‘If it doesn’t happen in habit, it doesn’t happen.’
I’m not sure who to attribute this quote to – possibly Steven Covey. If he didn’t say it, he should have! But whoever it was, I’m a fan of this idea. What’s this got to do with the first QualityNews for 2017? As regular readers will know, I like to kick off each new year with something – a goal or challenge – that inspires action to make care better at the end of the year than it is at the beginning. This year, I’m challenging you to master and implement 10 leadership practices that will kick start your quality system, turbo charge your clinical governance and transform your consumer experience.
Most human services boards, executives and managers see themselves as quality leaders. which is just as well, because they are! On my travels, however, I see the same quality leadership mistakes over and over; usually made by well-intentioned people who think they’re doing the right things, or don’t realise they’re doing the wrong things. As a result, they put time and energy into creating lots of OK care, some terrible care, and occasionally, some great care. But occasional great care is not what we want, nor what consumers need.
The feedback from the Quality Intelligence Quiz in 2016 was also clear – ‘we want to understand this stuff better!’ So over summer I sat down and listed the key leadership problems that I see – (which are also commonly discussed in the literature) – and gathered together my resources based on research and experience of what works over many years, to see if I could sort out some practical suggestions for more effective quality leadership practice (yes, my idea of a summer holiday good time.) What should leaders do – consistently – to get a better return on their investment of time and energy? What started out as a plan to kick off QualityNews 2017 with a list of quality governance warning bells (which will happen in a future edition) morphed into something quite different.
What emerged was the ‘Ten Practices of Great Care Leaders’ (with thanks and acknowledgement to Steven Covey for the concept.) We talk endlessly about the importance of leadership in creating safe, high quality care – and everyone nods sagely – but what does this mean in terms of every day actions? There’s some things that should be done, regularly and well, that will result in greater staff engagement in care creation and improvement; and some things that should not be done – ever – as they have the opposite effect.
Whether you’re an old hand or an emerging leader, these practices apply to you! Use your leadership time more wisely! Challenge yourself, your board, executive, committees and department heads to stop doing the negative things and start doing the useful things. Commit to creating new leadership habits by the end of 2017: maybe all ten, maybe just one. Even a small change gets you started on the path to achieving the great care you want your service to be known for.
The Ten Practices of Great Care Leaders
1. Make the pursuit of greatness a shared purpose across your organisation
It’s not enough just to say we provide ‘excellent/amazing/best in the world/best in the known or unknown universe care’. To claim it you have to prove it. And to prove you do provide high quality care, and not just say that you do, you must define exactly what high quality care looks like at the interface between care giver and care recipient, and know how many consumers experience it. This takes grit, determination, clever planning and relentless action – all with your staff and consumers. ‘Hoping’ that care is great is not a strategy. ‘Trusting’ that everyone out there is doing a great job is not a measure. The pursuit of greatness must be meaningful to what staff do every day, or it will remain a boardroom dream. Work with your staff and consumers to create a model that shows – on one page – exactly what ‘greatness’ means for every one of your consumers, and the specific roles everyone in your organisation plays in pursuing it. If front line staff and managers don’t find the model relevant and helpful to their work, revise it with them until it is. Make it so clear and straightforward that it also passes the ‘take home test’; that is, when you test it on your family, they don’t run screaming from the room, afraid they will otherwise die a slow death from boredom, confusion or sheer ridiculousness. If your staff and family say – ‘yep, that makes sense, get on and do it’, you’re on a winner. If they also say ‘ looks great – let me at it!’, you’ve hit the jackpot. Patent it immediately and get on the international speaking circuit.
2. Pursue greatness with aspiration and realism
Over-confidence about the quality of care experienced by your consumers is the biggest of the big red flags when it comes to effective quality governance. Yes, set an aspirational goal to achieve great care for every person, every time and pursue it with gusto. But be realistic about what it takes to get there. Doing anything consistently well in a complex system such as your organisation is hellishly difficult, because of the sheer number of factors involved, and the way they react with each other. Just like the road system, achieving a good day takes more than good people, trying hard. More than committees, reporting and rules. It requires great people, surrounded by great systems, actively supported every day by great leaders. Creating quality care is a dynamic pursuit, not set and forget. There are many boulders on the road to great care; don’t pretend they’re not there. Actively seek them out and get about blowing them up, and be on the lookout for new ones.
3. Know thy consumer as thyself
Be insanely curious about what goes on for the people under your roof/your care. Remember that there are human beings with real feelings, in some sort of physical/psychological pain, on the receiving end of your organisation’s services. They are not some sort of mysterious avatar. What they want is what you want. To be treated with courtesy and compassion. To know what’s going on in a way they can discuss with their loved ones. To be as physically and psychologically comfortable as possible. To be given real choices, where possible, that take their lives and families into account. Treatment that gets the job done. Consistent, accurate messages about their progress. Not to be harmed. Focus your quality and governance systems on achieving these things, starting with an honest assessment of how well they are done now. If I came into your service as an ‘undercover’ consumer, to what extent would I experience these things? Would it depend where I was in the service? What shift I presented to? Who was on? Remember, one day it will be you, or a member of your family. You’ll be grateful, when you’re on the receiving end, if the service you end up in read this in 2017 – and acted on it.
