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Burst the Health Care “Bubble”

By Derek Feeley | Wednesday, January 29, 2020

Line of Sight

Every year at the IHI National Forum, we organize day-long pre-conference trips we call “excursions” to organizations outside health care. Participants have learned valuable lessons about safety, reliability, leadership, innovation, customer experience, and joy in work from sources that may seem unlikely, including hotels, theme parks, zoos, video game companies, and golf academies.

These learning opportunities make sense given the history of quality improvement and patient safety. After all, where would we be if not for the innovative thinking we’ve borrowed from car makers, aviation, nuclear power, and other industries?

Despite this history, however, we sometimes live in our own “bubble” in health care and in the improvement world. We get caught up in our way of doing things and forget that we have much to learn from others.

We sometimes let our tools and methods get in the way and fail to fully appreciate what W. Edwards Deming taught us about the Psychology of Change: every effort to improve systems involves people.

Improvement is not all about the driver diagram, run chart, or balancing measures. These are important tools but using them won’t be effective if people don’t feel a sense of engagement and agency while using them. To encourage involvement and empowerment, we should follow Deming’s advice to build trusting relationships, interdependence, and pride in work.

Attending to the human part of change has been part of why IHI has offered opportunities to learn from a civil rights attorney, a social justice organizer, an Olympic athlete, and a priest at recent IHI National Forums. Some people may wonder what these people could share that was relevant to people who want to focus on health care quality improvement and safety.

As it turns out, quite a lot.


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All Teach, All Learn

Considering theories, methods, practices, and ideas from outside health care helps us take the adage about “all teach, all learn” to its proper conclusion. After all, we don’t mean that only those in health care can teach or learn. For my part, keeping an open mind about where I might find inspiration has given me a whole host of items I keep in my toolbox for everyday problem solving. Here are a few things I’ve learned from some of the colossal minds who have been recent IHI Forum keynote speakers:

  • Get proximateBryan Stevenson is a civil rights attorney. His memoir Just Mercy is the basis of a movie I saw last week and wholeheartedly recommend. For me, the most powerful lesson Stevenson shared at the 2017 Forum was about the importance of proximity. Essentially, Stevenson noted that we can’t solve problems without getting close to the people who are experiencing those problems. This resonated deeply with me because I believe I’ve done some of my best work as a leader close to the point of care, engaging with people who care for patients every day. Like most health care leaders, I don’t do my best work at my desk. I do it by being proximate.
  • Real change takes a movement — Tarana Burke is social justice organizer who heads the ‘me too.’ organization. When Burke said at the 2019 Forum that it takes a movement to change the culture around sexual abuse, assault, and harassment, she could have been talking about patient safety. To create the systems necessary to reliably protect patients from harm requires the work of all of us. That’s why IHI is convening the National Steering Committee for Patient Safety. That’s why the National Steering Committee will publish a national action plan on safety in a few months. IHI has the humility to recognize that we can’t make care safer on our own, but we can help to spark the movement just as Tarana Burke has done with #MeToo.
  • We’re all leaders in our own lives — When World Cup athlete Abby Wambach talked about how leadership is not the privilege of the few, but the right and responsibility of all, she reminded us that leadership is not a possession. It’s not about rank or occupancy of the corner office. Leadership is about how you live your life and how you interact with people. It’s about how you relate to others and bring out their best. You don’t need a special title to do those things.
  • Stand in awe, not judgment — Father Greg Boyle was probably the external Forum speaker who had the biggest impact on me. The most powerful thing he said was about how we should stand in awe — not in judgment — of the way in which people facing poverty carry their burden. This ought to be the same for all inequities. We should stand in awe of our patients and colleagues who — in spite of the inequities they face — achieve what they do. We must also share the burden of dismantling those inequities because they hurt all of us, not just some of us.

If we agree that psychological safety is needed to create a health system that’s safe for patients and the health care workforce, then it makes sense to learn from people like Bryan Stevenson, Tarana Burke, Abby Wambach, and Father Greg Boyle. How can we ever create a climate where people feel safe to improve if we don’t deal with social injustice, harassment, and inequity?

Improvement can only thrive in an environment in which everybody can bring their best to work. For example, if someone is suffering from harassment of any kind — whether it’s in the workplace or anywhere else — how are they going to bring their best to their patients? How are they going to feel part of the movement we’re trying to create? How are they going to fully lead their own lives?

Unless we’re willing to open our eyes and our minds to perspectives from people who don’t work in health care, we’ll miss some tremendous opportunities. Given the magnitude of the challenges we face in health care, we can’t afford to pretend that we have all the answers we need. It makes sense to keep our minds and hearts open.

Editor’s note: Look for more from IHI President and CEO Derek Feeley (@DerekFeeleyIHI) on leadership, innovation, and improvement in health and health care in the “Line of Sight” series on IHI.org.


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