Pennsylvania Family Support Continuous Quality Improvement Guide

Pennsylvania Family Support Continuous Quality Improvement Guide

The Pennsylvania Family Support CQI guide is designed to help Family Support and Home Visiting staff further understand what CQI entails, and why CQI is a key component of ensuring a high-quality program.

CQI Reporting Templates

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CQI Annotated Reporting Templates

Please review the annotated reports here, for a detailed breakdown of what information should be included with CQI reporting. If any questions should arise please email following account: RA-PWPAHOMEVISITING@pa.gov and include your Family Support Consultant.

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What is CQI?

A systematic approach to specifying the processes and outcomes of a program or set of practices through regular data collection and the application of change strategies that may lead to improvements in performance.

For more information on what CQI is visit the Administration for Children’s and Families Continuous Quality Improvement Toolkit: A Resource for Maternal, Infant, and Early Childhood Home Visiting Program Awardees.


Why is CQI Important?

  • Increased adaptability
  • Increased productivity
  • Improved morale
  • Helps us work on complex problem; and
  • Work through the messiness of life

Family Support Reporting Requirements

The Family Support team follows the federal requirements for CQI reporting, which have been established by the Health Resources Services Administration (HRSA). HRSA requires Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program grantees to collect certain data and report on their program’s performance through annual and quarterly performance reporting, to develop and implement plans for continuous quality improvement (CQI), and to meet certain statutory requirements related to demonstrating improvement in at least four of six benchmark areas and implementing data exchange standards for improved interoperability. MIECHV also promotes rigorous evaluation at the national and local levels and supports research infrastructure in the field.


Who is Responsible for CQI?

Through June 30th, 2022 only MIECHV and a small number of Nurse-Family Partnership grantees report on CQI. After June 30th, 2022 all programs awarded through the future Request for Application (RFA) will be required to participate in CQI implementation and reporting.

If your Family Support Program is not currently participating in CQI but would like to participate please email the following account: RA-PWPAHOMEVISITING@pa.gov to request more information on the process.


Due Dates

CQI PDSA – Monthly

MonthDue DateMonthDue Date
JulyAugust 18thJanuaryFebruary 18th
AugustSeptember 18thFebruaryMarch 18th
SeptemberOctober 18thMarchApril 18th
OctoberNovember 18thAprilMay 18th
NovemberDecember 18thMayJune 18th
DecemberJanuary 18thJuneJuly 18th
An effectively implemented CQI plan can be a successful method for improving performance measure progress in a data-driven way. Plan-Do-Study-Act is a cycle of activities used to achieve process or system improvement. Demonstrates current efforts, trainings and activities towards reaching the SMART AIM goal. Reports should show performance over time, and represent data studied in short intervals. 

CQI Team Plan – Yearly

Portion of Grant YearReporting PeriodDue Date
July to MayJuly to MayAugust 30th  
Establishes effective and efficient objectives and goals. Guides conversations reflects on the internal and external aspects that relate to the inputs and outcomes of CQI Projects. The essential foundation for a successful CQI project is a supportive, multi-level, interdisciplinary team.

CQI Summary Report – When Completed (On PDSA Form)

Portion of Grant YearReporting PeriodDue Date
July to JuneJuly to JuneWithin 30 days of the end of each CQI Project.
Reflects on the entirety of the CQI Project after completion. Determines if the implemented changes have yielded positive outcomes. Reflects on the success, ups and downs of working towards the SMART AIM goal set at the start of the project.

CQI Training / CQI Learning Initiative Series for Family Support and Home Visiting Staff

This webinar series ran from August 2020 to March 2021, please note if there are questions or any follow-up clarifications when viewing the webinars please email the following account: RA-PWPAHOMEVISITING@pa.gov and include your Family Support Consultant for more information.

Handouts for webinars are available here: http://www.pa-home-visiting.org/cqi-webinar-series/

CQI 101 – What is CQI and Why is it Important?

