Rx for excellence: Hard work, conviction and planning

American journalist, Jacob Riis, reflecting on success once said, "When nothing seems to help, I go and look at a stonecutter hammering away at his rock perhaps a hundred times without as much as a crack showing in it.

Yet, at the hundred and first blow, it will split in two, and I know it was not that last blow that did it, but all that had gone before." Achieving the gold for the Joseph D. Brandenburg Center has been the result of hard work on the part of all employees. The important key elements that were critical for us were: I . It is important to know the desired outcome to implement continuous quality improvement (CQI) at the agency.

2. It is necessary to believe that the task can be accomplished.

3. It is critical to develop a plan of direction

The keystone ingredient to making it happen and keeping it going is persistence - It is imperative to highlight that like the stonecutter, achieving the gold is definitely a result of all the diligent and conscientious work that occurred before receiving the award. It also must be remembered that the journey continues.

Our starting points - The motivating factors for the Joseph D. Brandenburg Center* to pursue a quality initiative, prior to Maryland leadership endorsing the concept, was due to strong beliefs in: Continuous improvement... Customer satisfaction... Employee empowerment. The philosophy of CQI formalized existing values and made our work environment more productive. Maryland's leadership today under Governor Parris Glendening has fully embraced CQI throughout Maryland. The Department of Health and Mental Hygene's Secretary Martin Wasserman, M.D., J.D., has pledged to make the department a world-class organization. Brandenburg Center's history and futuristic philosophy match that of the department. Brandenburg's journey begins The Brandenburg Center began its quality journey in 1992 by approaching the Department of Health and Mental Hygene's (DHMH) Training Services Division about using the agency as a pilot project to implement CQI principles within DHMH's agencies. No budgeted monies were available for training; thus, the partnership allowed a learning opportunity for both organizations. With them providing the training, they could determine what worked well during implementation as they later assisted other agencies with a quality initiative. From this pilot, TSD has since assisted 40 DHMH agencies in developing a quality initiative. Areas of focus in the Maryland Award The application process for achieving the gold covered five major areas:

Executive leadership... Customer satisfaction... Management of process quality... Human resource development... A site visit.

The following review of each of the five categories in the application demonstrates what the Brandenburg Center has been working on in each award over the past 4 years.

Management leadership - The agency's philosophy starts with its vision, mission, and values. Yearly, executive management and coordinating committee members collaborate to develop the agency's goals and objectives. Quarterly thereafter, the same group reconvenes and assesses progress on this agency blueprint. The coordinating committee is synonymous with steering council and represents a cross section of all employees. This team is responsible for overseeing and directing the quality journey.

Management leadership and commitment... Executive management identifies the pursuit of quality as a long-term process requiring personal commitment, and they: Attend all CQI training with other employees... Are involved in at least one key phase of the quality process, e.g., coordinating committee, trainer, facilitator and/or team member... Insure employees are freed from primary duties to attend team meetings, training, and celebrations as well as to complete surveys; this is not an easy task in a 24-hour residential agency... Review yearly with employees the agency's vision, mission, and values plus the year's goals and objectives. . .

Communicate with all customers frequently through mailings, telephone contacts, newsletters, and meetings...

Institute an additional employee evaluation process beyond that required by the state; this process assesses each employee's role in the quality initiative and establishes employee goal setting for the year. ..

Support two agency-wide celebrations yearly plus team celebrations and encourage creativity in funding the events. .. Conduct mental wages meetings with each employee yearly where only positives are discussed...

Write positives on employee paycheck envelopes; there is also special interest given to special events or losses in employees' lives. Executive management provides a broad perspective in determining the agency's direction and what can be accomplished on an operational basis. For example, they:

Prefer the title pilot to initiate new programs for customers; preference is given to implement programs emphasizing positives, e.g., pilot a reward system for no sick leave usage by employees... Share the agency's quality initiative with others; to date, 22 State, Federal and/or private agencies have received training from the agency's trainers

* Review processes and policies on a continual basis attempting to obtain employees to be involved input all facets respond the quality journey plus be daily decision ms...

Empower employees to be involved in all facets of the quality journey plus be daily decision makers in executing his or her job. As a result of management's dedication to walk the talk and provide proactive leadership, Brandenburg Center in 1995 was reaccredited by The Accreditation Council as well as had zero deficiencies in both licensing and certification (State) and Title XIX (Federal) site surveys.

