Tools for Grantees: Quality Management Manual < Previous | Home | Next >  III. Step-By-Step Quality Management Guide: Nine Critical Steps   Develop Project-Specific CQI Plan   •  Establish project-specific QM team that represents all staff integral to the service or issue.    •  Identify a team leader or sponsor    •  Delineate specific goals for the team.    •  Allocate time and resources for the team. Delineate team responsibilities.    •  Develop timeline for reporting findings and improvement strategies.

Establish project-specific QM team that represents all staff integral to the service or issue.  TOP

A single person using quality improvement practices can make a difference in an organization, but rarely does a single person have enough knowledge or experience to understand everything that goes on in a process or to single handedly improve the process. Major gains in quality improvement most often result from teams – a group of people pooling their skills, talents, and knowledge. Working together, teams can tackle complex problems and chronic issues and formulate effective solutions that can be sustained over time. In order to comprehensively understand a problem and improve the process, it is essential that all staff integral to the service or issue be involved in the improvement process.

Identify a team leader or sponsor.  TOP

Once the quality improvement project has been selected, a team leader or sponsor should be identified and team members selected. If the organization or program is small, the Quality Guidance Team or Quality Council might also serve as the projectspecific CQI Team.

The team leader, quite simply, runs the team. He/she coordinates the logistical details such as meeting times, provides facilitation during the meeting, maintains the team’s focus on the stated goal, and communicates team progress to senior leadership. While the team leader may record the meeting minutes, this responsibility is ideally rotated among team members to reinforce the concept of shared responsibilities and ownership of the process.

The team leader does not need to be the person at the top of the organization. In fact, when the team leader is the top person in the organization, there may reluctance by team members to have full and open discussions about what areas of improvement they feel are necessary and some may feel uncomfortable about expressing their true ideas and opinions. Informal leaders within organizations should be sought out, and include those who are mature, organized, and focused, and who have a good understanding of the process under study. Almost any committed staff member can function as the team leader if they are properly trained. All team leaders should be trained in basic CQI tools and techniques and simple meeting management. The team leader should have some expertise in the issue being discussed.

In addition to the team leader, a sponsor should be identified who can serve as a champion and cheerleader for the quality initiatives being undertaken. The sponsor should be a senior leader and serve as the primary contact person for the team leader and the team. While the sponsor does not need to attend every meeting, he/ she should have a solid understanding of the issue being addressed and participate in meetings at key points throughout the process when decisions are being made or finalized for implementation.

Once the team leader and sponsor have been selected, the rest of the team members should be identified. For small programs with only a few staff members, this may be relatively easy since everyone in the program may be a part of the process identified for improvement. In larger programs many individuals may be involved in a particular process. Regardless of the size of your program you will need to select your team members carefully to assure that every step of the process is represented. The number of members on the team will vary, but 6-8 individuals is a good rule of thumb. Anything larger may become unwieldy, and anything smaller may not represent all of the key steps within the process being reviewed.

Examples of the composition of teams by type of process being improved are provided below:

Clinical: Increase adherence to Annual Pap Smear standard of care by 15%

- Clinical provider (physician, NP, PA)
- Medical assistant or LPN who might be assisting the providers
- Specialty provider, i.e. gynecologist
- Unit manager or individual responsible for staffing and patient flow
- Outreach worker or client advocate
- QI Coordinator/Quality Advisor

Case Management Team: Improve timeliness of case management client intake

- Case manager
- Supervising case manager or social worker
- 1-2 referral sources, i.e. medical provider, AIDS Service Organization
- Scheduling staff
- Unit manager or supervising staff
- QI Coordinator/Quality Advisor

Access to Care Team: Reduce New Appointment Wait Time from 1 month to 2 weeks

- 1-2 scheduling staff
- Senior provider staff
- Clinical provider (physician, NP, PA)
- Data management staff
- Unit manager or supervising staff

In all cases, consumer representation should be considered, particularly when a project involves client satisfaction. Although it may not be appropriate for all teams and projects, consumers bring added value to the discussion and should be invited to a minimum of one or two meetings to discuss specific components of the process under review.

