Hello, my name is Stephen Smith, the owner of 3Pi Squared, and this is the ABA Business Leaders Podcast. Before we get into the episode, I want to tell you a little bit about our membership program. 3Pi Squared has helped over 700 ABA practices start up and expand. Our membership has over 45 hours of content from experts in the fields of law, accounting, diversity and inclusion, childhood development, mindfulness, business development, HIPAA compliance, marketing and branding, billing, and more.
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To learn more about the membership, please go to our website www.3PiSquared.com and click on ABA Business Leaders. And now, let's get to the episode. So today we're going to be talking about quality, quality services and how you define them. And then once we define them, then what do we do with it? And how do we measure it? So do you have anything really to add to that, April? Yeah, I mean, no, we have a lot to go into once we get into our presentation. So I don't want to restate too many times.
But yeah, I mean, those of you guys who are listening, we'd love to hear what you define as quality services within your agency. Yeah, it's going to be very unique to your practice. We have our template quality policy that we'll show and kind of go through it. And this really is our first video of our KPI series that will be coming out to our ABA Business Leaders members. So you can't really talk about key performance indicators until you have a quality policy.
And you can't really talk about a quality policy until you have a quality team. So this is kind of step one, how to create a quality team, how to make a quality policy, and then how to measure quality and then the ongoing processes that are involved in that. So really, that's it. So without any further ado, I guess we'll get into the presentation. Okay. So how do you define quality services? So the first step of this is creating your quality team.
So before we figure out what our quality policy is, before we figure out what we're going to measure, you may have some general sense of what you want to measure and your goals, right? And again, this kind of depends on where you're at.
Like if you're having issues around cancellation rates or insurance claims or maybe you're getting bad reviews or satisfaction surveys are kind of low, that may be at the top of your list and be, yeah, that's definitely got to be something that we're measuring or focusing on. So you may have some general idea of where you want to go with this, but we really want to do this as a team. Like we want to build a leadership team here. And we talk about that on the values-based leaderships, right?
You want also to have a leadership team there around HIPAA. You'll want to have a leadership team. So really, if you have enough people in your organization at this point, you really want to create this team for many reasons. So it's really important to have a team and we don't want it just to be the director level. We don't want it to be just BCBAs. You don't even want it just to be clinical staff, right?
We want it to be as many different areas, as many different perspectives as you possibly can. So you should, again, it's going to depend on the size of your organization, right? But you probably want to have a sample of every department that you currently have. So we would have like, you know, one director level, maybe, maybe two. I don't know. It's going to depend on how you want to do it. And then having a BCBA representative in there and then definitely having like an RBT in there as well.
And then admin. And this may also depend on what kind of admin stuff you're doing. So if you're doing insurance billing in-house or you're doing just scheduling or maybe your admin person is taking care of intakes or insurance authorization. So you know, like you want to have as many people in there with different perspectives as you possibly can, because they're going to come at this from a different point of view.
And it'll bring things up that you may have not even considered bringing into your quality statement. So that's really important. So that kind of talks about why it's important to have a team, you know, and who should be on this team. So we really want to have as many departments as we can on this team. Represented. Represented. Yeah. And I mean, like, it's not like it's going to take a whole lot of time, right?
And you can build out the quality policy and like your goals around it without bringing everybody into every meeting. But when you're talking about, okay, this is the feedback that we've gotten. Now what do we do with it? Like it's really good to have, you know, a team with everyone, you know, every department in it, because you want them to take ownership of it anyway, because you can't do this all on your own, right?
And you really need the people that are going to be, you know, using those apps or using those devices or dealing with those individuals to be a part of it. Because again, you may say, okay, well, we have to do it this way. And then they're going to give you the 15 reasons why there are barriers there that while this would be a perfect way to do it, it's not feasible in the current situation, right? Right. And to help brainstorm ways that we can move forward, right?
And put these things in place like we would like them. Does that make sense? Mm-hmm. Okay. So then the quality policy. And again, we in our company policy manual, we provide a quality policy template. You know, it's a good starting point. It's not... Yeah, it's very generic. It's not... It's not going to be your quality policy. It's not meant to be your quality policy, but it is a starting point. So what is quality to you, right? So you know, very similar to company values, right?
