Continuous Quality Improvement (CQI) Resources for Healthy Marriage and Responsible Fatherhood Grantees

Introduction

Continuous quality improvement (CQI) is a systematic and data-driven process that helps organizations identify challenges and then develop, test, and implement strategies for improvement. CQI is an important element of ACF’s learning agenda for healthy marriage (HM) and responsible fatherhood (RF) programs, which support healthy relationships, positive parenting, and economic well-being. The CQI resources presented under the Resources section of this page have been developed to assist HMRF grantees in their program improvement efforts, as part of the Fatherhood and Marriage Local Evaluation and Cross-Site (FaMLE-CS) and Building Usage, Improvement, and Learning with Data (BUILD) projects. Both projects are led by the Office of Planning, Research and Evaluation in collaboration with the Office of Family Assistance, both in the Administration for Children and Families (ACF). ACF has contracted with Mathematica to conduct both projects.

Purpose

Because ACF requires HMRF grantees to develop and implement CQI plans, the FaMLE-CS and BUILD projects have developed resources to help grantees incorporate CQI into their regular program operations. These resources can also be used and adapted by other organizations interested in CQI, or other funders that want to support their grantees’ CQI efforts.

Resources

Below are key CQI resources that practitioners and developers can use in developing their CQI plans and implementing the CQI process. Additional resources can be found on the Continuous Quality Improvement Resources page of the HMRF Grant Resources site.

General CQI Information

• Continuous Quality Improvement Best Practices (OPRE Report 2022-185) (PDF). This resource describes how organizational structure influences CQI and includes four best practices for implementing CQI, such as supporting the implementation team.
• Tips for Using Continuous Quality Improvement to Navigate Change and Complexity  (PDF)(OPRE Report 2022-186) (PDF). This document, developed during the COVID-19 pandemic, provides considerations for using a CQI approach during changing contexts.

Developing a CQI Plan

• An Overview of the CQI Template (OPRE Report 2022-187) (PDF). This resource provides a guide to the HMRF CQI plan template developed for HMRF grantees.
• CQI Template (OPRE Report 2022-188) (DOCX). This template provides a structure and recommended content for the CQI plans for the 2020 cohort of HMRF grantees. It can be completed by responding to questions and prompts within each section.
• What Makes a High-Quality CQI Plan?  (PDF)(OPRE Report 2022-189) (PDF). This presentation walks through the HMRF CQI plan template, highlighting considerations for developing a strong plan.

CQI Practices and Tools

• Building a Strong Foundation for Program Improvement through CQI Implementation Teams (OPRE Report 2022-190) (PDF). This resource describes the importance of having a CQI implementation team, who should be on the team, and how it should operate.

