TQM - total quality management

Quality development in local government through the CAF
The case of the Public Centre for Social Welfare (OCMW) of Grobbendonk

G. Peeters, J. Sledsens and P. Staes Grobbendonk, October 2005

1. Setting of the organisation

Grobbendonk is situated where the Aa runs into the Kleine Nete. It is a green community of 10,700 inhabitants where in the past many people used to work in the diamond industry. Grobbendonk has a long history in social health care. As early as the 15th century (1437) a house was built there that originally served as a shelter for elderly women, was subsequently turned into an orphanage and in the end again became a rest home, a so-called rust en verzorgingstehuis – RVT (Rest and Nursing Home).

Since 1976, the Social Welfare Council has seized every opportunity to always tailor services to the needs of the local community. The Public Centre for Social Welfare (OCMW) of Grobbendonk currently offers a wide range of services. Besides having a well-developed social service system, the OCMW puts the emphasis on two pillars: home care and residential care for the elderly.

Home care services include an extensive cleaning service employing around 15 people, a smaller family care service, an odd-jobs service and a meals-on-wheels service.

"De Wijngaard” rest and nursing home provides care to dementia patients and to elderly people who can no longer be cared for at home.

The provision of services is based on a strong vision endorsed by both management and all staff. Expert individualised, tailor-made care whereby the end user's privacy is greatly respected, linked to the development of a climate of open communication, constitute some of the themes emphasised in the OCMW's mission statement.

2. Quality care within the organisation

Before the mission statement of the OCMW became a fact, the organisation had had quite some experience in the field of quality care. Eight years ago, a staff member of the rest home was appointed part-time as quality coordinator.

Before the quality decree on welfare and care provisions came about in 1997, the rest home had already drafted its first mission statement and vision, following which improvement projects were launched, existing operations were closely examined and first procedures were developed.

In 2003, the OCMW Board appointed a half-time quality coordinator for the OCMW, thus underlining the importance of quality care in services. The OCMW's mission statement and vision were drawn up, and the quality manual on family matters and that on the rest home (RVT) were combined.

3. Why the CAF?

To make a good start with a systematised quality approach, a reference, i.e. a "zero measurement”, was needed. We could choose from a number of possible measurement systems such as the balanced score card, the EFQM model, the Common Assessment Framework (CAF) etc. We had already heard of various systems and we thought the EFQM model in particular would be appropriate. However, we never got round to applying it. Only when during the 2001 Quality Conference we learned of the CAF, we warmed up to the idea of making an assessment.

In the end we opted for the CAF assessment model because this measurement instrument has been especially developed for organisations in the public sector. We chose to carry out the self-assessment ourselves because we considered a self-assessment more effective than an external audit (better awareness of what one discovers oneself), the cost was low and staff involvement was greater.

In late 2003, the OCMW secretary and the quality coordinator followed a short course on the CAF at the Public Management Institute (Instituut voor de Overheid).

4. The self-assessment process

4.1. The board's motivation

Before the operations of an organisation can be screened it is vital for the board to endorse the idea. Therefore, the quality coordinator first contacted the chairman. After explaining the system, she was quickly given the green light to also explain it to the board members.

At the board meeting of February 2004, the CAF system was presented in a Power Point presentation of the Public Management Institute.

The strong points of the system, such as its simplicity, scientific character, limited budgetary impact and speed very much appealed to the board members. The board gave the go ahead to start preparations and carry out the measurement within the organisation.

4.2. Composition of the self-assessment group

The composition of the self-assessment group had to be as representative as possible, which was the task of the secretary and the quality coordinator. The list of proposed candidates was submitted to the OCMW chairman for approval. The composition of the group was again determined within the OCMW Board and the VOK [1] . There were a total of 11 members: the OCMW chairman, 2 board members, the OCMW secretary, the quality coordinator of the OCMW, the head of social services, the director of the rest home, 2 social assistants, the senior nurse of the rest home, and the cook of the rest home (formerly responsible for the kitchen).

The members were personally contacted and invited to participate in the self-assessment.

4.3. Training of the self-assessment group

The next step was training the self-assessment group. Everyone roughly knew what the CAF was but the finer details had to be further explained. The first self-assessment meeting (on an afternoon) was fully dedicated to a deeper analysis of the subject.

"What does quality mean for each of us? What does quality mean for our organisation?” After a brief history of quality care in our own organisation, the CAF was discussed in the overall context of quality thinking.