And you can...I would urge you to consider making your company values first. And then you can tie those values into quality, right? Yeah, I feel like the values, like your company values into your mission statement, your vision statement and quality policy. And I feel like those things all will go hand in hand. And it's like once you do the work on... You know, I think they'll flow.
If you do it in that order, it'll flow because there's definitely parts of that that's going to help direct like your quality. Right. Right. And so again, if you're veering off of your quality statement, quality policy, we can check back in with our values, right? And tell, okay, what's going on here? What are the barriers that are in place that are causing us to divert from the values of this company, right?
And so like, and some of them may be very similar, the values and the quality policy, there may be similar statements. That's fine, right? It's not like they have to be completely unique to each other. You want them to be similar, right? Yeah, they're going to be similar because I mean, your mission statement is like also like talking about where you are right now and your vision statement is like where you want to be like a big picture of like perfect world scenario.
And so like your quality policy, like should be in line with that of like where, you know, it should match and be in line with where you're wanting, where you are now, where you're wanting to be and that helps spread. But then there's also going to be pieces in there that may be even more specific. Yeah, that's what I was thinking. Like you're going to have more detail. Yeah. So this is kind of like, there's more meat on the bones, right?
So the values is like, kind of like, you know, very hot pie in the sky, like kind of woo woo stuff maybe, right? And then your quality policy is going to have like some teeth behind it, right? Like there's going to be something that is very measurable that is defined based on that, right? And then we can look at that and say, okay, fine, this is what we're actually measuring. How do we make sure that we have visibility there and that we're measuring the right things?
So understanding what your definition of quality is is super important. So like what, what, I don't know what your definition of quality is, right? Is it on time services? Is it, you know, a low cancellation rate? Is it making sure that you have high satisfaction surveys? Is it that, you know, your treatment, I guess, expectations are being met, you know, your client and your family's expectations of treatment are being met.
And maybe it's that, you know, kids are coming out of your system in a certain amount of time. Maybe that's how you're measuring. So like, Right, and some of your quality could be measuring like your staff's performance. Yeah, exactly. How your staff show up. So, so any of this could be measurements that you're doing, but you can't really measure anything until you, you have a good understanding of what quality is to you.
And then once we, we have our team and we have our quality definition, then we can kind of move forward, right? And so this is, again, this is just a generic quality policy, right? So we're committed to enriching our clients lives by following the BACB standards and enhancing our clients and the family through ongoing improvement of our services. And so the company will be responsive to the client's needs, will deliver effective evidence based therapy to our clients.
We will uphold the BACB ethics codes. Will provide reliable consultation and support. Will ensure effective and efficient use of resources that we will either meet or exceed our clients expectations, enhance client satisfaction through our feedback process. And then we will continuously improve those services. And that's kind of the last piece of your quality system is, is the continuous improvement process of it.
So again, this is very generic, but this is where you can kind of, you know, start to put your own statement in here, right? Like what, how do you envision quality? What do you see as when you think about quality, what does that look like to you? What are, what are the statements that, that you imagine hearing when you're thinking about quality services? Do you have any, anything to add to that? No, I don't think so. Okay. So, measurements.
So, you know, once we have an idea on the list of quality statements or quality policy, I would recommend, you know, starting out small, right? Like, you know, you can come up with a list of 25 things, but we really want to narrow the focus down, especially at the start. We want, we want it to be, we want it to be a narrow focus. We want to ensure that it's something that we can all handle, especially if you've not, if this is a new quality team, we don't want to get everyone overwhelmed.
You know, they're all going to have their own day-to-day jobs that they're having to work on. And so we want to make sure that we're, we're focused on just a few things. And then it's going to be easier to measure, right? And so we just want to, we want to focus on a couple of things.
So like how, how would you choose, you have this list of all the things and you're really excited about pouring all of this work and effort into making your services, you know, the most amazing services to provide quality. And I hear you saying don't do too many, you know, start off small, take, you know, one step at a time. Well, where, where would you start? Like do you prioritize those or do you look at like big picture?
Like is there a prerequisite type skill or type prerequisite that you should like focus on first that then leads to other things or do you just pick your favorite? Like any advice on that? I mean, there's many ways that you can do this, but like doing a risk analysis may be beneficial here. So it's not like in HIPAA, you also need to do a risk analysis, right? So the idea here is, okay, you've listed out, you know, 25 different ways of that you believe that you can measure quality.
