It seems to me that without meaning to or wanting to, most of us involved in helping healthcare professionals learn about systematic quality improvement have been making it more difficult than it needs to be for those new to our work.
It is possible to provide a much more welcoming introduction to Quality Improvement. And it is all the more important that we do so now that QI (aka practice-based learning and improvement) is required by medical specialty boards, by the ACGME of residency and fellows programs, and by the Joint Commission.
Here at Improvement Learning’s Healthcare Improvement Skills Center we spent a year working with colleagues in three different healthcare systems piloting what we hope many healthcare professionals will find to be a friendlier way in. The piloting went well and we have since spent six additional months incorporating this new approach and associated activities into an enhanced and expanded version of our HISC website, as you can now see. The purpose of this first installment of our new blog is to lay out what we have done here and, as clearly as possible, why.
What can we all do?
O One thing we can do is demystify improvement science as rapidly as possible. We can invite those new to QI to go through a rapid self-assessment inventory that describes in straightforward, down to earth language what we are talking about – what QI is.
O At the same time, we can encourage those who go through this sort of self-assessment to identify first and foremost what they already know about QI and what they already are able to do (what they bring to the party). We should explain that much of what they already do in their clinical work and in the way of clinical reasoning just needs to be applied here, in QI work, to the processes, procedures and systems in their particular practice settings. They should “think of the practice as your patient” (Ogrinc and Headrick).
O We can also do a much better job of encouraging those new to improvement work to identify those aspects of QI with which they would appreciate some help. We should make it clear that they don’t have to know it all in order to embark on meaningful and productive improvement efforts. (And as far as possible, we need to facilitate their getting that help.)
O In fact, the sooner we get those new to QI thinking about an improvement effort they would truly like to initiate, the better. Our pilot work would suggest that starting with the identification of a first project, and asking people to do their best to begin thinking through an improvement project plan (using something like the set of question found in the “Plan & Assess My QI Project” tab’s “Quality Improvement Project Plan” on this site) serves at once to deepen their motivation and ground their self-assessment, strength identification, help seeking and QI skill development efforts.
O And, of course, we can help them to identify things about QI work they would like to learn more about, but more often than in the past on an as needed basis. With the sort of approach advocated here, when the individuals and teams we are coaching begin to work on various phases of their improvement initiatives, they and those of us supporting them should be in a much better position to consider what resources, resource people, tools, experiences and/or structured activities might prove especially useful (e.g. using a certain checklist, or looking at or reviewing a brief tutorial, or going through one of the Healthcare Improvement Skills Center QI skills learning modules).
Our role should be to help clinicians identify and build on their existing strengths while at the same time encouraging them to seek out the help they need and to learn more about those things they want to know more about or to be able to do next. Our job certainly should not be trying to impress them with how much we know and how little they know.
This isn’t rocket science. A number of you, healthcare professionals and healthcare educators alike, have been coming to most if not all of the same conclusions. We would merely encourage others to make these things as explicit as possible in their work. We all need to work together to lower the bar when it comes to systematic improvement in healthcare.
Mark Cheren, EdD
An earlier version of this posting was first published on the Improvement Learning “Learning Initiatives” blog, WEDNESDAY, APRIL 28, 2010. Revised for the current posting on the HISC 3.0 “Healthcare Improvement” blog, TUESDAY, OCTOBER 31, 2011.