed in different ways, enabling thoughtful root cause analysis
• Longitudinal data across programs that focus on progress being made by particular children, youth and families over time
• Data that supports progress toward the desired outcomes and federal measures of safety, permanency, and well-being
• Data that are not just numbers but anecdotal “stories” of children and families served and how agency support for them leads to desired outcomes.

Decision-Making
Determining the priorities for continuous improvement efforts is an ongoing role of senior-level sponsors of CI within the context of an unfolding strategic and change plan cycle. This role requires applying the CI process to the strategic and change plan efforts themselves, identifying strengths and gaps within them and establishing new or adjusted initiatives and chartering new or amended CI teams.

Communication
When the continuous improvement process is open and inclusive of all levels of the organization, stakeholders and partners, the result is more buy-in and commitment versus resistance or confusion, and more innovative and realistic tactics and initiatives. Effective agencies use comprehensive communication mechanisms to keep those it serves, staff and stakeholders informed and build understanding, buy-in and participation.

Celebrating Progress and Taking Risks
It takes a lot of energy and passion to sustain change efforts, and teamwork and collaboration are essential to maintaining this energy and passion. And there are risks in attempts to innovate and collaborate resulting in failures, mistakes and frustrations. At times, agencies become risk averse, preferring to do things within strict compliance boundaries (e.g., placement in licensed homes) instead of taking measured risks in the best interests of children, youth and families (e.g., placement with relatives).

Well-designed methods and activities to frequently recognize and reinforce the strengths of the agency and the progress being made by both individuals and teams are essential to maintaining that energy and tolerating that risk. Recognition programs should stimulate healthy, fun competition and promote individual and team goals. These programs should at the same time emphasize that appropriate risk-taking and related failures are constructive learning experiences- indeed, the primary means for generating important new insights and making important course corrections.

Professional Development
Developing staff capacity and capabilities in alignment with change planning and continuous improvement priorities requires effective methods for professional development. Staff capacity must be built to support desired outcomes such as recognizing disparities or appropriately engaging families. Leadership and supervisory development programs should be built around change and continuous improvement efforts themselves, versus employing abstract or conceptual curricular approaches. All staff should understand, buy into, and internalize the critical thinking steps used in the agency’s continuous improvement process.

Performance Management and Other HR Programs
Evaluations and individual or team development plans are most powerful when they are explicitly linked to the strategy and change plan. Processes and methods that supervisors use must be objective, consistent, constructive, and collaborative with those who need to improve their performance. Hiring and promotions should be based on those positively reacting to the culture of change vs. those that resist in non-constructive ways. These same principles apply to programs, functions and individuals within the agency, as well as when establishing and managing contracts with private providers