Why It Matters
QI tools are both necessary and insufficient to improve health and health care worldwide. We also need a much deeper understanding of what matters most to humans.
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Quality: What’s Love Got to Do With It?

By Kedar Mate | Monday, February 28, 2022
Quality What’s Love Got to Do With It

Photo by Millo Lin | Unsplash

“Ultimately, the secret of quality is love. . . If you have love, you can then work backward to monitor and improve the system.” Avedis Donabedian, health systems research pioneer

Courage. Trust. Equity. Love. These are IHI’s core values.

Although courage, trust, and equity are not necessarily typical organizational values, love is the one that often surprises people the most. IHI undertook a months-long reevaluation of our values a few years ago. Led by staff members from across IHI, including our former CEO Derek Feeley, love was the value that raised the most questions during this process.

Was it too sentimental? Too personal for a work environment? We kept coming back to the word again and again. We deliberately chose love, courage, equity, and trust because these are the values we want to guide how we act and behave internally with each other, and also what we hope to create in the world.

Even now, the idea of love as an organizational value provokes a range of responses. Some people would rather we not include it in job descriptions or other human resources documentation because they fear it could seem unprofessional and might deter some people from working at IHI. On the other hand, some job candidates have told me they are attracted to IHI because we speak about love explicitly as a stated organizational and cultural value.

At IHI, love means that “we build relationships grounded in patience, gratitude, and respect.” For us, the personal matters to us as professionals. During a recent staff conversation, for example, one staff member, Monique Riebe, reminded us that we have to lean into our “radical humanness,” especially during this time when the lines between work and personal life are so blurred. Love is personal and so much of improvement work is about relationships between human beings and doing the hard work necessary to change mindsets, values, and culture.

Improving health and health care worldwide is not just about applying a new quality or safety tool or skill. If you talk to many QI experts, they will say that changing mindsets, values, and culture are key to improvement, but then the conversation often turns to tools, spreadsheets, graphs, diagrams, and PDSAs. All these things are vitally important to making a system better. Yet, while these tools are necessary, they are insufficient to create the changes needed to make a difference in lives around the world. That work requires a much deeper understanding of what matters most to humans.

Shortly before he died in 2000, Avedis Donabedian, a pioneer quality scholar, said, “Ultimately, the secret of quality is love.”

Think about that. He spent his whole career mucking around in the trenches of quality and system science. Then, at the end of his life and career, his vast experience taught him that if you attend to culture and relationships, the technical processes and systems thinking would follow.

IHI has the privilege of working with many great organizations and individuals around the world who want us to push them harder to do better. We do this with love and compassion because we respect and value their efforts.

And as we work on equity, quality, and safety, IHI is trying to create a sense of optimism, respect, kindness, and gratitude. We are helping humans to help each other. And when you make somebody safer, make a situation better for another person, recognize what matters to someone, bring a more patient-centered approach to care, or determine a diagnosis more quickly, all of those actions are indeed, at their core, expressions of love.

Editor’s note: Look for more each month from IHI President and CEO Kedar Mate, MD, (@KedarMate) on improvement science, social justice, leadership, and improving health and health care worldwide.

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