Dear IHI —
I work in the quality department of a large hospital, and we’re inundated with quality improvement ideas. We’re thrilled that so many people are interested in this work, but we’re getting more suggestions than we can follow up on from all directions — the C-suite, middle managers, and front-line staff. How do we prioritize, and what does it signal to the organization about where we focus our resources? — OVERWHELMED
Dear OVERWHELMED — I’m glad you realize how lucky you are to have so many requests. But they come with a couple of challenges. At IHI, we have a saying: “waste no will” — you certainly don’t want to give people the impression that their interest is going unnoticed. But you also have to leverage your resources so you will have maximum impact. I’d suggest organizing your work in three parts — or as we often recommend in QI, “segment” the work.
Segment 1: Everyone who expressed interest deserves a response. Hopefully, one or two people in your department can meet briefly with each person who submitted a request to provide light coaching about the aim and approach. Suggest some resources to learn the basics of QI, whether internal or from the IHI Open School. Let them know you’re interested in learning how the work goes, and be sure to follow up to see how they’re doing. There are bound to be some bright spots, and as you find them, you may want to shift resources to help them shine.
Segment 2: If the C-Suite is calling you, jump on it! Nothing wrong with tending to your self-interest. Just be sure that what the leaders are proposing is well-aligned with the organization’s quality and safety goals. In most systems, the front line and even middle management can’t articulate their organization’s priorities, so this is a chance for you to support projects that promote these goals, help spread the word about the organization’s priorities, and to demonstrate that progress is possible.
Segment 3: Among your supplicants, some will have promising projects that could really benefit from your help. I would look for what you might call “major” projects — things that will take serious time and resources and have tangible impact on better health and lower costs (in other words, “value”). You could guide your decisions by constructing a priority matrix with domains such as impact, how much time and resources it will take, how long before you can see some results, how much interprofessional teamwork (including residents) it involves, or how much it might improve health care inequities. I’d ask leaders what domains they care about most.
Finally, for practical purposes, I’d ask myself questions like these: Will this project land us in the organization’s annual report, or even better, the local or national news? In other words, what’s the headline going to be? Another good question: Will this project allow staff to develop improvement skills?
Good luck! You’ve got a lot on your plate. Don’t forget to keep you own work-life balance in mind.
Don Goldmann, MD
Chief Medical and Scientific Officer, IHI
Editor's Note: "Dear IHI" is an advice column in which IHI experts answer questions from health care change agents in the field. Leave your tips in the comments, and look for a new installment every other Thursday. Have a question for "Dear IHI"? Send it to info@ihi.org or on Twitter using the #DearIHI and @theihi.
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