The dangerous ‘Everyone comes to work to do a good job’ belief

How would you like a report into an organisation you are associated with to be called ‘A Shameful Chapter…’?  No, me neither.  And yet this is now the case for many people who are, and have been for the past decade or so, associated with the Oakden Older Persons Mental Health Service (Oakden facility); with the release of the latest in string of reports on suboptimal care at the service.

The South Australian Independent Commissioner against Corruption (ICAC) report: ‘Oakden – A Shameful Chapter in SA’s History (Feb, 2018) discusses ‘systemic failings in processes and oversight that allowed events at the Oakden facility to occur for more than a decade…’  Many of you will know the story.  With regret I write that it is not an unfamiliar one in health and aged care.  Care was poor or absent, the facilities were described as ‘a disgrace’ and complaints and improvement mechanisms designed to detect and fix problems were ineffective.

There are many issues in this report worthy of discussion and learning.  I hope that your organisation is taking the opportunity to use the report findings to do a ‘care stocktake’, whatever sector you’re in.  We know that, in the complexity of human services, the standard of care is not set and forget; it goes up and down in response to changes in the many interdependent factors making up care delivery. Everyone can benefit from a regular care quality reality check. If the whole human services sector doesn’t grab the opportunity to make positive changes as a result of the lessons from this, and other associated inquiries,  the Oakden residents’ suffering was all for nothing.

Everyone’s out there doing a good job…
I want to focus on one aspect of the findings, related to this quote from the report: ‘The problem was the regime that existed that enabled the Oakden facility and its operations to deteriorate to such an extraordinarily poor state, and to operate in that way for such an extended period of time without any meaningful intervention….for this reason I think this report ought to be considered by all public officers in positions of authority, irrespective of the agency within which they are employed.’

This sort of statement is made in just about every inquiry into poor care, and I’ve become interested in the ‘why’ behind this – because although we know the issue, it’s far from fixed.  The relevant report recommendation for the purposes of this discussion is No.3: ‘The CE (of the Department of Health and Ageing) and the CEOs (of the Local Health Networks) implement a structure to routinely remind all staff working at a treatment centre of the management structure in place at the centre; the assignment of responsibilities…and the expectations and responsibilities imposed upon each member of staff…’

There it is – the thing I would wave my wand over if I only had one spell, because it would transform care in an instant: personal responsibility for the quality of care provided to consumers.  This is a critical but often overlooked ingredient in all instances of poor care, and seldom discussed in depth at conferences or in scholarly articles about clinical governance and fixing care problems.  And yet – isn’t responsibility the cornerstone of clinical governance?

I don’t often see the practice of personal responsibility prioritised in most health services. We talk about it – but real action is often headed off at the pass by the ‘good people come to work to do a good job’ statement, often followed by ‘everyone here is responsible for quality.’  I’d bet good money on the fact that both these statements were regularly heard around Oakden – as they are in most human services. But these beliefs are dangerous; not only do they give us a false sense of security, but they excuse senior and middle managers from doing the hard yards (and within the politics and constraints of most organisations, they are hard yards) required to create and maintain the personal responsibility and accountability of every one of their staff, by:
    Clarifying and agreeing specific personal roles in providing safe and high-quality care
    Providing the management and systems support to assist staff every day to enact that role and fulfil their responsibilities
    Effective processes, based on a ‘just’ culture,  for calling staff to account and implementing the responsive action required when accountability falls down.

If these were a given, quality and safety systems and clinical governance would be able to get on with the proactive job of supporting staff to drive and lead the pursuit of consistently high-quality care for consumers. But without the personal accountability component in place,  quality and safety systems end up as spotters and rescuers; focused on identifying poor care and trying to do something about it.  Ironically, most of the ‘quality improvement’ remedies that are put in place via extra training, policy and process change, or projects to introduce new practice are doomed precisely because they require personal responsibility to be properly implemented.  In the end, except for systems, equipment and IT-related ‘forcing functions’, most quality and safety improvement relies on the people who must work with the change wanting, and being equipped, to fulfil their accountability for the quality of care they provide.

The degree of difficulty increases exponentially when, as the report goes on to say, ‘many staff thought that Oakden was a dumping-ground for those staff needing performance management.’ There we go on the merry-go-round of suboptimal care; put poor performers into challenging services and…hope? – that good care will result.  I know, think about it and your head spins and your ears buzz.   In any other high-risk industry we’d have gone out of business years ago.

