The IHI Open School recognizes our 2018 Change Agent of the Year, Jenna Smith-Forrester, MSc, a medical student at the University of British Columbia, for her exemplary leadership of an IHI Open School Chapter and her dedication to inspiring her classmates to embrace quality improvement throughout their careers in health care. Read her winning essay below.
What turned into a six-year journey in leadership and personal growth with the Institute for Healthcare Improvement (IHI) began on a bus in the Honduran Highlands.
My introduction to quality improvement (QI) and IHI started on a volunteer medical trip with Mayo Clinic and one of the most inspirational people I’ve ever met, Dr. John Bachman, a revered Family Practitioner in Rochester, Minnesota. Each morning our medical brigade started with a bus ride; this was a story time. Dr. Bachman would share influential experiences and drum up our inspiration for the day. I was struck by the story “Star Thrower,” which highlighted the power of one. It said when working in your own domain, you can and will make a difference.
On these same bus rides, each member of our 50+ person team would be given five cue cards. We were asked to write compliments to colleagues on four of them and use the last as an improvement card. Specifically, we were asked to be attentive to the system in which we worked and record our thoughts about what stood out as ineffective, redundant, or otherwise suboptimal.
Each evening, the group would meet to review the cards. All were submitted anonymously, allowing the exercise to eliminate hierarchy, engage all participants, foster collegiality, address concerns in a timely manner, and crowdsource for solutions. In one week, these cards led to hundreds of iterative improvements in our team functioning, service delivery, and, ultimately, patient outcomes. This was systems-level thinking and PDSA cycles in action. This was powerful.
This experience occurred at a time when I never saw myself as a leader. I feared public speaking. I feared negative evaluation. And I feared that I had nothing important to say. However, finding myself in the right place, at the right time, with the right attitude, I would use this experience as my catalyst for change.
I wanted to learn more about QI, and I committed to working within my own domain. This started as self-study and completion of IHI Open School Courses, working towards my Basic Certificate in quality and safety. When I began my Master’s degree at the University of British Columbia (UBC), I joined the executive team of the Open School Chapter there. Through connections with this team and attending a number of Chapter, Open School, and IHI-led events and conferences, I was inspired by other students who pushed their comfort zones and challenged the status quo.
As my involvement in the UBC IHI Open School Chapter grew, I started volunteering and leading projects, attending and presenting at conferences, and experiencing the connectedness and supportiveness of the Open School community. I developed a comfort with public speaking and sharing my ideas, progressively challenging my fear of negative judgement and failure. I went on to serve as UBC Chapter President, facilitate the creation of Chapters in Kelowna (UBCO) and Prince George (UNBC), and expanded our provincial QI network by creating sustainable partnerships between various health authorities and other Open School Chapters in the region. At each step along the way, I found myself applying skills acquired from my Basic Certificate training and wanting to inspire other “star throwers.”
I believed that introducing the foundational principles of QI in pre-clinical training would empower students with new tools to solve problems. Through the Open School Chapter at UBC, I led teams that organized and hosted dozens of workshops, panel discussions, and training sessions of every shape and size — thereby training thousands of UBC students in foundational QI methodology and encouraging each student to embrace his or her role as a change agent. I also learned how to reframe previously fear-provoking opportunities into ones of excitement, and with that the possibilities suddenly seemed endless!
This realization propelled me to share my passion for QI education and advocacy in other ways. I helped integrate the Open School courses and Basic Certificate curriculum into UBC’s new medical curriculum and led lectures with medical students to underscore the synergies between leadership and QI. I also played a role in designing interprofessional lectures for medicine and nursing students related to communication in handovers. Perhaps one of the most meaningful experiences was working with Chapters and leaders across Canada to develop and host Canada’s first regional IHI Open School Chapter Conference. Our successful event was made possible by a team united by shared vision, transparency, and open communication that employed conflict resolution strategies and embraced exercises in collaboration and crowdsourcing of ideas, funds, and resources. Most importantly, it was an exercise in trust, both in people and “the process.”
There isn’t one single event I can share that highlights how influential my time with the Open School has been. My dedication to IHI is fueled by the desire to contribute to changing the culture in health care so that a better tomorrow starts today. The Open School and my time as a Chapter Leader has made me a better leader and given me community and enduring friendship, as well as unparalleled opportunities for collaboration, inspiration, and joy. Perhaps most importantly, its awakened my inner change agent.
I don’t believe in glass ceilings; I just think you need to dream bigger than they tell you how. To my fellow IHI members, leaders, and dreamers, may you each realize your own potential in creating happier, healthier systems and know the power of one.