The Heart of Quality Improvement for Nonprofits

Why Should You Care about Quality Improvement?

There is no shortage of well-meaning business leaders, public officials, and bloggers who think they’ve diagnosed what’s “wrong” with the nonprofit sector. Nonprofits are inefficient or poorly managed. Nonprofits need to think and act like businesses. Nonprofits aren’t innovative.

I don’t get offended by or hung up on the specific charges, because I already live by one assumption – everything can always be better. Just ask anyone who’s ever worked with me. I’m relentless. And I hate waste! As a sector that’s starved for resources yet charged with addressing some of society’s most intractable problems, we can’t afford to waste any time, energy, knowledge, or money!

One article appeared in the Harvard Business Review several years ago, claiming that nonprofits could find another $100 billion if they functioned more efficiently and effectively. I’m not going to turn my nose up at that. Are you?

Over the next four posts, I’m going to take a look at what quality improvement looks like in the nonprofit sector, what it can accomplish for us, and what it takes to be successful in this work.

What Quality Improvement Is and Is Not

Essentially, quality improvement models, methods, and tools support organizations in reducing errors and variation, increasing efficiency by reducing waste, and improving the quality of goods and services to customers by using analytical, systematic, and sometimes statistical processes. Errors are reduced by standardizing work. Efficiency is created by mapping and improving processes. Quality is improved by identifying and designing toward customer requirements. The field has grown since World War II to include a number of thought leaders, approaches, and applications. You can learn more about the field in this handbook or in this glossary.

It’s usually at this point that social service professionals recoil and exclaim one or more variations of these common objections. They seem to think that quality improvement takes the heart out of our work.

  • “What we do is an art, not a science!”
  • “We are working with human beings, not widgets.”
  • “Our work is hard to measure.”
  • “Our bottom line isn’t profit. It’s impact.”

All true statements, but none of them disqualify us from quality improvement work. In response, I’ll point out:

  • Efficiency is not the enemy of quality.
  • Standard does not mean identical.
  • Repeatable does not mean rigid.
  • You can measure subjective concepts.
  • And money is the means of our mission.

What is Quality? A Technical Definition

Unfortunately, I think quality improvement work in our sector has been so narrowly defined and mechanically implemented that it’s lost much of its value – it’s heart, if you will. I think I know how that might have happened.

The work of quality improvement starts with defining quality. The most common definition of Quality across several Quality Improvement philosophies is “meeting or exceeding customer requirements or expectations.” Unfortunately, when this definition is narrowly and literally interpreted in our sector, it privileges certain customers and overlooks other key dimensions of quality in our work.

Who are our customers?

Unlike many businesses, the people who pay for our goods and services are not often those who use or directly benefit from our services. Therefore, we have (at least) two customer groups: funders and clients. As a result of power dynamics in philanthropy and helping professions, unfortunately, sometimes it seems as if the only customers to whom we feel accountable are the ones who write the checks (or whose opinions and judgments impact the checks). So, sometimes, the needs and requirements of funders, accreditors, and licensing bodies eclipse those of the people we aim to serve.

What do they expect or require?

This is where our work gets even more complicated. Each of our customers has different sets of expectations and requirements. And, as my last blog series pointed out, they often conflict with one another and require a great deal of effort to track and report.

So, where does that leave our quality improvement work?

If we settled only with this definition of quality – meeting or exceeding certain customer requirements – the work of quality improvement becomes defined by and limited to the realms of compliance, accreditation, and funder reporting. In my experience, this is what consumes most of the quality improvement efforts in nonprofits today, and it usually plays out in a reactive, top-down, and mechanical way that lacks passion and heart.

And not only is this approach limited in its ability to substantially improve quality or efficiency, ironically, it often creates additional burdens and inefficient processes that can detract from the mission.

But What is Quality, Really?

So, is that a sufficient definition of quality? Does that really encompass all that defines quality in our sector? What about organizational impact and culture?

  • What about delivering the utmost value (i.e. impact) possible with the limited resources we are charged with stewarding?
  • What about meeting and exceeding the expectations of our other customer groups?
    • The vulnerable, under-represented, and marginalized clients and communities we serve?
    • The under-paid, under-appreciated, hard-working, well-meaning internal customers – staff and volunteers – who get into this work to make a difference, not to check boxes, fill out reports, and jump through hoops all day?
    • How do we increase value for them and meet and exceed their expectations?

It’s in asking and answering those questions that quality improvement work really improves quality and strengthens organizations. That’s the heart of quality in nonprofits. 

Earlier this year, I interviewed six of my colleagues who work(ed) in quality improvement roles within social services. They described what quality meant in their organizations, how they approached quality improvement, what made the work successful, and what that success looked like. Their stories were energizing, encouraging, and inspiring. In my next post, I’ll be sharing their vibrant and meaningful definitions of quality and stories of how quality improvement work strengthened their organizations and delivered meaningful value to all their customers.

*Programming Note*

On August 14, 2018, I’ll be teaching a professional development workshop at the public library on Quality Improvement for nonprofits. If you’re interested, click here.