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Up to 3 Adds Fun to Quality Improvement Process

Sue Reeves


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people throwing paper airplanes
Up to 3 staff launch paper airplanes as part of a quality improvement exercise.

What does a paper airplane-flying contest have to do with quality improvement?

It’s all about using teamwork and communication skills to build a better airplane—or to improve a process that leads to a better outcome.

 “COSF scores are developmental scores we give to kiddos when they enter or exit the program,” said Sue Olsen, director of the Exemplary Services Division at Utah State University’s Center for Persons with Disabilities. “We’ve been doing COSF for four years, and our scores are slightly lower than state average.”

The Child Outcomes Summary Form (COSF) is a summary of a child’s outcomes on a 7-point rating scale and indicates whether the child made progress toward age-appropriate behavior. The form is used for local, state and federal data collection and reporting.

Outcomes that are measured are social relationships (which includes getting along with other children and relating well with adults), use of knowledge and skills (which refers to thinking, reasoning, problem-solving, and early literacy and math skills) and taking action to meet needs (which includes feeding, dressing, self-care, and following rules related to health and safety).

Olsen and Marla Nef, the program coordinator for Up to 3 Early Intervention, began looking at ideas for quality improvements and at how they do COSF.

“We have a big staff,” Olsen said. “Sometimes it’s hard to get everyone on board. We broke the staff into six teams, and each team took one topic and did their own fishbone diagram to examine contributing factors as to why this might be happening.”

Olsen and Nef employed a process called Plan Do Study Act, which required each team to determine an objective, figure out how to study it and try a small amount of research. The teams could then identify what they learned and what could be done differently.

To learn the Plan Do Study Act model, teams built and flew paper airplanes and discovered the best way to assemble Mr. Potato Head in a staff retreat. Airplanes were tested in the hallways of the CPD.

“People have really shown a lot of commitment to the process,” Olsen said. “When someone is busy, someone else picks it up. The teams are invested, and different layers of leaders emerge. I’m amazed at the valid points they’ve already made.”

The teams have continued to meet and report monthly to the Up to 3 staff meetings.

The primary discovery they’ve made about Up to 3’s COSF scores makes sense, Olsen said.

“Eligibility for Up to 3 is based on informed clinical decisions,” she said. “Of course, when we think about it—when they come in, they don’t quite meet state mild-moderate scores. It takes longer for them to gain and master the skills that are being measured, but they go out higher.

It’s been really helpful,” Olsen said. “It’s not just Marla or I saying this is what I think. We’ve learned more about COSF, and we’re a lot more aware of our purpose.”


And in case you were wondering who won the paper airplane-flying contest ...

Katherine Bezzant flew her airplane 48 feet down the CPD hallway.


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