Delineate specific goals for the team.  TOP

In order to increase the effectiveness of the team, a clear and understandable goal or aim should be established. The goal or aim should be stated in simple and direct language. Here are some examples:

• Increase the percent of female patients who have an annual PAP smear performed from 60 percent to 90 percent.
• Increase the percent of case management clients who have an initial intake form completed from 85 percent to 98 percent.
• Decrease the waiting time for new patient appointments from 3 weeks to 1 week.

If the goal is not stated clearly and succinctly for the team, a lot of valuable time will be wasted and the team can become disillusioned and frustrated. A clearly stated goal will help keep the team on track and focused.

	Allocate time and resources for the team.  TOP
	Delineate team responsibilities.

When the team is in place, standard meeting times should be established and resource needs identified and provided. Meetings will run more smoothly if there’s an agenda, a chair/facilitator, and a notetaker to record decisions. The team should decide on the most convenient time for the team to meet and safeguard that time as much as possible. During the initial meeting, team ground rules should be established and reviewed. By reminding the team of the ground rules at the beginning of each meeting, the risk of being sidetracked is minimized. Examples of ground rules to establish include the following:

Meeting Attendance: One of the most important ground rules to establish is the expectation that all participants will attend all meetings and actively participate. Meeting time is precious and should be respected by all team members. Meetings should be scheduled through mutual agreement of team members which have clear start and stop times. To encourage participation, these times should be honored. Members will need to arrive on time ready to work. As a group the team can decide what constitutes acceptable reasons to miss a meeting and the process by which the team leader is notified.

Active Participation: The members of the team are chosen because of the unique perspective they bring to the improvement process. It is important that all members of the team speak freely and listen attentively. The value of ideas is determined by the thought put into the idea and by a person’s position within the organization or professional degree. High functioning teams respect and value all comments and ideas. The team leader should solicit participation from shy or timid team members and neutralize or diffuse over-bearing individuals by providing opportunities for everyone to provide input. If specific individuals consistently do not follow the ground rules, the team leader should speak with them one-on-one. If the behavior continues, advice from senior leadership should be obtained.

Team dynamics will be as unique as the team members themselves. Remember that we all bring our personalities and styles with us wherever we go. The key to a high functioning team is respecting and exploring each individual’s perspective and creating a synergy, where the whole is greater than the individual.

Team Assignments: Since team members are typically staff, balance team tasks with their regular work duties. Much of the work will take place outside of the regularly scheduled meetings. Tasks should be clearly defined and assigned to team members. The timeframe for completion should be negotiated and clearly stated. In some cases, work will need to be completed before the next meeting while others will have longer timeframes. Because it is a team effort, the team leader should not be expected to perform all of the work. Use of an established workplan with appropriate, realistic timelines is helpful for keeping the team on track.

Authority of Team: At times, issues will be raised that fall outside of the quality improvement team’s purview. To minimize disruption to the team and the process, the team leader should quickly resolve any issue that impedes the team’s progress toward its goal. The team leader, at a minimum, should work with team members to strategize how to resolve these issues and follow-up to ensure a quick and smooth transition back to the team’s original plan. As part of the quality improvement process, a wide array of strategies to improve a process can be identified. Some of the strategies proposed may not be a realistic option. For instance, a team may determine that additional staffing will resolve a specific problem, however, the budget cannot support this solution. To minimize these issues, it is important that parameters be established at the beginning of the project so that the team understands the boundaries of their authority. In a case such as this, leadership should take “hiring new staff” off the table as an improvement strategy, but encourage re-designing work flow, changing staff duties or hours as potential solutions.

Develop timeline for reporting findings and improvement strategies.  TOP

As the team begins to work together, a timeline for reporting findings and outlining improvement strategies should be developed. This will provide target dates for which to strive and will help keep the project on track.