Everything about this indicates services that are organised primarily around the needs of managers and clinicians, rather than consumers. This is where healthcare has come from, of course: great, committed people, doing great work as the foundation of great care.  But, although a cornerstone of great care, we now have ‘new knowledge’ that tells us this is not enough.  We know, from two decades of data and inquiries and learning about how to create safety in complexity, that everyone can have a bad day; be skewered by a weak system,  overwhelmed by volume, or just make a basic human error.  This applies to the people who come to work to do a good job – and those who just come to work to do a job.  All staff need daily, active, focused support – from leaders, managers and systems – to be their best.

Weak management = weak care quality 
I don’t think we really believe this ‘new knowledge’ however. Dumping the poor performing staff in a facility with the most challenging and vulnerable residents, who need those staff to be skilled, competent and above all caring, is a pretty big indication that we don’t. I suspect that ‘everyone comes to work to do a good job’ is a stronger belief – even when we know it isn’t always true. We accept this contradiction with an ease born of learning at the knees of our predecessors.  We grow up with it. Everyone in an organisation knows that mistakes are made, that care quality goes up and down and which service you’d avoid if you were a patient.  We know where the poor performers are; which service they are sent to ‘retire’ (if we can’t get them out on ‘gardening’ leave) – if indeed we try to manage them at all.  (And too often the ‘retirement’ plan is a job in the quality and safety unit, which in turn perpetuates weak quality systems…sigh.)

I get it.  The more senior the manager the more ‘up and out’ they are expected to be; aware of the corporate office or Department surveillance and  funding imperatives; fitting 20 patients into one bed whilst hitting the KPIs; preparing reports for high level committees (much of which is about care safety and quality, ironically, but often a narrow view that doesn’t pick up issues of neglect) and generally keeping the organisation looking good. That’s a big part of their job.

Unfortunately, in the rough and tumble of all this – and make no mistake, these jobs are not for the faint-hearted – point of care can get lost.   It seems everyone is working around the care, rather than on it. There’s no line of sight between decision makers and what consumers experience. This is particularly so if an organization hasn’t clearly defined the quality of care they want to create every day – in concrete terms, with the assistance of consumers and staff, and made achieving it a strategic, business and value priority.  In the absence of this, the ‘staff come to work to do a good job’ mantra fills the vacuum, and it’s easier for busy managers to just focus on their jobs, assuming that others are out there doing theirs.

In the research into quality systems’ effectiveness I’ve been involved with over the past three years, this was a consistent theme. Even in the face of evidence to the contrary, in the form of the many reports on incidents and safety issues crossing managers’ desks, and discussed ad infinitum in committees, I’ve never seen ‘turn our managers into high performing superstars as a matter of urgency’ recommended as a remedial action. Yet this would fix a lot of common care problems.  It seems to me that we propose just about anything but, in a series of repeated workarounds. Why? Because ‘management’ is too hard, or too boring, or too political, or too ‘soft’ to tackle?  Perhaps clinicians just don’t get the critical importance of management skills and competence in the same way they do clinically. Or we just don’t prioritise it:  we accept that poor care is part of what we do, employ some quality improvement, and move on. Is it just a bad case of cognitive bias and over-confidence on the part of the senior managers?: ‘we must be good because we’re us!’  It’s probably a mix of all of these. Bottom line though:  expecting strong quality of care in services with weak managers shows we healthcare types to be not as smart as we think we are.

Can’t the quality system fix it?

Of course, quality and safety systems that detect and fix poor care are important.  But ultimately they are only an aid to providing consistently high quality care for those charged with making it happen.  And it’s so easy to just go through the quality motions. Many of these systems appear to be in place because they are required for accreditation – which is understandable when you remember that ‘everyone comes to work to do a good job’ – so why do we need all this other stuff apart from accreditation?  It can all look good on paper but not paint a picture of what’s really going on at the bedside. From the report:

‘The committee process was too cumbersome to be effective…but it also suffered from the further defect that complaints and reports were not the core business of the committees but were matters that were incidental to their business. Whilst the committees that were in place were in theory appropriate, in practice they were ineffective…the committee structure was dependent upon the effectiveness of the person chairing the committee.’

For now, I’d like to finish by thanking those of you out there who are doing the hard yards of equipping your managers for their critical roles, because caring for consumers really does come first. Who do define high quality at point of care and align your organisations around achieving it for and with every client, consumer, resident and patient (and a special shout-out to those using the strategic quality system to do it!)  Who understand that high quality point of care is a function and outcome of a chain of line managers, right from the top, populated by skilled and supported people. You remember what it was like when ‘matron’ was all-seeing – and emulate it in a modern context. I’d clone you if I could.  In the absence of that option? – I’m waiting for the robots.



