Why It Matters
Quality improvement can have unintended consequences.
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What You Miss When You Don't See Quality as a System

By Petrina McGrath | Wednesday, November 14, 2018

Nov 14 blog post

Petrina McGrath, PhD, RN, Quality & Safety Director for the Saskatchewan Health Authority, is faculty for IHI’s Chief Quality Officer Professional Development Program. In the following interview, she describes why quality leaders needs skills and expertise that set them apart from other health care leaders.

What skills do senior quality leaders like Chief Quality Officers (CQOs) need most?

They need to be able to think at a systems level and help others see and understand systems. They have to be good listeners. It helps to be curious and the kind of person who likes to dig deeper to understand and solve problems.

The ability to coach and build capacity in others is important, whether it’s teaching your own team or coaching senior-level peers or the CEO. You need to help them see the current state of quality in your organization and help them think through the next steps necessary to get where they want to go.

Why is it important to take a systems approach to quality?

It’s exciting to do work with a point-of-care team or a group of support staff and help them make improvement. Over time, though, if we do these improvements here, here, and here without understanding the implications of changing this process upstream and downstream, you start to impact other parts of the system in unintentional ways.

In my organization, for example, we’d been doing great work in our support areas in developing greater efficiency. We focused on best practices in our human resources department and in our supply chain.

Separately, we started asking questions about why we couldn’t sustain clinical improvements in many areas after we’d done improvement events. We began to understand some of the contributing factors. We started to see, for example, that point-of-care managers had very little time to spend doing things that were important to sustaining clinical improvements. These included knowing and growing their people and continually improving their processes.

What happened to the time they used to spend in those key areas? When we stepped back and looked at how they were spending their time, we realized that other parts of our system were impacting the point-of-care manager. A lot of the efficiencies we’d created in human resources and supply chain had downloaded onto the point-of-care manager.

Why is this so important? When you think about a patient or family in a health care organization, the most valuable part of their experience comes from their interactions with clinicians and support staff during their hospital stay. The manager at the point of care plays a critical role in removing barriers that get in the way of those clinicians who interact with patients. They also ensure they have the training and the support they need to do their jobs well. If the manager is always in her office keeping the day-to-day processes running, she has little time to be visible in her unit. It’s harder to maintain strong connections with her team or support them in solving problems that arise.

Until we started digging deeper, we didn’t know that we’d unintentionally sub-optimized a critical part of the system. Without understanding that we needed to look at the big picture, we could easily have missed it because it wasn’t readily visible.

What’s unique about the role of chief quality officer as compared to other leadership roles in health care?

What makes the chief quality officer role unique is that it’s a combination of learning how to improve organizational processes, and also about the people part of the organization. You have to balance improving processes with building capacity, developing people, engaging teams, and supporting them to be at their best. Also, the chief quality officer is a newer role in many organizations. This can be intimidating, but also exciting because in some ways this means you’re charting new territory.

Editor’s note: This interview has been edited for length and clarity.

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