Internal Quality Advancement (Don’t Rely on Someone Else to Make Your Organization Better)

I have been involved with quality advancement activities at Grafton for 20 years. Now more than ever, I see leadership’s desire not just to follow best practice but to innovate and define best practices ourselves. I have been through many (many, many) regulatory inspections and accreditation surveys. While some of those experiences may have helped us shape our understanding about a matter, quite honestly just as often the experiences focused on areas that were not truly related to quality of our services. From the reviewer who was more interested in the nearest golf course than understanding our work, to the reviewer who proclaimed documentation was not in order when he had not yet opened the first record (yes, he then conceded all was fine), to reviewers who truly cared about the people we support and the evidence of the work we do, all of these reviews, it is clear that the best way to drive quality is through internal processes.

External inspectors and reviewers can too often serve as an easy way for managers to transfer responsibility to others for things we expect to be unpopular with employees.  Sometimes, we don’t want to be the bearer of news that will require change (e.g., additional documentation, additional notifications, additional time spent on a certain task, and the dreaded additional accountability). But it is a dangerous approach for a manager to transfer the rationale and motivation for such change onto an external entity. Employees then may believe that the change doesn’t matter because her or his supervisor doesn’t really agree with it/like it/care.  Employees then don’t receive information that explains the need for, or more importantly the benefit of, the change. Employees may even view management as weak and unable to establish best practices, capitulating to others to define how an organization operates.

It is critical to build and sustain an effective internal quality advancement program that digs deep. You want to find those areas where you are not succeeding or where you are weak. The program must have top-level buy-in and support. We are blessed at Grafton that not only does our executive leadership support the work of our quality assurance department, it actively pushes us to continue to find – and then work with others to address – opportunities for advancement. They never shy away from identifying new areas of improvement and taking active roles in uncovering the root causes of these issues.

Grafton has used internal quality advancements activities to drive numerous changes. Some of those changes have been large in scope and led to international recognition, such as our goal mastery initiative and restraint reduction. There have also been many other examples of improvements in systems, processes, and services that have been more subtle but have had a significant, meaningful impact on the efficiency and effectiveness of our work. Examples of these changes include simplifying a document to make it quicker for employees to complete, writing procedures in a step-by-step fashion to make them easier to follow, creating lanyard reference cards to make key information readily available. Small changes or large, it is an ongoing effort to constantly improve our care, and it is an exciting time to be part of Grafton’s quality advancement efforts.