And so then you put them on a spreadsheet and then you say, okay, which ones would be the most critical, right? Which ones if the wheels fell off, that would be terrible for your company, right? And so those may be the ones to start with, right? Just like figuring out, okay, like these are really important measurements that we really need to have some high visibility around these items, right? So again, this may be cancellation rate, this may be customer satisfaction or customer complaints.
This could be incident reports, you know, like it's just things that are going to be critical to ongoing services probably would be the ones that I would go with first. And they're going to be probably the most complicated anyway.
But then, you know, as you get comfortable, as your team gets a really, really good idea on how it's going to work, how they're going to work together to do this, then, you know, again, another one would be, I would highly recommend is like, you know, having something around ethics. And so like, in my opinion, like billing would be one of those just because of how important how critical it is to your practice. And if you're not doing that correctly, that can be devastating, right?
So there, I just posted in our group, there was, I don't remember the name of the company, they got charged for $2 million fine or something like that for incorrect billing practices. And so, like, you can have like, the best of intentions and be providing very effective services. And then you, somebody realizes that we can double bill and nobody's looking and still have a very poor quality company, right?
Like that, in my opinion, no matter how effective the services is, if you're being fined $2 million, I'm not sure you're providing quality services. And then what happens to those families if you had to shut down because you have a $2 million bill that you can't pay. So, you know, we want to look at that and a risk analysis is a good idea.
And then coming from, and we can't, we don't have time to get into this, but like, once you come up with that kind of list of like the highest priorities, when I was working as an engineer, we would use, it's called Swiss cheese model. So it's like, each system you have in place has holes in it. It's just right, like it's going to be focusing on, well, then you have multiple layers.
So your hope is that, okay, fine, there's like 15 holes in that first one, but maybe there's only seven in the other one, they don't completely line up. So then, you know, the second layer is going to block some of those issues that come out of the first one. And then maybe you have a third layer. And so an example of this may be, okay, around session notes, for example, okay, we have our admin staff verify that the time sheets and the calendar match up. That's our first layer of defense.
And then we have our second layer is our BCBAs are reviewing the session notes to make sure that it's, you know, the language is right, there's no missing information, right? And so that's our second layer. And so that will prevent, you know, issues around double billing, for example. Right, or catching mistakes. Or like sessions that didn't really go as long as they were claimed to be, right? Or whatever it may be.
So that would be the thing is that you would come up with your, the few points that you're going to do, and then do a risk analysis. If this went all haywire, what would that look like? And then what? And then what? Correct. I mean, there's the five whys, right? There's like, there are many different ways to do an analysis and come up with, you know, the scenarios and then figure out how you're going to measure that. You know, this is a different story for a different day.
And that's where we're going to get into the KPI, right? But we're going, like, so you, once you, again, once you have those few measures, now we need to figure out what are the inputs, right? So you say that we're going to meet or exceed customer satisfaction. Okay, that's great. That's a wonderful goal. Okay, but how do you know, right? How do you know that? So what is it that you're measuring that will ensure that you are meeting that?
Well, and I think we're very familiar with that in ABA, even if we haven't had business experience, because that's very similar to how we look at, like, our data collection when we're, you know, teaching a new skill and are we, you know, we have to decide what data to take, how to take it. And then at the end of the day, we have to look at it and analyze and say, is this data telling us what we needed to tell us about what we're wanting to see from this skill or whatever? Correct.
Yeah, and that's really what we're going for, right? So we're then saying, okay, these are the few things that we think are going to measure that goal, that statement in our quality policy. So you know, we're going to meet or exceed client satisfaction, right? Okay, fine. So how do you measure that? How do you make sure that you're doing that, right? And so there's going to be lagging and leading and, right, like, and subjective measurements for this.
And again, we'll get into KPI in a different day. But it's like, how do you know that? And especially, like, some of this is going to be, unfortunately, it's going to be satisfaction surveys, right? And some of that's just way to, but there are different methods that you can put in place that are more real time, right? And so we'll talk about that in more detail. But it's then, okay, we have a kind of an idea of how we're going to measure this.