Customer satisfaction - The Golden Rule states, "Do unto others as you would have others do unto you." Stephen Covey's interpretation in Daily Reflections for Highly Effective People states that, "While on the surface this could mean to do for them what you would like to have done for you, but the more essential meaning is to understand them deeply as individuals, the way you would want to be understood, and then to treat them in terms of that understanding." This interpretation represents Brandenburg Center's philosophy in working with all persons as customers.

Knowing your customer's needs is a continuous process which requires measuring whether you are meeting those expectations. For the people directly served by the Brandenburg Center, those expectations are primarily established by regulatory or accreditation agencies. Additionally, a yearly self-assessment for each consumer has been newly instituted where individual choices drive agency expectations. Also, for those same consumers, approximately 100 program observations are conducted monthly through the agency's Quality Enhancement Program. This monitoring system indicates strengths and areas where improvement is needed on an ongoing basis. The regulatory surveys plus customer feedback are particularly important in a 24-hour agency where services are continuous.

Other customers are surveyed using a numeric rating scale on the following schedule:

Employees -- twice a year

Short-term stay consumers -- following each visit

Families -- yearly

Volunteers -- yearly

Community day programs (where consumers attend) - yearly

As data is collected and analyzed, areas identified needing improvement have one or all of the following occur: Hold meetings to review concern...

Establish teams to address concern...

Change policies...

Initiate retraining, if needed...

Share information where needed...

Remeasure for effectiveness. Being a community resource... Brandenburg voluntarily expanded its external customer service base to enable the agency to function as a community resource. Not only has its quality journey been shared through training others, but our buildings, grounds, and professional services are available to the community at large.

More than 20 organizations meet at the agency throughout the year; office space is available to low-budgeted programs serving people with disabilities; in-service training is shared; and external group meetings, conferences, and workshops are held in Brandenburg Center's buildings. With its expanded customer orientation, increased volunteers, donations, agency credibility, favors, and services are just a few ways our consumers have benefitted.

Management of process quality -- Process analysis and improvement are ongoing at the Brandenburg Center. It was realized early in the quality journey that process simplification was a must and could only be accomplished by involving all employees. In many instances, teams have impacted processes as they worked on simplifying paperwork, instituting consumer adaptive devices, improving communications, streamlining the movement of requests through the system, reducing waste via recycling, and increasing computer usage. To insure team recommendations are working, monitoring occurs for a 12-18 month period.

Making time for the team quality improvement processes... Since the agency is a 24-hour program, it was also recognized that a simplified system was needed to insure that teams meet regularly while accommodating members possibly from three shifts plus maintaining consumer services. To accomplish that goal, a majority of team meetings occur Tuesday and Thursday afternoons with these times receiving priority for teams. Unless emergencies occur, no other meetings or consumer medical appointments are scheduled during those times. Occasionally, teams have met early in the morning to accommodate night shift employees. We also found there was a need to be mindful of the number of teams that we could successfully support at any given time. The agency has 4-6 teams in operation at a time, with one team ready to start as soon as a team presents.

The quest for improvement and quality cannot be accomplished without benchmarking... The agency benchmarks specific topics in other Maryland agencies that provide similar services as well as agencies throughout the country. Examples of benchmarking topics are:

Accreditation-outcomes...

Consumer safety and injuries...

Incident reporting...

Employee vacations, scheduling of employees' workshifts, and multi-shift teams

Brandenburg Center has also been benchmarked by others, not only for its quality initiative, but for the pilot use of lumbar support belts to reduce employee injuries and employee incentives plans. Operational emphasis is always to take a proactive approach on issues needing improvement. All processes have an ongoing evaluation after implementation. Team improvement project criteria... When teams work on various projects or a new process is implemented, it must: Meet or improve on a customer need... Consider all existing quality requirements from Step I in the process

Be coordinated and integrated throughout the agency. .

Include a plan of management and monitoring.

Since in state government funding is limited at best, economics is always considered when implementing a new or improved service or process. Our trainers are drawn from direct care employees, mid-level managers, and executive management. Even celebrations are creatively held with limited monies -- fundraisers are often employed to meet these needs as well. This same practice is used when a customer may have a special need and budgeted monies are not available. Employees organize fundraisers or seek out donations from community organizations. Human resource development - The statement by an unknown author: "Working together, ordinary people can perform extraordinary feats. They push a little higher up, a little further toward excellence," explains this category. The agency believes in the importance of employee training and retraining. At the Brandenburg, we value people as the source of our strength and believe that our investment in employee education, training, and development pays substantial returns by building the strength of the entire organization. It is challenging in a 24-hour residential setting to relieve employees from primary duties on a regular basis for training. Our quality initiative has taught us that there is a need to be creative, organized and committed to accomplish what is important. Thus, we have made training a priority and it occurs despite many obstacles.

