Room for Improvement:The Role of Quality Assurance in the Field of Human Services
This is a guest blog post by Ian Kile, Training and Quality Assurance Manager, Volunteers of America Colorado.
Compliance. Internal controls. Outcomes and data. Monitoring and auditing. Rarely do these words spark inspiration or ignite white-hot passion in the hearts of those drawn to human services in order to “do good” or “help people.” In fact, there was a time I was greeted with, “Ugh. We have one of those,” when I introduced myself as a Quality Assurance Manager to a group of direct service providers at an agency we were mentoring.
“All they do is tell us we’re going to get defunded because our case notes aren’t good enough or that we need another ream of documentation before they’ll let us help someone with their rent so they don’t become homeless.” It was clear that they had a very antagonistic view of quality assurance, which, once I was able to sit down with their quality assurance staff, I found to be enthusiastically reciprocated. “Ugh. Why can’t they just do things right the first time. I mean, all the rules are written out in the policies and procedures.”
It was clear that though these two groups shared an office space and worked for the same program, they lived in different worlds. One side wanted to provide program participants with the highest level of care possible while the other wanted to be able to demonstrate that they were providing program participants with the highest level of care possible. What resulted from this discrepancy was that quality assurance was viewed as a barrier that case managers had to breach in order to help the people on their caseloads. Likewise, case managers were viewed as a liability trying to game the system.
In my hotel room later that evening I was still thinking about the relationship between this agency’s case managers and their quality assurance staff; I was also thinking about the role of quality assurance in my own agency. Quality assurance didn’t have to be a barrier and, really, it should be the opposite. Quality assurance should seek to remove barriers where it can in order to increase the efficiency and efficacy of these human services; removing barriers for those trying to access service as well as removing barriers for those trying to provide them.
In order to develop a quality assurance program that empowers rather than restricts requires us to think about whom quality assurance serves: the agency carrying out the program’s mission, the staff putting into action the work that will accomplish the mission, and those seeking to access what the agency and staff are offering. For quality assurance to serve any of these groups to the detriment of another would be akin to a photographer tightening down only one or two legs of a tripod and leaving them to try and keep the camera steady, resulting in almost certainly a blurry image. It may seem like the agency, program staff, and program participants, each with their own motivations, would require separate approaches to quality assurance; but thankfully there is a common method that can be utilized in the application of quality assurance—the management of information.
Quality assurance is focused on the management of information by way of its collection, analysis, and communication. To see how this method serves all three groups—agency, program staff, and program participant—it is helpful to look at the primary tool that contributes to the collection, analysis, and communication of information.
Policies and Procedures
Policies and procedures draw the boundaries within which the agency, program staff, and program participants may operate. As such, an inclusive policy and procedure manual should take into account the needs of all three groups. While an agency typically holds authority over and responsibility for its policies and procedures, it is important to allow both program staff and participants to have a voice into the policies and procedures that affect the degree of efficiency and effectiveness with which the program is operationalized.
Recommended forums for program staff to communicate their needs regarding policies and procedures include 1) a policy review committee comprised of direct service staff that meets regularly to review, propose, and revise policies that can then be submitted to the agency for approval; 2) regular town halls facilitated by the agency where staff are encouraged to present their ideas on how to decrease barriers to providing services to program participants through the adoption of new policies, the revision of existing policies, or the removal of obsolete policies; 3) individual interviews conducted by quality assurance staff that seek to understand the impact of existing policies and procedures on staff and how they affect their ability to accomplish program goals. These same forums may be easily adapted to provide ways for program participants to communicate to the agency and to staff how policies and procedures affect them and their ability to access and engage with the program.
Strategic reviews are monthly reviews of programmatic data collected by quality assurance staff and conducted by program management. The data reviewed consists of programs finances, service targets, outcomes, and operational goals. This review is a time that allows management regular intervals where they can step back from the day-to-day operational concerns and communicate an objective view of their program in comparison to where it is in relation to the program objectives defined by both the funder and the agency. Each area is reviewed for timeliness, completeness, accuracy, and consistency; if any area of review is deficient in these qualities, quality assurance staff and program management work together analyze the information at hand and make a plan that addresses the deficiency and prevents it from future occurrences.
Internal monitorings are an opportunity to proactively identify current habits, practices, and standards utilized within a program, to correct or prevent any that could jeopardize the current operation or future funding of a program, and to encourage and celebrate those that enhance and enrich the program’s operations and service provision. The internal monitoring process is conducted by quality assurance staff with the intent to be instructive and not punitive, and is intended for the growth of all staff involved as well as to promote increased efficiency and efficacy of the program’s service delivery and management.
Internal monitorings consist of a review of the current agreements or contract between the program funder and the agency, individual staff interviews focused on collecting information demonstrating a common knowledge of program goals as well as clarity of individual roles, a review of progress towards achieving programmatic outcomes as defined by both the program funder and the agency, and an audit of all documentation requirements as defined by both the program funder and the agency. The information collected by the internal monitoring is analyzed by quality assurance staff and compiled into a quality improvement plan that identifies areas where the program would benefit through process correction, prevention, or encouragement. The quality improvement plan is approved by the agency and operationalized by both the agency and staff; all staff, including management and quality assurance, are responsible for the execution of the quality improvement plan because everyone has a part to play in upholding standards of practice and compliance.
Performance analyses are bi-annual reports that consist of data collected by quality assurance staff that analyzes program performance indicators in relation to program performance targets over the course of longer periods of time than strategic reviews. Performance indicators include effectiveness of services provided by direct service staff, indicating whether the efforts of the program are resulting in the outcomes defined by the program funder; efficiency of services provided by direct service staff, indicating whether there are processes in place that hinder the program’s ability to provide services in a timely manner; service access by program participants, indicating whether there are service gaps and barriers for participants in accessing program services; and feedback from stakeholders and program participants, indicating the program’s ability to collaborate with community partners when coordinating services for program participants.
The analysis of these indicators over longer periods of time is used to review the implementation of the mission and core values of the organizations, improve the quality of programs and services, facilitate organizational decision making, and review or update the program’s strategic plan through the identification of trends in program finances, service provision outcomes, and service access. The analysis communicates areas needing performance improvement by resulting in an action plan to address the improvements needed for each established or revised performance indicator, and outlines actions taken or changes made to improve performance.
Each of these tools—policies and procedures, strategic reviews, internal monitorings, performance analyses—contribute to a cycle of information collection, analysis, and communication between the agency, program staff, and program participants. They are the basis for a quality assurance program that asks if everyone’s goals are in service to the ultimate mission of the program; if not, what is needed to bring them into alignment with the mission of the program. It asks if everyone has the information they need to clearly understand where they are in accomplishing their goals; if not, it asks what is needed to get that information. It asks if everyone has the tools they need to be effective and efficient in accomplishing their goals; if not, it asks what is needed to develop those tools.
Quality assurance doesn’t have to restrict us from doing good or helping people, it invests in processes and empowers agencies, staff, and participants. Quality assurance plans for the future and asks hard questions about what steps we need to take to be better. Quality assurance helps us be better at what human services has long excelled at, telling the story of human beings living complicated lives in a world where there is, without a doubt, room for improvement.