And then it's, well, this, well, this blur our visibility, or well, it clear it up, will it make it so that we can actually see what we're hoping we see? Or is this a false sense of security, right? And then the other piece that you have around KPI and inputs in general is do you get so focused on measuring that input that the entire team's focus becomes around making sure that number looks good and not the intention behind the number? Right. That's what I was just about to ask you.
Like, there sounds like there, you know, there's definitely like some downfall if you're not focusing on the right thing or keeping track. And then again, this, this step back to the values, right? Back to the, why in the world are we doing this? Right? Is it, is it because we want our numbers to look good? Yeah. Do we want to turn work? Like, do we want to get more kids through our system or do we want to like really provide the quality and make sure that we're right?
And so that again, that's why you have to just bring it back to us and like live it, right? Breathe it. Like, it's just so important. There's, I have so many examples of people trying to implement a quality policy, KPI, doing a risk analysis, well-meaning intention. And within like, within just a few months, they're like, they're total focus, like they're having competitions between departments to get the numbers in the right place. Like, and I get why you would do that.
But then when the focus doesn't, is no longer the intention behind why we're looking at this and the only intention is now to look at this and make it better, make this thing better and not actually improve the process, improve quality of life, improve client outcomes. Then we're lost. We're on the wrong thing. And so you have to bring that back to values because it like, and you know, not even getting into this really, but I'll just, like, if you're going to then say, okay, I love this system.
I love this quality system that we've implemented and now I want to tie it back to incentive based bonuses based on this quality system. That's another layer that can be very disastrous. Again, if we're only looking, if our focus is only on the numbers and then we're tying bonuses to those numbers, the, we may inadvertently be providing the wrong incentive. So it's just really important as you're building this out, you build it out slowly.
You build it out with a narrow focus so that you can then when, when you feel like this is in a good place, then you can build it up and, and, and, um, add more to it when the team is focused on the right goal, the right intention. Does that make sense? Yeah, it's really hard not to like, we're like, we're like working on a whole KPI series for you guys and it's like, we're really excited about it.
And it was something that we're super overwhelmed with and then like, but now we're like focusing in on it. So like, it's like really easy for us to kind of get off on these tangents. And like really, we're excited about it.
Yeah. I mean, the goal is, is that we're going to have like, you know, like the basic foundation of KPI and how it works and how to measure and how to know you're measuring the right thing and then have like some examples, very ABA specific examples that kind of follow you through. Uh, so you get some kind of idea, right? And some of the measurements are going to be like, yeah, okay, I'll take those. And then others are going to be like, yeah, no, these aren't mine. I don't want them.
They don't, they don't appeal to me. Right. And so making it unique to your practice is so important. Right. There's, it's not my quality goal. Right. And it's, um, it's yours. And so it has to be yours. It has to be based on your values, your team's approach, um, and what you're doing. So yeah. So yeah. So measurement, does that cover everything that you wanted to, you know, again, once we, once we figure out our inputs, right.
And then, okay, so we're taking in all of this stuff, satisfaction surveys, real time parent complaints, customer complaints, whatever it may be. And then what are we doing with it? So great, you're taking this in. Um, but then what do we do? Right. And so then we need the mechanism of how to improve. Right. So we take this feedback. Um, we take it again, uh, these indicators leading, lagging, whatever it may be, um, based on our risk analysis, based on our quality policy, based on our values.
And then what do we do with it? How do we like that? That that a lot of people get stuck there. Okay. So we got some not so great satisfaction surveys back, or we got, you know, five complaints from our customers in a specific area. Um, what changes should we make now? Right. And how do we hold people accountable and make sure that we can change the behaviors and the policies that relate to these areas that we want to improve? Right. So it's how do you do that effectively?
Uh, how do you, how do you hold your leadership accountable? Uh, and then, you know, then we start the whole thing over again. So we put these things in place, you know, it would be very similar to programming for a child, I assume, uh, is that, okay, we made this significant change. You're going to date when you did it. Right.
And then you're going to analyze the data again, saying, okay, at this key point, we made one change and this is the change that we decided as a team to implement based on the feedback that we got based on the inputs that we got. Um, and now we're going to see if it makes any kind of difference in the quality outputs. Right. Yeah. And so that is where it leads us. Right. So it's continuous improvement. So it's an ongoing review. Right.