Employee training is provided or obtained for all employees in the areas of: Skill enhancement...

CQI principles...

Mandatory training for direct contact employees...

Orientation of new employees. We determine our training needs through an employee training survey, the agency's Quality Enhancement Program, and through regulatory agencies' requirements. Other agencies are also benchmarked for best practice programs that exemplify new directions in the field.

As previously mentioned, with limited training monies, creativity has been used to provide training. Employee talents and skills are used, as well as free speakers, grants, partnerships with other agencies. Our yearly goals for training are to: Conduct in-service training sessions by outside consultants speaking at the agency on five occasions (90I00 employees participate)... Schedule at least two training sessions of one to two days in length for each employee on quality and learning principles...

Send employees to off-site training (20-30 employees) . . .

Conduct an orientation program for all new employees.. .

Provide seven mandatory in-service training sessions for all employees...

Provide retraining programs on as needed basis... Provide release time for professional employees to earn CEU's...

Conduct six facilitator training sessions.. .

Renew and improve training skills in at least four sessions for trainers. Increasing employee empowerment, personal responsibility and risk taking... Part of the cultural change experienced by the agency has been the positive response of employees to these increased opportunities. Observing the growth of our employees since the implementation of the CQI initiative has been one of the highlights of our journey. The agency supports opportunities by encouraging all employees: To participate in teams; currently 90% of all employees have been on at least one team...

To assume various roles in the CQI process; there are 9 members on the coordinating committee, 1 8 facilitators and 8 trainers...

To participate in presentations; this may include Team presentations, CQI training/overviews to visitors, or CQI presentations at conferences or other agency sites. .. To participate in the site visit for quality awards, attend awards ceremonies, and participate in newspaper interviews, and articles.

Site visits - The judges spend four to five hours visiting the qualified applicants at each agency site. The process begins with a general overview presented by executive management. This is followed by the judges asking for input from other employees attending the meeting. The general overview session is open to all employees and off-duty employees often attend. This is followed by a tour of the agency with the judges questioning employees in each work area. Questions include what CQI has meant to the agency, to both its internal and external customers. The site visit also serves as verification of the written application. It is an opportunity for employees to shine. The growth and confidence of Brandenburg Center employees are no more obvious than in the presence of the judges at the site visit Final thoughts In conclusion, it is a most challenging task to write about achieving the gold without portraying people who come to work each day with a smile and offer themselves in a stressful and challenging job. In an article, you cannot observe the people who have grown in confidence to give presentations to groups of people, have accepted challenges and believe that change is possible.

Only visitors experience the friendly environment created by people who greet you as you enter the door or by answering the telephone with a cheery "May I help you." It is also difficult to visualize the beautiful rooms in each home for which the employees shopped, decorated, and designed that say "only the best will do for our consumers."

Lastly, try to appreciate the results of a team that began to decorate a cold concrete block interior and ended up as a beautiful area with 14 original watercolors and acrylics donated by a local artist What does it take to achieve the gold - empowering people and, like the stonecutter, a persistence at the job until you achieve your vision.

Author's note: Thanks to all Brandenburg Center employees and special thanks to Denny Georg, Cynthia Garner, and David Sandvick for assisting with the 1995 Quality Application.

* The Joseph D. Brandenburg Center is a 68-bed State residential program for individuals with developmental disabilities. The agency, located in Cumberland, Maryland, is under the auspices of the Department of Health and Mental Hygiene (DHMH).

Carolyn Brown is the director of the Joseph D. Brandenburg Center, Cumberland, Maryland. She has 22 years experience working in state government. In 1992, she initiated the pilot for a total quality management initiotive within the Department of Health and Mental Hygiene. She currently cochairs the Department of Health and Mental Hygiene's Quality and Learning Coordinating Council which lends direction to the quality movement within the department. Brown holds an MA in education and in business administration from Frostburg State University.

Copyright Association for Quality and Participation Jul/Aug 1996
Provided by ProQuest Information and Learning Company. All rights Reserved