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A Culmination of Culture, Community, and Quality

By Katherine Dunbar, CQL Vice President of Services and Systems Excellence

“Through our mission, vision, and core values is how we are able to provide exemplary services. It sets our staff up for success. It creates an environment where people supported can thrive. CHI Friendship will always be committed to providing the best services possible. We will never stop evolving, we will never stop improving, and we will never stop raising the bar,” says Dori Leslie, President of CHI Friendship.

For more than 30 years, CHI Friendship has been partnering with CQL | The Council on Quality and Leadership through CQL Accreditation, which offers organizations a framework for quality monitoring and enhancement. On March 11th 2019, CHI Friendship took their efforts to the next level by achieving CQL Person-Centered Excellence Accreditation | With Distinction, becoming the first organization to attain this designation under the new eligibility and accreditation criteria that were released by CQL in May 2018. These additional accreditation requirements mean that CHI Friendship is among the most elite human service organizations in the world working to provide exemplary services for people with intellectual and developmental disabilities.

CHI Friendship is a private non-profit organization headquartered in Fargo, North Dakota, providing individualized comprehensive supports to allow for full community participation and inclusion. Today, CHI Friendship serves over 250 people and employs approximately 375 people. Through their core values encompassing Reverence, Integrity, Compassion, and Excellence, their mission emphasizes human dignity and social justice to create healthier communities.

“Person Centered Excellence Accreditation | With Distinction is a monumental undertaking for an organization, and we’re so proud of everyone at CHI Friendship for this accomplishment,” says Mary Kay Rizzolo, President and CEO of CQL | The Council on Quality and Leadership.

Their achievement of Person-Centered Excellence Accreditation | With Distinction entailed enhanced standards for accreditation components, person-centered practices, quality improvement efforts, community impact, CQL Certification, and more. Going well beyond the expectations laid out in CQL Accreditation, CHI Friendship has been at the forefront of service provision through a number of initiatives to improve the quality of the supports they provide, and in turn, the quality of life for people receiving those services. Their commitment to people supported, employees, families, and other stakeholders can be summarized through an embrace of a positive organizational culture, an integration of community-building efforts among people receiving supports, and a dedication to high-quality services that promote person-centered outcomes.

Embrace of Positive Organizational Culture

“The organizational culture of CHI Friendship exudes positivity and respect towards all people,” says Tricia Wek Visker.

From bottom to especially top, CHI Friendship embraces a positive organizational culture of respect, appreciation, and camaraderie among everyone connected to the organization. One critical aspect of this involves the Direct Support Professional (DSP) workforce. CHI Friendship has implemented an inverted organizational chart, where DSPs are recognized at the ‘top’ of the agency hierarchy. This simple approach creates an environment where DSPs are not only appropriately understood and valued, but also leads to very practical and tangible actions. From recognition and appreciation efforts like National Direct Support Professional Recognition Week, ‘thank you’ boards, birthday parties, breakfasts, mentoring programs, and more, to the integration of DSPs in organizational decision-making DSPs play an important role at CHI Friendship.

“You feel appreciated by your peers for the things that you do. You are often recognized by management for going above and beyond,” says Irma Moran, a Direct Support Professional from CHI Friendship.

In addition to DSPs, this organizational culture encompasses people receiving supports as well. CHI Friendship focuses on the dignity of risk and understands the importance of people making mistakes, learning from them, and moving forward – especially without a punitive approach to service provision. This outlook is embodied with their ‘GEM’ mantra, or “is this Good Enough for Me?” that holds the services people receive and the lives they live, to the same standards that people providing supports have for their own lives.

There is an emphasis on the leadership team keeping close connections across the organization by asking questions, distributing satisfaction surveys, soliciting feedback from employees, and including them in agency decision-making. A level of transparency also exists in these efforts, as CHI Friendship takes steps to be transparent, sharing follow-up information about those surveys and the employee feedback. This connection between the leadership team and others was evident in the Person-Centered Stakeholder event at the conclusion of the accreditation on-site visit, where CHI Friendship ensured that all stakeholders played a meaningful part in the “What Really Matters” Factor Groups.

The culture that CHI Friendship has established also has broader implications for the greater community. It expands beyond the direct services that the organization provides, having an impact on others throughout the neighborhoods where people receiving supports live, work, and interact.

Integration of Community

“CHI Friendship does more than just passively ‘go out’ into the community. They are actively working towards creating meaningful connections within the community for all organizational members,” shares Elizabeth Sites, CQL Director of Organizational Excellence.

