Q&A with Beth Sandor
Beth is a Principal at Community Solutions. She co-directs the Built for Zero team, which helps communities end chronic and veteran homelessness.
■ What is quality improvement?
It’s a methodology for testing and improving new ideas that developed in the private sector. We’re bringing it into our work to end homelessness in several ways. First, we coach communities on the methodology. Local teams start by building a real-time, by-name list of people experiencing homelessness. That information is essential to creating a feedback loop that lets you know whether you’re making progress. We teach communities how to use quality improvement to test new ideas quickly, so they can avoid investing a lot of time and resources into things that aren't getting results. We know if change ideas are working based on the by-name list data, which is continuously updated.
We also use QI to guide our own work on the Built for Zero team. It’s a powerful tool for letting us know whether our large-scale coaching and data strategies are helping communities reduce homelessness or not and when new ideas are needed.
Actionable new ideas which can be tested and refined in rapid cycles to determine what works are a key part of the quality improvement process.
■ How do Built for Zero partner communities use QI?
Communities are trying to drive month-over-month reductions in chronic and veteran homelessness, but in the past it’s been very hard for them to know if what they’re doing is working. QI helps them test concrete ideas in short cycles and use the resulting data to understand what happened. Were there fewer people experiencing homelessness once they implemented those changes? If so, then great— let’s keep doing more of that and track that it’s working. If not, then what can be learned from that experience that they could either tweak or throw out in favor of a different strategy altogether? That information informs their next round of changes— it’s a process of continuous testing to drive improvement.
■ So you’re learning even when a change idea doesn’t work?
It’s all in this idea of failing forward. Part of quality improvement is seeing the data as information to drive improvement, rather than judgment. The goal isn’t to be right or wrong on the first try; it’s to figure out what it will take to get real results.
■ Is applying quality improvement methods to homelessness a new concept?
Communities have always wanted to know what works and to try those ideas. I think the missing piece has been knowing if those changes were leading to improvement or not. The level of data quality we’ve helped communities build is definitely new. Having a real-time feedback loop for the first time has enabled them to do much more rigorous testing of their strategies, and many are starting to bend the curve on homelessness downward for the first time.
■ How did you start using QI tools at Community Solutions?
The idea comes from manufacturing, but we’ve learned a lot from how it’s been implemented in the healthcare sector. The approach to the work itself translates across industries— how you break down the problems and how you approach the data.
About six years ago, I took a six-month quality improvement course through the Institute for Healthcare Improvement. I just remember feeling like: This is it. This is the change we need to make in how our organization works and how communities are working in our sector. Slowly over the course of the last five years we’ve been changing the way we're working to include quality improvement techniques. The key idea was that if we could help communities embed quality improvement deeply in their work, then we would see them start getting to the goal of ending homelessness faster and sustaining that result.
■ Has that worked?
Yes. I would even say quality improvement is the primary success factor in the nine communities that have now reached functional zero. These communities are using their data completely differently— they’ve developed real-time feedback loops, and they’re using them to make decisions. It’s exactly the way we need every community to work if we want to get to zero.
And that is our goal: to fundamentally shift the way communities are working. I really believe that’s the thing that’s going to end homelessness.
■ What are some of the challenges of using quality improvement tools in this field?
The initial challenge is having good data that people trust. In order to do quality improvement well, you need a way to measure if what you're trying is working or not. The only way to do that is through person-specific, real-time data on your homeless population. That is a big shift for the sector.
■ It’s one thing to get to zero. But what does it take to hold it?
Historically, we’ve framed homelessness as a static phenomenon. We count once a year and then we act like that number doesn’t change for 12 months. But that’s ridiculous! It’s not like if you just helped X number of people, you’d be done with the problem. Homelessness is much more dynamic than that.
Ending homelessness is actually about developing a system that once functional zero is reached, we can constantly solve for the problem over time. Zero isn't a destination— it isn’t like you get there once and then you're done. We need to have this continuous improvement mindset everywhere on this issue to ensure that we can hold on to the gains in ending homelessness over time as the problem changes and people’s needs change.
Gulf Coast, Mississippi, is a great example. They’ve been at zero veteran homelessness for over two years. Today if a veteran becomes homeless in Gulf Coast, they can house that person in less than 11 days. Imagine if that were the new normal everywhere.
Someday we’ll end homelessness altogether. In the meantime, we need to make it like breaking your arm or getting the flu. It’s not something you hope for, but if it does happen, communities would have the ability to resolve it quickly. The idea that people would spend a whole lifetime on the streets...that just isn’t something we need to accept anymore.