Making Magic Happen

“So, what exactly does your husband do?”

My wife pauses for a moment, then grins. “I’m not entirely sure. He attends a lot of project meetings, asks a bunch of questions… and somehow, he makes magic happen.”

Her friend raises an eyebrow. “Magic?”

My wife says, “Well, not literal magic. But somehow, problems that seem impossible to solve start getting better when he gets involved.”

At this point, I step into the conversation with a smile. "Being an Improvement Advisor isn’t about magic — it’s about using structured problem-solving, data, and collaboration to create meaningful change. My job is to help teams identify challenges, test solutions, and implement sustainable improvements."

The work of an Improvement Advisor (IA) usually involves a mix of the following:

• Facilitating projects: I guide cross-functional project teams through structured improvement efforts using tools like process maps, fishbone diagrams, key driver diagrams, Plan-Do-Study-Act (PDSA) cycles, etc. This includes:
  • Large projects that aim to accomplish strategic vision at the institutional level; and
  • Smaller-scaled efforts tied to departmental goals and/or challenges
• Mentoring:  One of the most fulfilling aspects of being an Improvement Advisor is mentoring others — whether it's a project manager learning how to navigate a complex initiative, a clinician exploring the fundamentals of quality improvement, or a colleague taking on a challenge. Mentoring is about fostering confidence, critical thinking, and problem-solving skills.
• Training: Training is a crucial part of my role as an Improvement Advisor. Rather than solving problems myself, a priority is equipping others with the skills, tools, and confidence to drive improvement within their own teams and departments. Training efforts fall into three key areas:
  • Fundamentals of Improvement Science – A class to foster broad appreciation and awareness of improvement science.
  • Applications in Improvement Science – A project-based course where participants gain practical experience in quality improvement (QI) and problem-solving. This course is a key step in developing institutional improvement capability.
  • Global Quality Improvement Training – Partnering with the Global Pediatric Medicine Department, I help train clinicians worldwide in QI principles. This work allows us to extend the reach of improvement science beyond St. Jude, influencing health care systems around the world. 

As pointed out by Dr. Mike Evans in one of his clever white board animation videos, improvement starts with curiosity. Questions are the tools that bring curiosity to life, helping to uncover root causes, challenge assumptions, and spark new ideas for change. But how do I know which questions to ask? I draw on my inner “RBL” and think about what RBL might ask in this given situation. This leads me to questions like: What’s getting in the way? Why do we do things this way? What if we tried something different? What does the data tell us? Can you tell me more about that? How might we test this? These are the kinds of questions that help uncover opportunities for improvement and guide meaningful change.

Speaking of questions, you might be wondering — what is RBL? RBL stands for Rebecca Steinfeld, Bob Lloyd, and Lloyd Provost, members of IHI staff and faculty, whose insights and expertise have shaped my approach to improvement.

An Example Week in the Life of Dave, the Improvement Advisor

No two days are alike, but a typical week as an IA is a blend of meetings, problem-solving sessions, and hands-on collaboration with teams. Here’s how a week might look:

Monday: Laying the Groundwork
A day of alignment and preparation, including strategic meetings, mentoring sessions, and planning for upcoming workshops and projects.

The day begins with a Daily Operations Briefing to align on key updates and priorities, followed by reviewing training materials and a strategic touch-base with leadership. Mid-morning and early afternoon are spent planning for an upcoming data workshop and training session, mentoring a project manager, and troubleshooting project challenges. The afternoon focuses on developing a structured improvement plan and checking in with key stakeholders on institutional initiatives.

Tuesday: Focused Project Work
Dedicated time for project sustainment, stakeholder updates, and mentoring team members in their improvement efforts.

The day may start with work on deliverables, data analysis, emails, planning, etc. In the afternoon, focus shifts to ensuring long-term success by developing a sustainment plan for a completed project. This is followed by a project update with key stakeholders to assess progress and next steps. The day wraps up with a one-on-one mentoring session to support team members in their improvement efforts.

Wednesday: Strategic and Data-Driven Improvement
A mix of global collaboration, strategic planning, and hands-on working sessions to refine and test improvement approaches.

The day begins with a call with the Global Pediatrics department, collaborating with international teams on data-driven improvement efforts. Next the focus shifts to a strategic planning session to ensure alignment with institutional goals. The afternoon is dedicated to a hands-on working session with a project workstream team, refining approaches and testing solutions for ongoing improvement initiatives.

Thursday: Deep Dive into Training and Development
A full day spent teaching improvement science methodologies via Safe and Sound Academy’s Fundamentals of Improvement Science.

Friday: Reflection and Future Planning
The day may start working on deliverables, data analysis, emails, planning, etc. Midday, the QI White Board Hour provides a collaborative space to discuss improvement ideas and address challenges. In the afternoon, the IHI Sprint Meeting offers an opportunity to connect with a broader improvement network, sharing progress and best practices.

The Art and Science of Improvement

My work as an Improvement Advisor is rooted in W. Edwards Deming’s System of Profound Knowledge. This model provides a framework for understanding systems, variation, psychology, and knowledge—four essential components that guide improvement efforts.

• Appreciation for a System: Organizations are complex, interconnected systems. To improve outcomes, we must understand how different components interact and influence one another. I help teams see the bigger picture and identify leverage points for meaningful change.
• Understanding Variation: Data is at the heart of improvement work. I guide teams in distinguishing between common cause variation (natural fluctuations) and special cause variation (unexpected disruptions), helping them make informed decisions rather than reacting to every fluctuation.
• Psychology of Change: People drive improvement, but change can be difficult. Building relationships, fostering motivation, and understanding what influences behavior are critical to ensuring that improvements are adopted and sustained.
• Theory of Knowledge: Testing changes through iterative cycles (Plan-Do-Study-Act) helps teams learn what works and what doesn’t. Improvement is not about quick fixes — it’s about systematically building knowledge to create lasting impact.

While each day brings its own challenges and opportunities, the common thread is a relentless focus on improvement — ensuring that every project, meeting, and collaboration moves the needle toward meaningful change.

At its core, being an Improvement Advisor is about creating meaningful, sustainable change. We use data, structured methodologies, and collaborative problem-solving to tackle challenges that might otherwise persist for years. Whether it's reducing wait times, improving patient outcomes, or making processes more efficient, our work is about making things better — and sustaining the gains.

Making Magic Happen

The “magic” my wife refers to is really a blend of strategy, psychology, and persistence. Change is hard — people resist it, systems push back, and improvement efforts can stall. A good IA understands not just what needs to change, but how to help people embrace and sustain that change. We build relationships, foster trust, and create an environment where improvement feels possible — and even exciting.

Why It Matters

The verbal exchange I mentioned at the beginning, or some version of it, happens more often than you’d think. The role of an Improvement Advisor isn’t as widely recognized as, say, a doctor or an engineer. Yet, in organizations dedicated to making a difference — like hospitals, research institutions, and non-profits — the work of an IA can have a profound impact.

At St. Jude, where every effort ultimately ties back to improving the lives of children battling serious illnesses, the stakes couldn’t be higher. Every process improvement, no matter how small, contributes to a larger mission of providing the best care, the best research, and the best outcomes. Being an IA means having a front-row seat to the incredible impact that thoughtful, data-driven change can have.

So, the next time someone asks what I do, maybe I’ll offer a new line: “I help people turn problems into progress.” And honestly, that’s a pretty magical thing to do.

David Wittman is a Project Manager II-Quality at St. Jude Children’s Research Hospital.

Photo by upklyak