In my last post, I introduced a widely accepted definition of quality – meeting or exceeding customer expectations – and how a narrow (and uninspired) interpretation and application of that definition in the nonprofit sector has led to a focus on compliance rather than improvement. Rather than defining high quality service for ourselves, nonprofits define quality as the satisfaction of funder and accreditor requirements and stop their efforts there.
So, what does that look like?
Today, quality improvement work in nonprofits is often the work of agency veterans, mostly social workers, who have fallen into, gravitated toward, and evolved their skills into this work. Areas of focus include accreditation, funder reporting, policies and procedures, risk management, data management, and, less often, performance management and process improvement. Unsurprisingly, the creation of these positions or an emphasis on this work is often catalyzed by the increasing standards of funders and accreditors.
In a study exploring the qualifications, efforts, and accomplishments of quality improvement professionals in the social sector (particularly behavioral health), a team of researchers calls this focus on external standards and compliance a “corruption” of quality improvement frameworks. The authors further note, “A second problem with focusing QA/I [quality assurance/improvement] monitoring efforts on compliance with standards is that there are a lot of them . . . It may be costly yet intellectually easy to drift into a ‘monitor everything, but improve little’ mindset.“[1]
QI Work that Actually Improves Quality
So, if we returned to what I’m calling the “heart” of quality improvement – a commitment to continuous learning and improvement – what would that look like?
Intrinsically Motivated
Rather than being compelled or catalyzed by funder and accreditor requirements, the work would stem from a commitment to improve the way we plan, make decisions, and do our work. The driving force is a commitment to do more with less, deliver more impact, and improve the experiences of all our stakeholders.
Guided by Our Own Definitions of Quality
Beyond what funders and accreditors tell us they desire or require, we need to define quality for ourselves. These definitions ought to be unique to our contexts and populations and focus on what’s necessary to achieve our missions. Quality might be defined by safety, inclusiveness, responsiveness, cultural competency, best practices, effectiveness, or innovation. What does your organization need to be, to exude, or to exemplify in order to achieve its vision and mission? What is your unique value proposition? What are your leaders committed to?
Directed Toward Goals, Driven to Change
Rather than seeking to maintain a minimum standard or check a box, we would direct our efforts toward creating the changes in our organizations that matter to us. Reducing client dropout. Increasing employee retention. Reducing billing errors. Coordinating our departments. Reducing burnout. Saving money. Informing strategy. Improving outcomes. What stands in the way of your mission? What distracts and burdens your staff?
Integrated, not Siloed
Rather than “quality improvement” work being a separate, extra burden imposed by an external force and overseen by a designated few, it would become an integrated aspect of the organization’s culture and processes. It becomes “the way we think” and “the way we do things here.” It is not limited to the IT or HR departments. It crosses boundaries and integrates the organization.
Applied and Iterated, Never Finished
Rather than completing checklists once a year or satisfying quarterly reporting requirements, the work and learning is applied in iterative cycles. It lives and breathes. It doesn’t sit on a shelf.
Up Next . . .
In my next post, I’m going to share some of the definitions of quality and some examples of the way this work has strengthened organizations, motivated teams, and promoted excellence within some local nonprofits that made commitments to going beyond proving compliance to improving quality.
On May 17th, 2018, I’ll be teaching a professional development workshop at UMSL on Quality Improvement for nonprofits. If you’re interested, click here.
[1] McMillen, C., Zayas, L.E., Books, S., & Lee, M. (2008). Quality Assurance and Improvement Practice in Mental Health Agencies: Roles, Activities, Targets, and Contributions. Administration and Policy in Mental Health and Mental Health Services Research, 35: 458-467.