Supporting people to play a vital role in their community is a top priority for CHI Friendship. By implementing CQL’s ‘3Es’ – Education, Exposure, Experience – they have worked to help people become more familiar and engaged with potential connections they can create and relationships they can nurture with others outside of the service system. Whether it’s people choosing where they live, becoming more engaged at their place of worship, or identifying fun activities they want to participate in, CHI Friendship is trying to make that happen!

“I am happy to be with Friendship. Friendship is fun. They take me to places around town that are fun for me.” states Todd Lueck, a person receiving supports from CHI Friendship.

Beyond where people live or what they do for fun, CHI Friendship has also put a spotlight on promoting competitive, community-based employment for people receiving services. This involves a combination of understanding people’s interests and desires in employment, helping to build social capital, establishing contacts with employers, and identifying innovative ways when traditional approaches aren’t working. Some examples of this include promoting entrepreneurship, establishing micro-businesses, and securing micro-grants with no-interest loans.

CHI Friendship’s years-long commitment to community-based employment for those they support earned them a 2015 CQL International Award of Excellence, which demonstrates that while the road to meaningful employment may be a long one, it is a worthwhile journey as part of an organization’s overall commitment to quality of life outcomes.

People Choose Where They Work

Dedication To Quality

“Friendship has learned over the years that quality is not a destination, it is a journey,” states Leslie.

For CHI Friendship, a critical piece of their quality improvement efforts center on outcomes, specifically through the use of CQL’s Personal Outcome Measures® (POM). New employees of CHI Friendship are quickly introduced to the POM, where they then have the tool for person-centered discovery and feel empowered to act on it. Along with understanding outcomes at the individual level, as an organization CHI Friendship collects and analyzes outcomes data at the aggregate level. By closely monitoring this data, CHI Friendship can make educated decisions about new agency initiatives, knowing that it is based on what the people who are receiving supports truly want in their lives.

Agency-Wide POM Data, Across All Indicators

CHI Friendship also takes numerous steps to ensure that staff have the knowledge, tools, and resources to support people in achieving those outcomes. “Friendship understands that the more educated their staff are, the better their staff will be. Our field is changing rapidly with new ideas and innovative techniques. Friendship’s approach has always been to try new ideas, see if they work, and share best practices with other providers, because we see ourselves as a leader in our industry.” shares Ryan Orcutt, Director of Education for CHI Friendship. They have implemented an array of staff development initiatives and continuous learning offerings that include training on sign language, supported decision-making, Alzheimer’s disease, rights, organizational culture, and more, along with having staff members undergo the process to achieve CQL Interviewer Certification and CQL Trainer Certification.

“By having two team members who have achieved CQL Trainer Certification, our POM data is now more reliable than ever. We feel very comfortable using our data to make individual and agency decisions,” adds Leslie.

In addition to the formal training and staff development initiatives, CHI Friendship pursues innovative practices across their services. One example is their embrace of the latest technology spanning a wide range of areas, like administering medication, promoting independence, improving personal security, and more. When it comes to finance-related outcomes, CHI Friendship has helped people establish ABLE Accounts, which is a tax-advantaged savings account program for people with disabilities. They have also developed accessible budget templates to improve people’s understanding and education surrounding people’s personal budgets, in an effort to enhance independence and advance fiscal responsibility. In advocacy efforts, CHI Friendship has worked to champion better funding and rate structures for their state’s human services system. Along with these broader legislative initiatives, they have also helped people receiving supports develop their self-advocacy skills for personal advocacy.

Celebration of Distinction

The accreditation visit culminated in a Stakeholder Event where over 80 stakeholders including people receiving supports, family members, direct support professionals, the organization’s leadership team, community members, and others met to participate in an intensive process, led by CHI Friendship. They worked to discover, dream, and design a plan focused on enhancing organizational implementation of Person-Centered Excellence over the course of the four-year accreditation term. An Appreciative Inquiry approach was used during this work by focusing on what the organization does best and capitalizing on these strengths.

One of the strengths of the organization is to provide creative and meaningful approaches to all they do. The agency presented their “What Really Matters Plans” via skits where stakeholders acted out their plans. Having the plans presented in this way certainly showed the review team that CHI Friendship understood and were invested in the plans they made to ensure they will continually improve quality.

CHI Friendship’s achievement of Person-Centered Excellence Accreditation | With Distinction demonstrates their deep commitment to quality and their success at navigating the new eligibility and accreditation criteria for this level of accreditation.

We acknowledge that it is not an easy process, but those receiving supports, employees, families and community members rose to the challenge and it’s having a tangible impact on people’s lives.

“This partnership with CHI Friendship has remained strong for decades,” says Rizzolo, adding “and we’re thrilled to see how it continues to grow in the years ahead!”