Observing variation: The first step in the CQI process

Embedded in the CQI cycle is an iterative process of developing and testing hypotheses: We identify a problem, we hypothesize as to its cause, we hypothesize that a given intervention will rectify the problem, and after implementing the intervention, we test whether our hypotheses were correct by measuring the extent to which the problem has been solved.

The process of hypothesis development and testing in CQI can be summarized by the following template:

• I observe that [there is a specific problem]. I think it is because [of this reason]. So I plan to [implement some intervention], which I think will result in [a desired outcome].

The process begins with an observation. For example:

• I observe that some counties in my state rely on congregate care settings for children in foster care much more than other counties do.
• I observe that children placed with kin stay in foster care longer than children placed in non-kinship foster homes.  
• I observe that my state has a higher foster care entry rate than almost all other states.
• I observe that some of my county’s residential care providers report more incidents of seclusion and restraint than others.

CQI is a problem solving process. So, in order to kickstart the process, we must observe a problem. In order to classify an observation as a problem, that observation has to be framed explicitly as a statement of comparison—unless we can make a comparison, there is no way to know that the scenario we observe has the potential to be improved.

When we can compare one group’s outcomes to another’s, we are observing variation in the system. In a child welfare context, the term variation refers to the simple fact that in any system different groups of children experience different outcomes.

Observing variation is not only essential to defining the problem to be solved, it also informs our pursuit of the solution. A statement about variation is the launch pad for asking the next question in the CQI process: Why does variation exist? When we know why an outcome varies (“I think it is because…”), we can use that knowledge to craft targeted interventions (“So I plan to…”) where they have the most potential to create the change we want to see (“which I think will result in…”).

In this series of CQIdeas we’ll explore how knowledge about variation can be used ignite the cycle of CQI. We’ll discuss how to identify variation in your system in the first place, how to make meaning out of the variation that you observe, and how to apply that knowledge throughout the CQI process.