DEAR IHI —
I’m new in the quality department of my hospital, and when I see people in the cafeteria or the elevator, they often ask me to explain what I do or to ask if my team can help them with a clinical problem. I need an elevator pitch for QI and what my department does. What would you say to someone who’s only giving you two minutes of their attention? — NEED TO BE BRIEF
Dear BRIEF —
Two minutes! That’s tough.
Now that quality improvement is everywhere in health care, we’re sometimes swimming upstream with people who think it’s a bunch of jargon or just another management fad that has no relevance to staff’s day-to-day work. Frankly, some of my colleagues don’t help when they lapse into QI-speak and the field’s origins in industry.
So my advice is first to get people’s attention, and even an extra minute or two, by showing how QI is relevant to them. I like to start off with something like, “I'm here to make your life easier.” I’d ask your colleague what makes her angry at work — perhaps what’s had her gnashing her teeth that very day. If she’s is a radiologist, she might be upset that she yet again got a request for a head CT “stat” from the emergency department without any clinical information. An administrator may be upset that someone wasn’t notified about an important meeting. I guarantee the person you’re talking to will be upset about something.
With this entrée, give the person your pitch. Here’s mine — feel free to borrow liberally.
Look, I'll skip the QI jargon. What we do is simple. It's not that different from the experimental method scientists use routinely — for example, to develop an Ebola virus vaccine. Vaccine scientists had a hypothesis that if they genetically altered a common virus to express part of the Ebola virus and gave it people, they would develop antibodies against the whole Ebola virus. They tested this theory through many sequential laboratory experiments and then with monkeys before trying the vaccine in humans, so far with very promising results. These experiments are similar to the PDSA cycles you always hear us prattling on about. We’re using rapid, iterative tests to find out whether our theory about what will lead to improvement is any good. That's the most important aspect of QI — predict, test, analyze the results, and decide whether to move on or try something different.
Of course, in delivering health care, we have to deal with persnickety humans, so we have to use our knowledge of human behavior and psychology to make the right thing easy to do. We use our tests to show results and build will for change. We also have to understand the systems in which people deliver health care, so that we know where to target our change ideas and initiatives. And we have to track results over time to know whether we really are improving – improving significantly by statistical criteria — or just maintaining the status quo. Finally, we pay close attention to variation among the places that are trying to implement our change ideas. If one clinic is doing better than another, we try to understand why and what we can learn from the differences.
At this point, if you’re still in line at the cafeteria, I’d make one final point. Tell your colleague that not all QI is done well — but that doesn’t mean the approach is the problem. People in health care are busy and they don’t want to waste their time. So, I’d assure your colleague that improvement can be rigorous and scientific — it’s certainly not “soft” or “fluff” like many people think it is.
With that, I’d suggest they check out this video about PDSA cycles so they can give improvement a try on their own — and leave them with your business card. Think of your pitch as an improvement project, and each conversation as a test. If you hear back, you’ll know your pitch worked!
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 email@example.com or on Twitter using the #DearIHI and @theihi.
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