Weaving The Threads Of Quality
Since its formation in 1969, CQL has provided international leadership in the simultaneous definition, measurement and improvement of quality in the field of intellectual and developmental disabilities.
CQL repeatedly linked values-based definitions of quality with practical measurement and improvement methods. Linking theory and practice, CQL has made leadership contributions in the field of intellectual and developmental disabilities through repeated demonstrations of practical and usable innovation.
CQL has continually raised the bar on the definition and context for quality. CQL introduced standards that addressed quality in services. We changed the discussions about quality when we moved attention from compliance with organizational process to being responsive to people. We are now reframing personal quality of life within the context of community.
But, reframing quality and offering new definitions is only a first step. CQL’s continuous leadership results from its ability to link definition with practical and usable methods of measurement and improvement. Throughout its five decades of leadership, CQL has demonstrated the practical application of the three dimensions of quality:
- Definition: What is quality?
- Measurement: How do we know we have it?
- Improvement: How do we get better?
Definition: National exposés of conditions in public institutions focused public, family, and professional attention on the question of quality. In response, CQL set performance standards in the areas of professional services, habilitation, legal and human rights, positive behavioral practices, team process and individual program plan development. The CQL definitions of quality were included in Judge Johnston’s court ruling in the Wyatt v Stickney decision.
Measurement: CQL sought out professional, public and family input in the development of measurable standards and criteria. We wrote standards manuals and designed survey methods that addressed a range of organizational processes. The Health Care Financing Administration cited the CQL leadership initiative in the Federal Register as it incorporated the CQL measures into the Federal Medicaid regulations.
Improvement: Throughout the 1970s and 1980s CQL Accreditation served as the “gold standard” in the evaluation of services for people with intellectual and developmental disabilities.
Definition: CQL shifted the definition of quality from compliance with its process standards to responsiveness to the people receiving the services. CQL introduced the Personal Outcome Measures® after extensive focus group meetings with people with intellectual and developmental disabilities and their families.
Measurement: After meeting with people with disabilities and their families, CQL designed and introduced a valid and reliable methodology for measuring the Personal Outcome Measures®. CQL published research data in peer reviewed journals such as Mental Retardation and the International Review of Research in Mental Retardation. CQL continues to maintain a national database of over 6,000 Personal Outcome Measures® interviews.
Improvement: The redefinition of quality as responsiveness and the introduction of the Personal Outcome Measures® greatly expanded the options for quality improvement. After two decades of leadership under the accreditation banner, the organization changed its name to CQL (The Council on Quality and Leadership) and introduced new methods of quality improvement. CQL began the development of a world-wide cadre of interviewers and trainers certified to use the Personal Outcome Measures®. The response to the personal outcome approach to planning, support provision and the measurement of results also resulted in new quality improvement initiatives in training, consultation, workshops, conferences and state contracts.
Definition: The continuing analysis of Personal Outcome Measures® data pointed to the importance of community connections for many outcomes that were seldom within the purview of a single disability organization. CQL linked personal outcome achievement with social capital, redefined quality within the context of community rather than programs, services or organizations. In addition, CQL redefined the role of organizations from providing services and supports to that of connecting people to their communities. Organizations serve as bridges between people and community resources and supports.
Measurement: CQL developed the Social Capital Index® as the metric for individual and organizational social capital attainment. In addition, CQL added requirement to its accreditation program that organizations collect and analyze community data and information in the areas of health, housing, employment, transportation, education and social capital. CQL also introduced the Certified Quality Analyst initiative to assist organizations, communities and states to use data in decision-making and public policy development.
Improvement: Building on the social capital initiative and the emphasis on community as the focus for quality improvement, CQL introduced Community Life® in the Quality Measures 2005®. After several field tests and trials, CQL introduced the Community Life® LENS workshop as a participant action research model for exploring, gathering and analyzing community quality variables in the areas of health, housing, employment, transportation, education and social capital.
Organizations and communities are examining personal quality of life through the lens of community. CQL has redefined quality as personal quality of life in a community context. We have looked at the broad themes of social capital, Community Life®, and the bridging role of organizations. We have again raised the bar in our definition of quality. We are offering individuals, organizations, and communities the tools for measuring these new aspects of quality. In addition, we are providing practical and usable methods for improving the quality of community-focused quality of life for all people.
James Gardner, Ph.D.
Former President and CEO, CQL