And so if you're going to implement a quality policy and get the team involved and then, you know, we're going to come up with, with inputs and, and, and then dealing with how we deal with inputs, uh, doing the risk and all of this stuff, we want to make sure that we're consistently doing it. Right. And so having that policy on how often we're going to do it, I would just like anything else, especially at the start, um, more often you can do it together.
The better I would do it at minimum monthly to start just to see where you're at, uh, to keep everybody focused on this, on this new system. Um, w just, just like with the values and implementing that, um, if people see this as just, oh yeah, this is the new thing. Steven came up with some crazy idea and like he's, he's put all this stuff out and then we're never going to hear from him again. Then no one's going to take this seriously. Right. Like, oh, this is just his thing.
This is word of the day, quality, quality, quality. Right. And I mean, it means nothing to no one. And then it's just another policy that sits there and no one takes it seriously and everyone does their own thing. So you know, if we're going to do this, we need to do it and we need to do it consistently. We need to do it ongoing and we need to show the people that are involved in it, especially that we mean what we say and we're going to, we're going to make changes based on their feedback.
Yeah, definitely. And I think that's like, as I'm doing the values based leadership and like helping companies come up with their values and turn it into their mission statement and go forth with that, it's, I I'm learning more and more that a lot of people are less like they're, they haven't been doing that because they just feel like it's another thing.
Yes. Like, oh, I didn't really come up with a mission statement because like that doesn't seem authentic to me to like slap something up and then not even like visit it again. And so like that's like, this is just also a continuation of that. Like with your values, yeah, if you're just like, oh, these are company values, slap it up on the wall and never mention it again. Then of course, yeah, it's the way with your quality policy.
Oh, this is our, you call it beautiful quality policy, slap it up on the wall, throw it in the handbooks or put on your website or whatever. But if you, if you don't do anything with it, then like you're not changing the culture of your, of your company. And so like all of these things, like embedding it within the culture within, you know, making it how, you know, referring back to it.
This is how you run things and then, you know, doing ongoing reviews and checking in on it and making sure that you're, you know, you're following it or that you need to adjust things or yeah, but like these things are definitely not just these things to have. Right. You can have them, but they're not just decoration. They're really to use as real tools. They're meant to be tools to be used. Yeah. And, and like I've been through a few, uh, like ISO audits, right.
With engineering firms and if the goal, like the intention for most staff is just to get through it, to get through it so we can say that we did the thing, then we're not, we're not focusing on the right. You're just wasting your time. Really? I hate to say that, but no, but I think it's like, but it is as like a business owner, an ABA business owner, a brand new business owner, someone who has just starting or someone who's like, okay, we've, we've got our feet on the ground.
Like, okay, let's start growing it more. Right. Like it's easy to not, it is so easy to not see the value in all of this, to not see exactly how it can benefit you, how it can help work in you just, especially like with like clinically, like we're focusing on the clinic side of it, like the clinical side of things and the kids skillsets then, you know, all of it, it's easy to let go of. It's easy to not think about. Like, I know what I'm doing. I know how to treat this child.
Right. Like I know what, what they need. Everybody's happy. Everybody's good. Like, cause that's like me too. Cause like we, with my company, we were just starting to really look at some of these like KPI pieces, like when we have values and our mission statement and you know, we supported our staff and I feel like we provide quality services.
We did surveys and questionnaires and you know, I feel like over the last few years of running a company, we were really starting to implement some of that stuff. But that was like after, like that was like after we ran it for 10 years and there was so much learning curve and so much just juggling and putting out fires that it always felt like this was like this nice fluffy new thing over in the corner that was there because we needed it to be there and it was pretty, it was decoration.
And also the big project and the thing I was hoping to get to one day. But what like I would like to urge everybody, like as an ABA business owner, as a clinically minded ABA business mind leader, who's not business minded, right? You know, helping Stephen with 3x2 and learning more about the ins and outs of some of this has really, I'm like, wow, man, this would have probably been, probably been useful like years ago.
And Stephen's like, well, I was trying to tell you, like, but I was like, I don't have time for that. I will have time for that. But it really like I urge you to make time for it. I really, I see the value in it. It just like I preach with values and mission statement and this is just like we said, another is just like, I don't even know. It's not another, it's just a continuation. No, it's all, it should be a continuation. Yeah. It should be a natural outcome of a value system.
