Quality Improvement is a Team Sport

“Quality Improvement is a Team Sport” and Other QI Career Lessons


  • " . . . my job as a pediatrician is not just to deliver care. My job is also to think about improving care as a continuous journey."

When asked about the influence the Institute for Healthcare Improvement (IHI) Open School had on his career and, specifically, his approach to leadership, James Moses, MD, MPH, had a surprising response.

“I’m the most biased person in the world to answer this question,” he chuckled.

Moses added, “The IHI, and the Open School specifically, was where I started my quality journey.” Today, Moses is the Chief Quality, Safety, and Experience Officer of Corewell Health (Grand Rapids, Michigan, USA).

In the following interview with IHI’s Jo Ann Endo, Moses explained how his early exposure to improvement methods and ideas made him see health equity as inextricably linked to quality and safety.

Early in your career you were the academic advisor for the IHI Open School. How would you say your Open School experience has influenced your approach to leadership?

I valued the Open School as an early physician figuring out my role in quality. When people were asking me to fix things, I wanted to build the skills so that I knew how to fix them. For me, the Open School helped me realize that my job as a pediatrician is not just to deliver care. My job is also to think about improving care as a continuous journey. If it wasn’t for the Open School, I’m not sure that would have happened.

Over the years, one of the highest honors and privileges of working with the Open School, and the Open School team, was the opportunity to bring that lens shift to other people so that they could see it too. I am extremely thankful for IHI’s leadership and its investment in the Open School over the years. I continue to encourage many of my colleagues to embrace the Open School because the courses have value even for people with years of health care experience.

My social work education trained me to think in a multidisciplinary way. One of the things that struck me when IHI started the Open School was the focus on multidisciplinary collaboration. Would you talk about that and its influence on your development?

I love the multidisciplinary component to improvement. I think it’s especially important for physicians, specifically. As physicians, our training tells us we have all the answers. We often think we can solve everything. We think we’re the smart ones in the room. When I think back on my training, I didn’t train with nurses at the same time. I didn’t train with pharmacists at the same time. I didn’t train with social workers at the same time. My training treated the doctors like we were on our own escalator.

Get Started with the IHI Open School

So, when we get out of our training, many of us behave as if we’re islands unto ourselves. But in improvement, I love the emphasis on multidisciplinary training, cooperation, and partnership you need to do systems thinking. You realize how complex the systems are. You realize that being an island unto yourself is only one point of view. You need absolutely everybody at the table to represent different components of the system so that you can understand how fixing something over here may have a negative impact over there.

Also, when you embrace social workers, pharmacists, nurses, case managers, and others, they bring a different lens to the work than we do from a physician standpoint. This is critical for solid problem solving. This also has to include patients and families. It’s so important to ensure they’re at the table too and included as part of the multidisciplinary team that’s necessary to drive improvement.

It is all the many parts of the process that I love the best. I love the fact that quality improvement is a team sport. It’s not about being smarter. We have to ask what is going to make us wiser.

You’ve done a number of things in your career to use QI to address health equity. I recall the work you did at Boston Medical Center on improving care for patients with sickle cell disease, for example. How do you see the role of a quality leader at any level in addressing health equity?

It’s been an interesting journey for me. I started out my quality career at Boston Medical Center (Boston, Massachusetts, USA), a place known for addressing health disparities. Even the simple act of engaging in quality improvement and establishing standards of care was helping to address disparities. Though Boston Medical Center always had that [equity] lens as an organization, the quality improvement methods were missing. Eventually, QI became a vehicle for us to do meaningful work on sickle cell care and a whole host of other initiatives. This included work to address opioid disorder before some of the national efforts kicked in.

What is the role of a chief quality officer or other quality leader in advancing health equity?

I think chief quality officers or quality leaders in organizations are an important part of the overall team to help address health equity issues. We can play a meaningful role within the clinical arena, specifically, to help address gaps. We can be the clinical translators of what it means to address maternal health and morbidity, for example. We need to address upstream issues, but how can quality departments also help improve what happens when patients are in our care?

It's been exciting to hear the questions many of my colleagues are now asking when health equity issues have come up. “I want to lift all ships, but sometimes when you lift all ships, you’re not paying attention to specific subgroups that are not benefiting from the interventions you're implementing or testing. How do we change our approach to quality improvement so that doesn't happen?” I’m glad we’re taking on these issues.

Also, when we have serious safety events, we don’t always ask whether biases — implicit bias or explicit bias — played a role in a delay in care or a medication mishap. Now I think we’re seeing more departments in quality and safety specifically embedding equity and an equity lens within the methodologies we use to do our work.

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

Photo by Dhammika Heenpella | flickr | Image licensed under the Creative Commons Attribution-NonCommercial 2.0 Generic license

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