The evolution of quality care and the different views in this regard were set out and an overview was given of the existing models for assessing organisations and the reasons why the OCMW of Grobbendonk had opted for the CAF.

This was followed by an explanation of the CAF model. The different criteria as well as the methodology based on two scoring tables were also addressed.

Finally, the members of the self-assessment group were told what would be expected of them.

4.4. Development of an assessment session

A session would proceed as follows: the members of the group were asked to carefully read two criteria including the relevant sub-criteria and assign scores. At the meeting each sub-criterion was again read and interpreted. To increase understanding, examples from the manual were sometimes read and explained. Usually the participants produced examples and facts themselves. Each meeting was led by the quality coordinator and the OCMW secretary. The coordinator wrote down all the facts that the participants in the meeting had identified in the organisation while the secretary recorded new ideas emerging during the brainstorming.

Concrete examples from the organisation were immediately fed into the computer and projected onto a screen so that they could help in assigning or adjusting scores. Each person was given the opportunity to adjust the assigned score. After each sub-criterion had been discussed, the scores were written on a flip chart. The highest and lowest scores were left out of consideration. Finally, the group agreed on a common score to be assigned.

There were 5 sessions over a period of 3 months. The last session ended festively.

5. The processing of the results of the self-assessment

5.1. Around 60 points for improvement and a list of priorities

Step 1: In the CAF report, all sub-criteria and their scores were classified in rising order, thus making up a first list. Behind each sub-criterion, points for improvement and ideas of the group were listed.

This resulted in an overview of the 10 lowest scores, which absolutely needed to be addressed, and the 10 highest scores.

Step 2: About 60 points for improvement were gathered. Each member of the VOK drew up a list of priorities from among these points, taking into account the policy note and the long-term plan of the OCMW. These were written on a flip-chart and linked to the list of priorities of the self-assessment group. This resulted in 30 points to be worked on.

Step 3: In this last phase, each VOK member gave a score from 1 to 10 to the 30 points (1 = highest priority, 10 = lowest priority). This led to a final classification whereby the first 10 points to be worked on (action points) were considered priorities.

The priorities were linked back to the sub-criteria so as to maintain the character and outcome of the CAF, resulting in an overview of the first 10 sub-criteria that had the lowest scores and therefore had to be given priority.

Subsequently, a timetable was drawn up for these actions points.

5.2. Feedback

The results and timetable of priorities were presented (using PowerPoint):

-as advice to the OCMW Board on 14 March 2005.

-to the self-assessment group on 9 May 2005.

-to the relatives of the residents of the rest home at the annual family evening on 17 May 2005.

-to all the staff members of the organisation on the annual quality care info afternoons on 6 and 13 October 2005.

6. Action plan and policy

Within the VOK, concrete actions were developed for the 10 priorities. Since they were announced in March 2005, 6 of the 10 improvement projects have already been launched and/or completed.

The OCMW's policy planning has been adjusted on the basis of the CAF results. A number of points for improvement on the list of priorities have been systematically embedded in the organisation's operations. Further to the CAF, staff are becoming even more familiar with the quality care principles.

In 2007, the whole exercise will be relaunched.

7. Some critical comments

-Composing the self-assessment group requires consultation. Good representativeness is important and there is always the danger of subjectivity.

-Giving examples regarding the sub-criteria in the CAF brochure is not always easy.

-The initial resistance among managers and policy staff to function in one group is real.

-Scoring: how to assign a score? When do you score 1 for instance? If you can give one example or two, or do you have to give three? Or do you score 3 with 3 examples…

-Facts and examples are sometimes formulated too carefully.

-In our case, it would have been better if the criteria regarding HRM and leadership would have been the last ones to which scores had been assigned; the group is more relaxed by then.

-In the assessment of the factors, the benchmarking data regarding score 4 are not really relevant for a small local government.

-In a working group, influencing is something to watch out for.

-Strong supervision is absolutely necessary to make sure that everyone in the group has his/her say.
A shared job has advantages: in our self-assessment group the supervision was the task of 2 persons. In this way one could take notes while the other led the discussions.

[1] VOK ( Vast Overleg Kwaliteitszorg – Ongoing Consultation on Quality Care) is a communication body consisting of the quality coordinator, the secretary, the head of social services and the director of the rest home. This consultative group meets every two weeks .