4. Stop ‘doing’ quality
‘Doing quality’ makes no sense. When staff say they are ‘doing’ quality, this is not a good sign. Usually it means they see ‘quality’ as a series of tasks they would really rather not be doing, rather than the experience they’re creating for consumers. Using this term is cementing a negative mindset about the whole process of improvement. There are only two verbs associated with quality: you’re either creating great quality care – or you’re supporting someone else to create it. That’s it. This also goes for ‘having’ clinical/quality governance. Let’s get a bit more energy into the equation: ‘We govern for great care’.
5. Understand that ‘Everyone is responsible for quality’ probably means that no-one is
If ‘everyone’ is responsible, that means there are plenty of other people to fix a problem. Which means it’s not my problem. Unless individuals understand their specific role in creating great care (and receive specific support for that role) they are unlikely to enact it. Here’s a challenge: aim to get a critical mass of staff in your organization answering the ‘who is responsible for the quality of care in your organisation?’ with: ‘I am – and let me tell you exactly how’. Embedding that change in understanding alone will transform the quality of your care and consumer experience.
6. Hold a blowtorch to jargon and fads
Einstein said: ‘If you can’t explain it simply, you don’t understand it well enough’. Conceptually, the pursuit of quality care should be simple, but is often over-complicated. Quality is created by the people who provide and experience the care. Tools and methods are only as good as they help people create great care together. This is the test of any quality system, tool or method. Confusing and annoying these people by waving shiny things with unintelligible names at them is not a smart strategy. Staff will judge you on your ability to make the process for creating, monitoring and embedding great care simple, relevant and helpful, not on your command of quality-ese. As with any tool, ‘new’ is not always ‘improved’ – and sometimes it is. The really skilled people are the ones who can sort this out: ‘will this new tool or approach help or hinder us in out pursuit of great care?’ Under the layers of jargon and fancy wrapping, most quality tools and methods exist to help you plan, detect, implement, streamline or measure. Choose the tools – old and new – that help you do these things in the easiest most effective way, explain them in plain language, and your staff and consumers will thank you.
7. Remember that people support what they help create
Designing new policy, processes, rules and training without the people who are charged with their implementation, and expecting positive engagement and sustained change, is a path to madness and despair. On the bright side, this commandment also reminds you to seek the people who are creating great care and acknowledge them. Focusing on the things that go wrong doesn’t inspire people to do them right. Seeking and learning from the good stuff is every bit as important as fixing the bad stuff. Find the amazing thing people are creating in your service and spread them like mad.
8. Live the truism:’ Information drives understanding, but feelings drive action’
To engage people in creating great care, hit them with the facts, and then get out of your head and paint the human picture that shows the need for change. There’s a reason that car ads spend their precious expensive minutes more on feelings than facts. If you can get both the ‘Oh, that’s interesting’, response to the facts, and a ‘Wow, we should do something about that!’ gut response, you’re at least 78%* more likely to have enthusiastic participants in the change. (Well, a lot more likely.)
9. Ask three defining questions at every meeting
So many graphs, so much paper. What did your latest quality-related meeting achieve? Did it get you closer to achieving your purpose? Or was it a procession of process, a cavalcade of compliance, with the impact on point of care concealed in the mists of mediocrity? [OK, enough alliteration.] Put all that information and time to work! At the end of every meeting ask – and answer – As the result of this meeting:
Are we on top of our risk and poor care hot spots?
How well are we supporting staff to achieve great care for every consumer?
Are we clear about the actions we will take to progress great care for every consumer between now and the next meeting?
10. Lead with Quality Intelligence
We’re not born with the knowledge required to lead the creation of great care. Improving safety and quality is a technical specialty, requiring Quality Intelligence: a specific set of knowledge and skills. But it’s easy to fall into the trap of thinking the bureaucracy of quality is all there is to creating high quality care. Leaders work hard to put in place governance systems, care processes, committees, compliance, improvement activities, measures and reporting. But these are just supporting structures. The quality of the consumer experience hinges on people: the motivation and ability of managers and staff at point of care to create consistent greatness from the chaos of complexity. This requires leaders to understand how to create consistently safe, great care within the complexity of their organisations. They must develop the right organisational mindset, define great care and support staff to implement the right actions to achieve it, based on the reality of the challenge. They must point everyone in the same direction, and build teams that display resilience and proactivity. Systems must be designed to support and guide great practice, and an accurate picture of progress towards great care painted with robust measures. Leading the human side of quality requires leaders who go beyond the bureaucracy of quality to develop a deep understanding of what this really takes.