Continuous Quality Improvement
Continuous Quality Improvement (CQI)
Continuous Quality Improvement (CQI) is a deliberate, defined process which is focused on activities that are responsive to community needs and improving population health. It is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality for state and local program levels.
The goal of CQI at the Minnesota Department of Health (MDH) Family Home Visiting (FHV) program is to improve outcomes by building capacity of local partners through:
- Establishing a culture of CQI,
- Building CQI infrastructure and,
- Applying CQI methods to daily practice
For more information about Minnesota’s FHV CQI efforts, contact firstname.lastname@example.org.
Why We Promote CQI
Continuous Quality Improvement is considered a best practice in public health. MDH is a Maternal, Infant, Early Childhood Home Visiting (MIECHV) awardee that administers funding on behalf of the U.S. Health Resources and Services Administration (HRSA) to local grantees throughout Minnesota to deliver home visiting programs. MDH FHV is required by HRSA to develop a CQI work plan and report on it annually. MDH FHV must demonstrate utilization of CQI best practices and measurable improvement at the state program level while assisting family home visiting programs to increase their capacity to use consistent and planned CQI methods to improve program outcomes.
Who We Support
MDH FHV supports local family home visiting programs who receive federal and state funds to deliver home visiting programs. Family home visiting programs can be managed by local public health agencies, county health boards, tribal nations, and nonprofit organizations. The majority of programs that MDH FHV supports are those using an evidence-based home visiting model funded by state and/or federal home visiting dollars.
Ways We Support CQI
An interdisciplinary team that includes a CQI Coordinator, Home Visiting Consultants, Research Scientists, and Student Workers work closely to support local family home visiting programs in building their CQI capacity by providing:
- Peer learning opportunities
- Technical assistance
- Data collection, reporting, and analysis
The MDH FHV Section is committed to the principles of CQI and supports efforts at both the state and local levels to improve the effectiveness and delivery of family home visiting services provided to families with young children.
These guiding principles include:
- A focus on improving services from the client’s perspective
- Meaningful engagement at all levels is required for success
- Recognition that all processes can be improved
- Continual learning using an “all teach, all learn” philosophy
- Decision-making is improved by using both data and team knowledge
- CQI data is used for learning and improvement, not for judgment or supervision
The Minnesota Department of Health uses many different resources to support CQI efforts, but several essentials will get you on the path to success when planning a CQI project. Family Home Visiting has created a CQI Toolkit, available on the FHV Toolkits page, with more information on CQI practice and essentials.
Model for Improvement
The Model for Improvement provides a framework for rapid testing and change leading to improvement. This model consists of two parts: addressing three fundamental questions and then engaging in tests of change using the Plan-Do-Study-Act cycle.
Langley, G.J., Nolan, K.M., Nolan, T.W, Norman, C.L., & Provost, L.P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco: Jossey-Bass. P.24.
A document to describe and launch the improvement project through establishing a common vision for the work.
Key indicators that are used to measure performance and track improvement. Measures are used to evaluate if the aims and goals of an improvement project have been met.
A visual display of the theory for what “drives” or contributes to the achievement of a project aim. The driver diagram shows the relationship between primary drivers (those that contribute directly to achieving the aim), secondary drivers (components of primary drivers), and the goal(s) to achieve. The driver diagram is a tool that helps you translate a high level improvement goal into a logical set of smaller goals and projects.
The Plan-Do-Study-Act (PDSA) cycle is a method for rapidly testing a change by developing a plan to test (Plan), carrying out the test (Do), observing and learning from the results (Study) and determining what modifications should be made to the test (Act).
A document that strategically sets smaller goals by timeframe. It helps plan when and who is responsible for PDSA cycles being completed in either the test, implementation, or spread stages during different action periods of an improvement project.
Parent Leadership in CQI
Parents engaged with CQI efforts as active leaders can offer valuable feedback and develop innovate ideas for improving services and processes. To improve services for families, it is important to partner with families.
The HV CoIIN Parent Leadership Toolkit is available at no cost and you will receive a copy for download after completing a simple request form.
For additional CQI resources and tools, visit MDH Center for Public Health Practice.
A Collaborative is a time-limited effort of multiple organizations that come together with leaders and experts to learn about and to create improved processes in a specific topic area. MDH uses the Institute of Healthcare Improvement’s Breakthrough Series (BTS) Collaborative model as a framework for CQI in FHV.
The topic selection process engages internal and external stakeholders. Topics that are chosen are issues that have a high level of interest at the state and local program levels, as well as room for improvement based on national benchmarks in FHV performance measures. Past statewide CQI learning collaborative have focused on these topic areas:
Screening and Referrals for Maternal Depression and Developmental Risk
In 2017, Minnesota Department of Health (MDH) facilitated a nine-month statewide Screening and Referrals learning collaborative with 16 teams. The goals of the collaborative were to improve early identification, connection to services, and follow-up for families after a developmental, social-emotional, and/or caregiver depression screening indicated a need for referral.
Family Enrollment, Engagement, and Retention
In 2018, Minnesota Department of Health (MDH) facilitated an eight-month statewide Family Enrollment, Engagement, and Retention learning collaborative with 16 teams. The goal of this collaborative was to increase the proportion of eligible, referred families who participate at high levels by changing how FHV staff enroll, relate to, and engage families in services.
- Family Engagement Toolkit (PDF)
- Improving Family Engagement in MIECHV-funded Home Visiting Programs Poster (PDF)
A visual summary of the Family Enrollment, Engagement, and Retention Learning Collaborative changes tested, results, and conclusions.
In 2019, Minnesota Department of Health (MDH) facilitated a twelve-month statewide Breastfeeding learning collaborative with 31 teams. The goal of this collaborative was to increase the intention, initiation, duration, and exclusivity of infants receiving breastmilk.
To request additional Collaborative materials, please contact: email@example.com
Data collection, reporting, and analysis
MDH FHV Evaluation staff support CQI initiatives by providing guidance related to data collection and reporting. Guidance documents for reporting can be found on the Current FHV Evaluation Resources page. Further, data reports are generated regularly to support current CQI efforts and inform future project focus. To request assistance with data collection, please contact: firstname.lastname@example.org.