• Implementation Team Agreement Worksheet (OPRE Report 2022-191). (DOCX) This worksheet can help CQI implementation teams document a shared vision with clear roles and responsibilities for how they want to conduct their CQI activities.
• Grantee Implementation Team Sample Meeting Agenda (OPRE Report 2022-192) (DOCX). This resource offers an example of how CQI implementation teams can structure their team meetings to promote high quality and efficient CQI discussions.
• Two Decision-Making Models (OPRE Report 2022-193) (PDF). This resource describes two collaborative models that CQI implementation teams can use to make key decisions.
• Facilitation Strategies for Fostering Discussion and Consensus (OPRE Report 2022-194) (PDF). This resource provides key points and considerations of different facilitation strategies for fostering discussion, building consensus, and incorporating diverse perspectives.
• Guiding CQI with SMART Goals (OPRE Report 2022-195) (PDF). This resource covers common questions related to developing and measuring progress towards SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals.
• Including a Diversity of Perspectives in Interpreting Data and Decision-Making (OPRE Report 2022-196) (PDF). This resource describes the benefits of having a diverse range of perspectives on a CQI implementation team and includes a tool to map the extent of representation on the team.
• Client Workshop Experiences: Sample Feedback Forms (OPRE Report 2022-197) (PDF). This resource provides an overview of two types of feedback forms teams can use to understand client experiences in workshops. The first form is an editable exit ticket (OPRE Report 2022-198) (DOCX), a low-burden tool to collect feedback after a session that can be quickly used to inform programming. The second is a longer, editable workshop feedback form  (DOCX)(OPRE Report 2022-199) (DOCX) that can be used to assess clients’ overall experiences and satisfaction with the program.
• Communication Protocol Worksheet (OPRE Report 2022-200) (PDF). This worksheet can help CQI implementation teams think through how they will communicate their CQI progress, insights, and decisions, and the different individuals and groups with whom they should communicate (including but not limited to other program teams, policymakers, and community members).
• Using COM-B to support improvement (OPRE Report 2023-265) (PDF) . This resource covers the COM-B (capability, opportunity, motivation, behavior) framework for understanding human behavior and discusses how COM-B can be a useful tool in your team's efforts to design and implement improvement strategies. It also provides an example of how to use COM-B in practice, detailing a design activity to use with staff to brainstorm facilitators and barriers to change.
• Scaling and sustaining improvement efforts (OPRE Report 2023-266) (PDF) . This resource covers considerations for scaling and/or sustaining an improvement strategy after a CQI cycle concludes. It includes recommendations for reflecting on the key aspects of the strategy; formalizing the strategy to share with others; and creating a plan for scaling and sustainability.
• Developing effective program improvement strategies (OPRE Report 2023-267) (PDF) . This resource provides guidance on three key steps to take when developing improvement strategies. It includes six one-page tip sheets on different methods for learning about challenges and developing and prioritizing strategies.
• Synthesis Matrix (OPRE Report 2023-268) (PDF) . This resource provides a tool that practitioners can use to synthesize findings across data sources in a road test. This matrix tool is useful for organizing insights by key learning questions.
• Collecting data for improvement: Focus groups (OPRE Report 2023-269) (PDF) . This resource covers considerations related to planning, conducting, and analyzing data from focus groups. It also includes a summary of key logistical steps related to planning a focus group, and a notetaking template your team can use to ensure you're capturing key insights, quotes, and context.

Methods

Two main principles guided the approach to developing these tools and resources.

• First, the team focused on the foundational topics and technical skills that HMRF grantees need to conduct CQI. Foundational topics align to the different steps of the CQI cycle, such as identifying areas of improvement, creating improvement goals, and road testing improvement strategies. The resources aim to support and improve grantees’ capacity to carry out the steps of the CQI cycle, such as collecting data to support CQI and using data to better understand programmatic challenges. 
• Second, the resources were designed to meet the broad range of CQI skills and experience levels across HMRF grantees. For example, for the foundational topic of CQI implementation teams, one resource focused on the importance of establishing a CQI implementation team, while others were designed to support teams’ operations. As a collection, the resources are intended to be useful and relevant to all grantees and enhance their ability to engage in CQI.

Citations

General CQI Information

Avellar, S. and L. Pollock (2019). Continuous Quality Improvement Best Practices (OPRE Report 2022-185). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Richman, S., Holcomb, P., and Rachidi, A. (2020). Tips for Using Continuous Quality Improvement to Navigate Change and Complexity (OPRE Report 2022-186). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Developing a CQI Plan

Avellar, S. and L. Pollock (2019). An Overview of the CQI Template (OPRE Report 2022-187). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2019). CQI Template (OPRE Report 2022-188). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Rachidi, A., Richman, S., Holcomb, P., and Pollock, L. (2020). What Makes a High-Quality CQI Plan? (OPRE Report 2022-189). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

CQI Practices and Tools

Buonaspina, A., Kalisher, A., and Richman, S. (2021). Building a Strong Foundation for Program Improvement through CQI implementation Teams (OPRE Report 2022-190). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Implementation Team Agreement Worksheet (OPRE Report 2022-191). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Grantee Implementation Team Sample Meeting Agenda (OPRE Report 2022-192). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Two Decision-Making Models (OPRE Report 2022-193). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Facilitation Strategies for Fostering Discussion and Consensus (OPRE Report 2022-194). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Buonaspina, A., Kalisher, A., and Richman, S. (2021). Guiding CQI with SMART Goals (OPRE Report 2022-195). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Including a Diversity of Perspectives in Interpreting Data and Decision-Making (OPRE Report 2022-196). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Client Workshop Experiences: Sample Feedback Forms (OPRE Report 2022-197). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Workshop Feedback Form Example (OPRE Report 2022-198). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Workshop Exit Slip Example (OPRE Report 2022-199). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Avellar, S. and L. Pollock (2020). Communication Protocol Worksheet (OPRE Report 2022-200). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.