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Is there such a thing as a quality improvement (QI) personality? Maybe I wouldn’t go that far. After all, anyone can learn QI skills. I will say, however, that it helps for those who lead quality improvement efforts — no matter where they are in the world — to have certain qualities. Courage is one of the most important.

Courage? You might think that’s too strong a word to use, but I invite you to think about the courage it takes to do the following:

• Stand up and tell the truth — When the norm is to report data that looks good to those in leadership or positions of authority, it is not easy to appear in front of your peers and seniors to say the numbers aren’t great and to start documenting and sharing what is really happening. For example, in work that I support in Ethiopia — a country with a national neonatal mortality rate of 28/1000 live births – a rural district reported 0 newborn deaths over the course of the previous year. When this was shared with QI teams and leadership across the district, it was clear that everyone in the room knew these data to be false. Being the first one to start documenting and reporting these deaths — or the first leader to encourage this — is not trivial.  
• Maintain hope — The daily reality of many frontline rural health care workers is hard and sometimes bleak. They are often underpaid, overworked, lack basic necessities to provide quality care, and often do their work without adequate support. Some practice in remote places where the right care for a complex patient may be miles away. As a result, there are times when they must watch patients suffer or die needlessly. Working in a broken or inadequate system can make any of us feel powerless. It can be difficult to believe in something better, or that you could ever have the power to create change. QI takes work and results don’t often come quickly. When you’re already stretched thin, it takes courage — and a little bit of faith — to take the risk to engage in the QI process.
• Be vulnerable in front of others — For people who aren’t used to displaying data, using technology, or speaking in front of groups, it takes courage to stand in front of their peers and supervisors to present their run charts, challenges, and proposed solutions.
• Acknowledge that you don’t always have all the answers — This may be most challenging for people in leadership positions, but many of us don’t take enough time to acknowledge that we don’t know it all, talk to patients, or go into our communities to hear what people need most from their health care providers.
  

Courage isn’t enough, of course. Commitment to patients, vision, strong leadership, and creativity are also essential for successful health care quality improvement. With a combination of those qualities, I’ve seen teams make the following changes that had previously seemed unimaginable:

• With strong support from their leadership, a rural primary hospital successfully advocated to get the equipment needed to set up a neonatal unit for preterm and ill infants.
• A health center used data to make the case to get electricity and generator backup. Data can be a powerful advocacy and accountability tool to address critical components of quality.
• Health center midwives and community health workers changed the content of their community educational forums to focus on listening to the needs and preferences of pregnant women, rather than simply telling them what to do.

These examples might seem specific to especially resource-constrained environments like those in Ethiopia where my team is based. I hope, however, that you’ll consider the similarities to your own organization. Aren’t strong leadership, good data, and listening to patients the keys to success with any quality improvement initiative?

Hema Magge, MD, MS, is Country Director for the Institute for Healthcare Improvement's work in Ethiopia.

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IHI Africa Forum 2021(4–6 May 2021 | Virtual)