A solid foundational administrative structure is a critical component in the development of a well-functioning continuous quality improvement (CQI) system. Strong administrative oversight and commitment by leadership is an obvious element of this component. To illustrate commitment and to promote staff and stakeholder buy-in, leadership should ensure that:
- Agency-wide CQI standards, requirements, policies, and procedures are clear and consistent
- The State possesses or builds the capacity to implement a strong operational CQI system
- There is strong guidance of the CQI program
To be successful, the new systems must create linkages within the entire agency, both vertically and horizontally. By focusing on creating a strong administrative structure, with adequate resources and solid direction, the agency will help ensure the effective functioning and sustainability of its CQI system.
State agencies should have procedures in place that result in a statewide systematic approach to implementing, overseeing, and exercising oversight of the CQI process, ensuring that it is being applied fairly and consistently. There should be a well-articulated, common approach to implementing, reviewing, and adjusting any CQI process.
Some States facilitate CQI by establishing a centralized CQI unit or division that serves as a bridge to connect all areas of the agency, from upper management to support staff. In this case, agencies may assign joint responsibility for monitoring the progress of CQI and any initiatives to both field and central office CQI staff, based on the initiative. Regardless of centralization, an agency will illustrate its commitment to CQI by having designated CQI staff, adequate resources, clearly written procedures, and by expanding its CQI system to go beyond the case review process.
The agency’s CQI requirements, policies, and processes should be clearly articulated in writing, and should illustrate consistent standards and procedures for the entire State, including other public agencies that operate title IV-E programs for the State. The standards and requirements should be structured to ensure that all jurisdictions across the State are implementing and executing CQI activities as designed and intended. Additionally, there should be an approved, consistent training process for CQI staff, under the guidance of the CQI oversight division, to include any external stakeholders who are involved in conducting CQI activities.
State agencies should have capacity and resources to implement and sustain a statewide CQI program on an ongoing basis, using designated CQI staff. Designated staff who focus on CQI activities will be able to develop a high level of expertise in quality assurance (QA) case review and other CQI activities. Having such staff also helps send a message to frontline caseworkers that they are accountable for the outcomes of cases they carry.
It is important that all jurisdictions of the State be assessed and reviewed at least annually through the QA case review process, in order to ensure consistent evaluations of all areas and that practice and system adjustments are made as needed, achievements are recognized, and new goals are being set.