Key Tips and How-Tos

Make quality and risk management a team effort

Prevention is key to managing risk and quality

Have a plan

Ensure that quality improvement is done on a continuous basis


Make quality and risk management a team effort


  • It’s not possible for one individual to handle all of the tasks involved in quality and risk management. Ideally, these tasks will be spread among a quality improvement workgroup or other team of people — including staff and volunteers.
  • Experienced program leaders, instructors and trainers can play a valuable role in quality monitoring and improvement activities.
  • After determining which types of tasks need to be done, assign accountability to those who will be responsible for the planned tasks.

    See: Quality Improvement Volunteer Position Description


Prevention is key to managing risk and quality


  • To a great extent, ensuring quality and managing risk involves the use of certain required forms and mechanisms designed to prevent future problems. Make it a routine practice to collect the following required risk management forms and to confirm expectations upfront.

    • Ask facilities and partnering agencies to sign a Program Co-sponsorship Agreement as a condition before allowing their personnel to attend a training workshop.
    • Require that leaders and instructors sign Statements of Understanding as part of their training workshop application process and before you provide program materials.
    • Ensure that during the program registration process, all class participants sign a Release Form before starting a program for the first time.
    • Orient anyone involved in the quality and risk management procedures about what forms are needed and how to carry out any evaluation procedures.






Have a plan


Stakeholder input

When developing your annual quality management plan, consider what information your stakeholders may needed. Stakeholders may include:


  • Oversight committees, for example, the AF chapter board or public health/program committee, the State arthritis steering group, etc.
  • Any funding agencies, for example, the CDC, United Way, local foundations, state legislatures, etc.
  • Key personnel and partnering agencies involved in delivering the programs.


Quality management options

Depending upon your local resources, determine the extent of quality monitoring and improvement efforts needed in addition to the required risk management activities. Some options for quality management include:


  • Site visits: Conduct initial site visits to assess whether a site meets the facility minimum standards or do follow-up site visits to periodically monitor adherence to program policies, and assess instructor teaching quality and program fidelity and safety.



Site Visit Checklist for AF Aquatic and AF Exercise Programs

AF Self-Help Program Site Visit Checklist

  • Participant satisfaction/ outcome evaluations: Partner with a local university or other organization with research and evaluation expertise to study participant outcomes or satisfaction. Outcomes can be assessed using the standardized impact tools developed by the Association of State and Territorial Chronic Disease Program Directors Arthritis Council. 

    Tips from the AF Michigan Chapter.

  • Program personnel feedback: Collect information from the program personnel (trainers, leaders and instructors).


  • Performance review: Monitor and coach instructors’ and trainers’ performance periodically through methods such as:

    • Pairing experienced trainers/instructors with new ones
    • Asking your active instructors and leaders to submit a videotape of a teaching sample to assess their instructional quality
    • Including practice teaching segments in any recertification or other professional development sessions
    • Asking co-trainers and instructors to complete questionnaires to assess each other’s strengths and weaknesses and compliance to the standardized protocols
    • Collecting feedback from class and workshop participants

  • Annual review process: Establish a process for annually monitoring and evaluating whether you have met your program objectives and whether your implementation strategies have been effective. For instance, you might examine:

    • Effectiveness of site partnerships
    • Increases in number of new partnerships, course sites, offerings and people reached
    • Effectiveness of various promotional and recruitment strategies
    • Effectiveness of leader/instructor retention strategies
    • Other indicators of success identified by your stakeholders




Ensure that quality improvement is done on a continuous basis


  • A widely used quality paradigm is the Plan-Do-Study-Act cycle.  Basically this  continuous cycle includes four iterative steps for quality improvement—including planning it, trying it, observing the results and acting on what is learned. An important principle of this cycle is to ensure that you have a systematic process for looking at the data and input you do collect and that you use that to help improve how you disseminate the programs. That process may simply be having your quality improvement workgroup review your data results on an annual basis to assess the strengths and weaknesses of your program efforts and to determine the need for any changes in your approach. (To learn more about how the Plan-Do-Study-Act cycle is being applied to quality improvement in the health-care setting, see the Institute for Healthcare Improvement Web site.)


  • Remember to communicate your compiled data back to those involved in the data collection as well as other key stakeholders. This communication is an important feedback mechanism that reinforces how important it is to collect the data. These reports will also help you communicate the importance and value of the work you are doing.



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