Summary
- "By giving people the tools and methods to think differently, use their expert knowledge, and use improvement science, staff can achieve great things.”
For Susan Hannah, a senior director on the Institute for Healthcare Improvement (IHI) Europe team, teaching improvement is especially gratifying when a team is highly motivated — “desperately wanting to make a difference with the work they do” — but are not sure how to go about it. For Susan, there is nothing more rewarding than observing a team “as they have their aha moments” and learn to apply quality improvement (QI) methods and see the difference they can make.
In her years as an Improvement Advisor, Susan, who is faculty for the Improvement Coach Professional Development Program, has had the opportunity to observe this process many times. In a recent interview, she shared several tips for using QI to empower improvement teams:
Be clear on what you want to achieve. This may seem basic, but teams often struggle with writing an effective aim statement and determining appropriate outcome measures. Teams must think about “how good they want to be and in what timeframe they want to achieve that [improvement], but it also needs to be quantifiable,” Susan explained. If you cannot quantify what you are trying to achieve with an outcome measure, then you might not have the right aim statement. “Unless we know the ultimate outcome of our ambition and where we are trying to go, then it’s hard to know whether we’re moving in the right direction,” Susan continued. “Without knowing those things, we can’t really work on improving interventions and our process steps.”
Rethink data and measurement. Health care workers are often accustomed to measuring for quality assurance or compliance, and they do not necessarily know how to use measurement for improvement. Susan helps teams rethink the purpose of the information they are gathering. “How do you understand the gap that you're facing and how do you analyze and use it to drive improvement?” she asks teams. Answering those questions can help a team use their data to identify their gaps and help focus their improvement work.
Remember to use balancing measures. Balancing measures offer a way to assess a project’s wider effects by asking whether improvement in one part of the system is causing new problems in other parts of the system. Susan noted that balancing measures are “often seen as an add-on measurement,” and not prioritized. “Unless we are looking at the unintended consequences of the work we are doing, we’ll never know whether it’s having an effect on the broader system,” she said.
Do not overthink early data collection. When Susan started learning about how to apply improvement methods, “I hadn’t appreciated the importance of gathering process data from the very beginning,” she said. Subsequently, she always encourages teams to get started with data capture from the very first PDSA. “Don't spend too much time thinking about it,” she urged. “Develop a plan with some measures that will be good enough to get you started. Once you get started, you will grow knowledge quickly and get more effective in the way in which you’re doing that work.”
Who Has Permission to Make Change?
Susan noted a striking discrepancy she has noticed. Sometimes staff think they need permission to make changes, while leaders often hope that staff will take the initiative. “So, leaders’ perception is that the staff know they have permission, and the staff are worried about making changes because they’re not sure it will land well with their senior leaders,” Susan remarked.
Ultimately, Susan sees improvement skills and knowledge as empowering. By giving people the tools and methods “to think differently, use their expert knowledge, and use improvement science,” she said, “staff can achieve great things.”
QI knowledge “gives teams confidence when they realize they have tools and methods to help them apply rigor to the changes they’re making,” Susan stated. It helps them make informed decisions. It also helps their leaders have confidence in them so they can continue to “do what they know is going to make a difference.”
Photo by chutipon Pattanatitinon | Unsplash
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