And it's worth taking time, even if yeah, there's so many balls up in the air that you're juggling, right? Or fires you're putting out, whatever little example that, you know, however you want to say it, but it's worth making time for even if you say, okay, I'm going to set X amount of time per month and we're just going to get started on it, right? Just get started.
Even if it's little baby steps before you know it, like, you know, it might take you a year to really get it up and running, but at least you're working on it. At least a year from now you'll have something that's up and running. And so I think that's too, as we're juggling all the things, you know, you don't have to go all in and jump all in this and shift everything to this and put your team together and do all the things and make the perfect policy and put all the things in place.
But just set aside a couple of hours a month to focus on doing a little bit of this and like working your way through it. And it'll really, it'll really pay off. And I mean, most of this stuff you're probably doing and if you're not, you should be doing anyways at least like, you know, doing quality checks on session notes, making sure that you're not double billing, making sure that you're getting satisfaction surveys from your clients, right?
Like taking customer complaints and feedback from parents, right? All of this stuff you're probably already doing already. So you might as well then take this information and then make behavior and policy changes that will just improve the quality of your organization. If at nothing else, for no other reason, do it the way that maybe I can motivate myself so you never have to hear that complaint again.
Or the other motivating factor that you may have if you're a director of operations right now is that, oh, we can then put this on our rate negotiation letter, right? And so this is how we measure quality and this is how we know that we provide quality services and this is why you have to give us more, right? Because this, we have effective quality ethical treatment and your customers are getting a high quality outcome from us that they won't get anywhere else, right?
And so that is just another reason. It's also great for marketing, right? And so there are many benefits to doing this, not just the values and quality intention behind it, but there are other very, you know, they're going to be, I guess what? External motivators, external factors, like. Yeah, they're going to be like, you know, like the consequence of doing this is like, those are the benefits, right? So like, we'll just naturally organically grow from that, right?
And so, and then again, your company grows and because you have this quality system, these values in place, you can grow sustainably, you can grow ethically, you can grow, you can grow without so much micromanagement and oversight needed from you. Your team is built with this quality focus and based on values and intention that you started your company with, right? So it just flows and it can be very helpful.
And then you don't find yourself in a situation that maybe you've left your previous employer for, right? Does that make sense? Yeah. That's it. That's all I got. And so, like I said, we'll be focusing, this is kind of step one, just understanding the starting point of how to get KPI into your system, right? So we really, you like, again, you can do KPI without a quality framework, without a quality policy, you can.
But if we have no intention behind why we're measuring something, we really shouldn't be measuring it, right? And if we have no intention about what we're going to do with the things that we're measuring and we're just willy-nilly changing stuff, it's not, no one is going to benefit from this. You're going to frustrate your staff, you're going to frustrate your team, you're going to frustrate yourself.
And you're not going to have the visibility if, okay, this thing is bad, we have to change it, then you have no visibility of was this change meaningful in any way? And actually effectively do what I wanted it to, because you don't even know what you're wanting to do, right? So it's just, it's my opinion, it's really important to have that foundation before you just start collecting data and doing KPI, right? So that's it, that's all I got. So hopefully this is helpful.
I would love for any of you that are watching this, listening to this, tell us how you know that you're providing quality services and what do you do if you're not, right? If you're getting an indicator that may give you an idea that maybe my quality has gone down, what do you do with that indicator? How do you improve your quality of services? I would love to know, it's just curiosity for my sake. But that's it. So hopefully, like I said, this is helpful.
Subscribe to our podcast, like and review it, super helpful. This allows us to provide these free-ish videos. And yeah, that's it. So have a wonderful day and we are not doing a live event next week. We're actually taking two weeks off from live event, but we will be each Friday for the next two weeks, we'll continue to be putting up new podcasts wherever you listen to your podcast, but we will not have live events, we are going to enjoy the Canada games now that we're now in Canada.
So I hope you guys have a great day and we will be back with you. We have great couple of weeks. We'll be back with you in March. I hope you enjoyed this episode. If you'd like to learn more about 3Pi Squared and the products and services that we provide, please go to www.3PiSquared.com. And if you enjoy our podcast, I'd really appreciate it if you could subscribe or add it to your favorites. This way you won't miss any episodes.
And you can also check us out on Facebook, Twitter and LinkedIn by searching 3PiSquared. Thank you so much for listening.