  • Orientation, objectives, and expectations for the CQI Learning Initiative 
  • MIECHV CQI requirements 
  • Key principles of CQI and the Plan, Do, Study, Act (PDSA) cycle  
  • Writing a SMART Aim statement  
  • Basics of designing a Plan, Do, Study, Act (PDSA) cycle  

Recording: http://www.pa-home-visiting.org/wp-content/uploads/2020/09/CQI-Webinar-101-08-25-2020.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


CQI 102 – Establishing A CQI Team

  • Mitigating resistance by understanding the psychology of change
  • Identifying who should be at the table: CQI Teams
  • Establishing roles and duties on a CQI Team
  • Implementing and hardwiring changes as a team

Recording: http://www.pa-home-visiting.org/wp-content/uploads/2020/09/CQI-102-Establishing-a-CQI-Team.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


CQI 103 – Making Informed Decisions Using Data (10/27 repeat 10/29) 

  • Guidance on selecting CQI projects  
  • Using data to make informed decisions and write SMART Aim statements
  • Identifying changes to test 
  • Learning from variation and interpreting run charts  
  • Analyzing root causes of problems

Recording: http://www.pa-home-visiting.org/wp-content/uploads/2020/11/CQI-103-.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


CQI 104 – Strategies For Using CQI Tools (12/8 repeat 12/10) 

  • Tips for PDSA cycles: What tools and activities are useful? (5 Whys, Fishbone Diagram, etc.) 
  • Process Mapping 
  • Developing your team’s theory for change (Key Driver Diagrams)

Recordinghttp://www.pa-home-visiting.org/wp-content/uploads/2020/12/CQI-104-12082020.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


CQI 105 – How To Scale-Up and Sustain Improvement Activities (1/12 repeat 1/14) 

  • Learning about structures to spread changes
  • Running “ramps” of PDSA cycles 
  • Ramp planning to detail how to scale-up testing of change ideas
  • Level 1, Level 2 and Level 3 Change Ideas

Recordinghttp://www.pa-home-visiting.org/wp-content/uploads/2021/01/CQI-105-Scale-Up-and-Sustain-01-12-2021.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


CQI 106 – Using Program Data to Evaluate Progress

  • Defining your measures of a CQI project
  • Understanding the role of measurement for improvement
  • Types of measures and building a measurement strategy 
  • Review of Run Charts 

Recording: http://www.pa-home-visiting.org/wp-content/uploads/2021/02/CQI-106.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


CQI 107 – How to Communicate Your CQI Results (3/2 repeat 3/4) 

  • Learning about structures to spread changes
  • Holding onto gains and how to articulate your findings 
  • Communicatig CQI projects to your community or families: The good, the bad and the ugly 
  • Moving Forwards: What resources or assistance is needed? 

Recording: http://www.pa-home-visiting.org/wp-content/uploads/2021/03/CQI-107-03-05-2021.mp4

Please note: We are unable to offer certificates of attendance for watching the posted webinar recordings. 


Helpful CQI Resources

Please review the following resources if any links or tools are not working please email the following account: RA-PWPAHOMEVISITING@pa.gov

Plan-Do-Study-Act Model for Improvement
https://www.health.state.mn.us/communities/practice/resources/phqitoolbox/pdsa.html

Institute for Healthcare Improvement
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx

Building a Strong CQI Team
https://www.jbassoc.com/resource/continuous-quality-improvement-toolkit-module-3/

Partnering with Families and Caregivers
https://www.jbassoc.com/wp-content/uploads/2017/07/Module-3_Resources-for-Partnering-with-Families-Handout-1.pdf

Quality Data
https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/hv-pmcqi-resource-using-performance-data-inform-cqi.pdf

Using Data to Drive CQI
https://www.acf.hhs.gov/opre/report/continuous-quality-improvement-toolkit-resource-maternal-infant-and-early-childhood-7

Tests of Change: Level 1, Level 2, and Level 3
https://www.acf.hhs.gov/sites/default/files/images/opre/module_9_change_strategy_intensity_examples_handout_508.pdf

Three Types of Measures: Outcome, Process and Balancing
http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx

Engaging Stakeholders
https://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide1/index.html

Child Welfare Information Gateway CQI
https://www.childwelfare.gov/topics/management/reform/soc/communicate/initiative/ntaec/soctoolkits/continuous-quality-improvement/#phase=pre-planning

Sustainability and CQI
http://www.pa-home-visiting.org/wp-content/uploads/2021/10/Sustainability-Worksheet.pdf

CQI Tools
For how to use the CQI Tools below please refer to the CQI 104 Webinar Above

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