Institute for Health-care Improvement

Citation

(2005), "Institute for Health-care Improvement", International Journal of Health Care Quality Assurance, Vol. 18 No. 1. https://doi.org/10.1108/ijhcqa.2005.06218aab.010

Institute for Health-care Improvement

Institute for Health-care ImprovementImprovement tip: “quality” is not a department

Keywords: Quality improvement, Organizational culture, Strategic planning

Your organisation will only make meaningful and sustainable quality improvements when people at every level feel a shared desire to make processes and outcomes better every day, in bold and even imperceptible ways.

Robert Lloyd, Executive Director of Performance Improvement at the Institute for Healthcare Improvement, offers some tips for improving quality within your organisation.

If your hospital, medical practice, or health system has a quality improvement department, congratulations, says Robert Lloyd. If the general assumption is that this is the place where quality improvement resides and is performed, however, you’ve got work to do. Quality is not a program or a project; it isn’t the responsibility of one individual or even those assigned to the Quality Department. The Quality Director is basically the coach, facilitator and cheerleader. His or her job is to instil principles of quality at all levels, helping everyone in the organisation – every employee, executive, caregiver, and consultant – feel driven to achieve excellence.

This fundamental lesson is at the heart of successful quality improvement, and often the most challenging and hardest for an organisation to grasp. After all, everyone believes they perform at a high level of quality – it’s the American way, it’s written in slogans, posters, even billboards. “We care”, “We’re number one”, “We’re the quality leader”, and so on. In addition, when quality departments are diligently taking steps to comply with quality directives from external review or accrediting bodies, it is easy to feel complacent. However, this is only part of the story. Organisations will only make meaningful and sustainable quality improvements when people at every level feel a shared desire to make processes and outcomes better every day, in bold and even imperceptible ways.

Robert Lloyd often makes this point with a story. It’s short and sweet, no doubt part real and part legend, retold again and again at quality events. In 1969 when the USA was planning a trip to the moon, the major TV networks had crews stationed at NASA headquarters in Houston, Texas, to cover the lead up to the launch. One day the reporters and camera crews had some down time while waiting for the NASA officials to arrive at the pressroom. As they passed the time milling about the halls, someone noticed a janitor coming toward them with a broom and thought, “Well, nothing else to do, why don’t we film some ‘B’ footage to have on hand.” A reporter happened to have a microphone handy, so he said to the approaching janitor: “So, what’s your job at NASA?”

As the story goes, the fellow paused, leaned on his broom, looked thoughtfully into the camera and said, “My job is to help us get to the moon.” He then picked up his broom and went on his way. Whatever the apocryphal elements may be, I tell people: There in a nutshell is “quality”. This is a man who sees himself not as a janitor but as part of a team helping people get to the Moon.

Quality is a way of thinking about work, how you approach work every day for yourself personally and for those that you serve. It’s not about the right turn of phrase or staff titles. So in terms of quality projects, Robert Lloyd advises you ask the following questions: “But what are the teams really doing? What have they done to make something better for your doctors, nurses, patients and their families?” Quality is about making change, getting results. Activity doesn’t equal accomplishment.

This approach is not always easy to embrace. Health care providers and administrators see it as idealistic; they feel so swamped with daily commitments and duties that they see quality improvement as an added burden. It’s more work, extra work, over and above their “real” job. But if quality isn’t their job, what is?

This reflects a fundamental shift in perspective – a cultural, almost philosophical evolution – that some organisations have to attain in order to really understand quality and be able to achieve it. Quality has to be connected to an organisation’s mission, its strategic vision. It has to be part of the work and weave, the very fabric of the organisation. For more information: www.ihi.org