Investing in Resilience: Continuous Quality Improvement for Adaptation in Uncertainty

  • By Abby Alexanian, April 19, 2021

Continuous learning and adaptation has never been more important for social service providers than the past year of unrelenting change and hardship. At Root Cause, we’ve found that during this time, when grantmakers invest in service quality and continuous improvement practices, it builds local organizations’ resilience in the face of challenges–such as a global pandemic–and their responsiveness to the communities they serve. With a focus on accessibility, use of best practices, equitability and engagement with partner organizations, providers get better at collecting and using data to help make decisions and measure progress towards their goals.

From 2018-2020, Root Cause partnered with The Duke Endowment (TDE) and the Get Ready Guilford Initiative (GRGI) to coach 13 early childhood direct service providers in Guilford County, North Carolina. This work would not have been possible without substantial investment by TDE, and later Blue Meridian Partners - an investment that provided both funds and the loud-and-clear message from these grantmakers that the practice of improving program quality is a critical strategy for creating better outcomes for communities. Participating programs received a small stipend and 24 months of individualized Continuous Quality Improvement (CQI) coaching using a program quality assessment to identify priority areas and track improvement over time. The assessment covers six core areas that research and experience tell us are critical to providing impactful services:

  • Accessibility
  • Family & Community Engagement
  • Referrals & Partnership Management
  • Staff Support & Performance
  • Trauma-Informed Practice
  • Use of Evidence

Embedded within each of these six quality areas are essential practices for racial and economic equity, without which programs cannot effectively support their service populations. Similarly, program quality improvement is enabled by performance measurement practices that allow providers to collect the right data at the right time and make use of it for learning and improvement.

What we learned tells us a lot about how to empower service providers by investing in quality improvement efforts:

CQI is an adaptive practice that providers can use to be responsive to community needs in the face of significant changes or hardships. Despite the impact of COVID-19, all of the programs we coached showed net gains in quality even six months after the onset of the pandemic. Many providers shifted the focus of their CQI work to address quality areas affected by COVID-19, such as connecting directly with the families they serve or building virtual programming to increase access to services. Because CQI involves collecting data to understand if a new practice achieved its intended result, programs are able to learn in a matter of weeks whether COVID-19 service adaptations are hitting the mark and continue to make changes to improve.

Quality improvement leads to meaningful and concrete changes. Collectively, the group improved program quality by an average of 35% over two years, as measured by the program quality assessment. In practice, these improvements looked like:

  • Reduced wait times for families in a WIC office
  • More staff who are trained and confident in using trauma-informed practices
  • Better data collection and storage practices
  • More touchpoints with participating families for feedback and input

Improvement gains increase with repetition. Among our program cohort, the average percent score improvement on the Assessment increased slightly after each PDSA cycle, indicating that providers are in fact “getting better at getting better” each time they use CQI to work on an aspect of program quality.

Improving performance measurement capacity goes hand-in-hand with improving service quality. Our evaluation of the Guilford County cohort found a strong positive correlation (r=0.69) between improvements in performance measurement and improvements in program quality. Providers who got better in areas like collecting usable data and developing logic models also tended to see meaningful improvements in one or more program quality areas.

Social service quality improvement increases community participation, leadership, and feedback loops. Providers in our cohort improved their family engagement practices by 66% overall, which translates to hundreds of new touchpoints with families and community members (via surveys, focus groups, advisory councils, and other methods) to ensure that service-related decisions increasingly include and respond to the needs, perspectives, and expertise of the service population itself.

It’s no secret that much of the data service providers collect is driven by compliance with funder requirements - but we see a possibility for change within the grantmaker-grantee partnership to align performance measurement systems and data collection requirements to meet both the organization’s CQI needs and the grantmaker’s reporting needs. When more providers use their data to proactively identify improvement areas, set goals and metrics and then build the capacity to improve, we see more effective services, greater community engagement and increasingly equitable access to needed services. Through this approach to data alignment and targeted financial and capacity-building support for quality improvement, grantmakers have an opportunity to leverage their considerable influence in the social sector to boost outcomes for families and communities.

Abby Alexanian

Senior Manager of Strategic Initiatives

Abby Alexanian brings to Root Cause more than seven years of experience as a practitioner, researcher, and consultant in the nonprofit and public sectors.

Abby’s work focuses on early childhood programs and system building, place-based initiatives, quality improvement for direct service providers, strategic and business planning, and preventing and addressing early childhood adversities and toxic stress.

Before joining Root Cause, Abby worked as the children’s advocate and case manager in a domestic violence shelter in Ann Arbor, MI, where she designed and implemented a new children’s program to reduce toxic stress and build child and family resilience. She holds a Masters in Public Policy and an MBA in Nonprofit Management from the Heller School for Social Policy and Management at Brandeis University and a BA in International Studies from Vassar College.