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"Sometimes, the experience of learning how to make change empowers [people] to become advocates as well as improvers."
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The Multiplying Effect of Improvement Science

By Jafet Arrieta | Thursday, September 3, 2020
The Multiplying Effect of Improvement Science Photo by Arek Socha | Pixabay

American cultural anthropologist Margaret Mead once famously said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

I often have the privilege of seeing proof of this, especially when working with the participants in IHI’s Experto en Mejora Continua de la Calidad (Improvement Advisor) 10-month professional development program. As director of Experto, I see the potential for using improvement methods to not only transform health systems, but entire societies.

How can I make such a bold claim? Because I’ve seen the multiplying and catalyzing effect of improvement science. Often, when people who learn about improvement get excited about making change, they become eager to go beyond the initial problem or project they wanted to tackle during the course. They start to see how they can develop, organize, and lead a group of thoughtful, committed improvers to transform their organizations and improve outcomes for patients.

For example, a physician from Argentina joined the Experto program in Chile in 2018. She was inspired from the very first learning session. She said, “Wow, this is more than I expected. I can already see the potential for change.”

By the time this physician attended the second learning session, she had helped to launch not just one, but a series of improvement projects throughout her hospital. She said, “Why would I limit the possibility for improvement to my individual project if I can pass on the knowledge and skills I’m learning?” After recruiting others who wanted to make change, her organization launched an improvement incubator that developed approximately 30 improvement projects.

What people get from learning improvement can go well beyond building their own improvement skills and the skills of others. Sometimes, the experience of learning how to make change empowers them to become advocates as well as improvers. This was the experience of two quality advisors working for a public hospital in Colombia who were trying to improve pediatric cancer care.

The quality advisors began to teach what they were learning from the Experto program to others at their hospital. Over time, they saw that some of the barriers to change they faced went beyond the initial scope of their project. For example, they realized that it would be difficult to improve care without having enough of the right infrastructure to treat the patients in their facility. So, they met with the board and presented data and patient stories. They helped their hospital leaders understand that, without the means to treat patients on site, it was not enough to improve the standards of care and the ability of the staff to diagnose pediatric patients with cancer. They eventually successfully advocated for new investments in additional beds and an MRI machine.

When these quality advisors told me their story, I saw how their ability to motivate and catalyze change was bigger than just two people or even an entire organization. When teaching improvement, we talk about systems thinking. We talk about leadership. We talk about the human side of change. But when people combine all of these with their intrinsic motivation and passion for what they do, the sky is the limit. Our colleague in Argentina, for example, has talked about how her enthusiasm for spreading improvement resulted not only from professional development, but also from the personal transformation she went through as she started to see the possibilities for meaningful and lasting change on a broad scale.

Clinical Training is Not Enough

I’m a physician by training. I’ve come to believe that the typical education we get as clinicians is insufficient. We don’t learn to truly transform health systems so we can in turn improve individual and population health. We need the adaptive knowledge that comes with improvement science to make change on a broad scale. We know that our traditional systems are imperfect and yet we continue to teach the same methods and skills in virtually the same way as we have for decades.

Before we learn about improvement science, many clinicians go through our lives thinking we have all the tools we need from our training. We don’t realize that, by learning some intuitive and even commonsense tools and methods, we can do much more to help patients and families.

Improvement science presents an opportunity to marry subject matter knowledge with adaptive learning approaches that that can unlock the untapped potential of many more professionals. This is why understanding the psychology of change, the human side of change, and the intrinsic motivation that leads people to train for years to become health care professionals is so important.

In my experience, personal connection is the key to spreading improvement knowledge. The improvement movement we’ve seen growing in Latin America for the last 10 years has been in part because our team members connect with the participants at all levels, and we understand that improvement science appeals to what people find to be most fulfilling and meaningful as human beings. Enabling people to do what they love has allowed us to spread this knowledge.

It may seem like I’m romanticizing it, but I’ve honestly seen people fall in love with improvement. And when you love something, when you’re passionate about it, you want to share it with the world. There’s no way you’re hiding it.

Jafet Arrieta, MD, DrPH, MMSc, is a Project Director and Improvement Advisor for the Institute for Healthcare Improvement.

(Having difficulty watching this video? Watch on YouTube.)

You may also be interested in:

IHI Psychology of Change Framework white paper

How Improvement Science Can Meet the Moment (or Miss the Mark)

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