Continuous Quality Improvement: Maryland Home Visiting  

Continuous Quality Improvement In Home Visiting 

Continuous Quality Improvement (CQI) is a deliberate, defined process which is focused on activities that are responsive to community needs and improving the health of families we serve. It is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality for state and local program levels.
The goal of CQI related to home visiting is to improve outcomes by building capacity of local partners through:
  • Establishing a culture of CQI,
  • Building CQI infrastructure and,
  • Applying CQI methods to daily practice
Why We Promote CQI
Continuous Quality Improvement is considered a best practice in public health. The Maryland Department of Health (MDH) is a Maternal, Infant, Early Childhood Home Visiting (MIECHV) awardee that administers funding on behalf of the U.S. Health Resources and Services Administration (HRSA) to local home visiting programs throughout Maryland to deliver services to families at risk. MD-MIECHV is required by HRSA to develop a CQI work plan and report on it annually. We must demonstrate utilization of CQI best practices and measurable improvement at the program level while assisting home visiting programs to increase their capacity to use consistent and planned CQI methods to improve program outcomes.
Improving Processes
CQI is a federally mandated requirement.  HRSA requires all HV programs to practice CQI.  By implementing CQI practices, all home visiting programs are able to make ongoing improvements and modify processes as needed. In addition, CQI practices help eliminate redundancy and aid with streamlining processes and procedures to be more effective. 

CQI Tools and Resources
Maryland MIECHV programs use several tools to aid in our CQI processes. Each program has a designated CQI team that meets on a monthly basis and works together to develop a Team Charter with a SMART (Specific, Measurable, Achievable, Relevant, Time-Based) aim statement for each topic being tested. The Plan-Do-Study-Act (PDSA) approach is used to test change in practice, supported by tools such as process maps and fishbone diagrams. Programs report their progress on a quarterly basis by filling out and submitting a CQI data dashboard to the MD-MIECHV CQI consultant. 
Maryland MIECHV CQI Requirements for Programs
MIECHV program grantees are required to develop and implement plans for CQI and submit an annual report and CQI plan to HRSA. This report is informed by the data dashboards programs submit quarterly along with qualitative data gathered during quarterly CQI calls with programs. 
All members of the CQI teams are required to complete the Ohio State online training that consists of three modules related to fundamentals of CQI. Once the training has been completed, individual team members are required to submit their certificate of completion to the state CQI lead.
CQI Projects
MIECHV programs use CQI to improve services and systems to enhance their program’s function and efficiency. Some examples of projects our programs have worked on include: 
  • Level of Engagement of Fathers in Home Visiting Programs 
  • Home Visiting Completion Rate 
  • Housing and Transportation Process for Home Visiting Clients
  • Data Quality 
  • Retention of Staff and/or Families 
  • Submission of Required Documents to MD-MIECHV 
  • Floor Time (an HFA requirement)

Maryland CQI Leadership Team 
The CQI consultant is a certified Lean Six Sigma Black Belt.  A leadership team has been formed, consisting of five individuals from local programs that have taken the Lean Six Sigma Green Belt course. This team, led by the state CQI consultant, will directly support MIECHV home visiting  programs using a peer support model. The purpose of this leadership team is to ensure other local CQI teams have the tools needed to improve processes; meet the needs of families; assure staff are accountable; provide opportunities for autonomy and creativity in developing solutions; and assist in developing ways to document processes that will benefit all MIECHV programs.  
First Annual CQI Retreat
The first MIECHV CQI Retreat was hosted in August of 2020. There were 100 attendees daily spanning the three-day event.  The goal of the event was to bring together all MIECHV staff including home visitors and supervisors so that we could re-energize and re-engage in new CQI efforts and initiatives. The goals of the retreat were to:
  • act as a refresher;
  • introduce new strategies and techniques geared toward on-going improvements;
  • provide an opportunity for each site to gather new information and ideas; and
  • provide an opportunity for the staff that will have recently completed the Lean Six Sigma training to begin supporting peers.

Recordings of each session can be found here:


For more information about home visiting in Maryland or the MIECHV grant, please email us at:
Updated October 2020