“I became impatient with the fact that we were implementing so little of what we knew,” says Carol Haraden, IHI Vice President and patient safety expert. This interview is the first installment in a new periodic series on the IHI blog that will feature quality improvement and patient safety experts commenting on how they started their QI work, how they maintain their energy, and what resources have been most meaningful to their success.
Q: When did your interest in quality improvement or patient safety begin? How did you get involved in QI work?
I was always involved and interested in research, but at some point I became impatient with the fact that we were implementing so little of what we knew in health care. I just could not turn my attention to the next interesting problem without trying to solve the dilemma of the profoundly poor uptake of current knowledge. This work came to be known as translational research, but that did not exist in the early 1980s.
Q: Can you point to a tool, model, or resource that was a game changer?
The bundle concept, for sure. Not so much the content; that was known. But the approach of all-or-nothing measurement. That was an absolute game changer. Folks moved from being comfortable with good-to-mediocre reliability of individual processes to an understanding that very few patients got all the care that was necessary and sufficient to improve the outcome. That profoundly changed the way they thought about and delivered care.
Q: What do you know now that you wish you knew when you began your QI journey?
How spread and scale-up really works, both the technical AND the social aspects. We have always been able to create “bright spots” of great outcomes — exemplars — but our ability to scale up those results has been minimal. I am still learning, but I know now that you have to start planning for spread on Day One. A great analogy for clinicians is that of patient discharge. Clinicians start planning for discharge on admission with that goal in mind. Spread and scale-up needs to be the same. You cannot start too soon. Also, no one learned this in their academic programs. It is a new science; we assume that leaders know how to do this, but they do not. Why would they? Without leaders deeply understanding and driving a system for spread and scale-up, it will not happen. Some patients will benefit from great improvements, but no way will this happen for the majority.
Q: How do you keep up your energy to do the work of improvement?
[Seeing] the work of clinical teams creating improved outcomes and processes for patients is incredibly energizing. They are just amazing.
Q: What do you think the patient safety community should focus on in the next five years to have the biggest impact?
First, full scale-up of the great results that have been demonstrated in several systems internationally, so that we live up to the promise of great care for all. Second, deep and systematic innovation for seemingly intractable problems. We have got to stop trying to solve today’s problems with yesterday’s solutions.
Q: If you could recommend one book or article to readers interested in quality improvement, what would it be?
The Improvement Guide — it is the “bible” of improvement. It is so readable and enjoyable. It is full of wisdom around solving the problems that hold us back in such practical ways. Invaluable if you are involved in improvement — and we all are, one way or another!
Read more blog posts by Carol Haraden:
Patient Safety: Moving from Defect Reduction to Proactive Prevention
The Elusive Coverage and Completeness