Are these fundamental mistakes inhibiting your progress towards great care? (‘The trouble with vegetables…’)

A change of pace to kick off 2018: a ‘quality fiction’ – telling one story, and revealing another: the fundamental mistakes I see many organisations make that stop them from creating the quality of care and services they want to provide.  Our research into ‘what makes an effective quality system’ conducted over 2015-2017, confirmed that the issues highlighted in this ‘quality fiction’ are not only common, but are significant barriers to achieving consistently high quality care within organisations, and may be key reasons for the slow progress we’re making in the human services sectors more broadly.  There’s also a few clues on what you can do about it…

Do you recognise anyone? Or any place?

The trouble with vegetables…

There was much happiness in the kingdom of Complia when the Prince announced his engagement to the Princess of Transformania, a kingdom across the sea.

Before he left for the wedding and royal honeymoon tour, the Prince called the Chief Farmer and Chief Quality Controller to his office. The Chief Farmer was a trusted employee and had overseen the thriving orchards of Complia for ten years – so well that the delicious fruit they produced fed the whole Kingdom.

“In six months I will return to Complia with the Princess. One of the things she will miss most about her home in Transformania is her vegetable garden. She has tended it since she was a small girl and loves every plant. It is beautifully laid out and is a very pleasant place to spend a sunny afternoon. The Princess is also an amazing vegetarian cook and likes nothing better than to create delicious dishes full of fresh garden vegetables.

“I’d like you to prepare a vegetable garden for her here. When we return in six months I want to see a beautiful garden filled with magnificent vegetables, ready for our first feast here as husband and wife. The garden must have peas, beans, tomatoes and potatoes, because they are my favourites. I’m not sure which are the Princess’ favourites; just make sure there is a comprehensive range of delicious vegetables for her to choose from. Oh – and this garden must be even more beautiful than hers. The aesthetics must be perfect.”

The Chief Farmer shifted uncomfortably from foot to foot. “Pardon me, Sir, but, as you know, we’ve just opened up a large number of new orchards for export. No-one has any spare time. Are you going to supply new staff to work on the vegetable garden?”

“More staff! Are you kidding! The Royal budget is stretched to the limit as it is, what with my brothers and sisters producing ever increasing numbers of children. And the development of the new orchards has been a very expensive exercise as you know. This is a vegetable garden. How hard can it be?”

“Well, sir, to be honest I’ve never put together a vegetable garden before. I’m an orchard specialist.” The Chief Farmer looked uncharacteristically nervous.

“Really! Well, personally I can’t see the difference. A plant is a plant. I don’t want to hear excuses. I’m sure you’ll figure it out. Don’t we have excellent, committed orchard staff who come to work every day to do a great job?”

“Um, er, yes Sir,…but…”

“So, they should be able to produce a high-quality vegetable garden, shouldn’t they? If they put their mind to it and work a little harder? I’m sure you can organise and delegate the staff to get this done, can’t you?” The Prince’s voice rose. ‘”Or do I need to replace you with a Chief Farmer who can deliver this for me?”

The Chief Farmer loved his job. “No, of course not. I’m right on it.” He bowed and turned to go.

“Oh, and by the way,’ the Prince called after him. “Tomorrow I’ll send you the resources you’ll need to create the garden. There will be mulch and fertilizer and timber and tools, and a fancy ladder and a robot hoe that I bought off late night television. I’m sure they’ll come in very handy. You can buy the seeds when you decide what to plant. And – there’s one more thing. You must use the TQM method of growing: ‘Total Quality Meatless’. The Princess mentioned she had heard about it at a conference and was keen to try it out. Imagine how impressed she’ll be when she arrives here and finds we have used it to build a whole garden from scratch!”

“Ah, Sir…I don’t know what that is…”

“Look it up on You Tube man! Where’s your initiative? Anyway, the Chief Quality Controller will have the job of monitoring your progress and reporting it to me while I’m away, so you can work on it together.”

The Chief Farmer winced. “Of course, Sir,” he muttered with a sinking heart as he passed through the heavily guarded door.

The Chief Quality Controller watched him go. “Sir, I haven’t had much experience with vegetable gardens either…”

“Honestly!” The Prince banged his desk. “What do I pay you all for? If you don’t know, find out. And when you bring me the progress reports, I only want to hear about the excellent progress being made. Unless there’s a disaster of course – but obviously that won’t happen. Are we clear?”

“Crystal, Sir.”

“Now, leave me. It’s time for my wedding suit fitting.”

Soon after, the Prince left for his wedding and royal honeymoon tour. The months passed. The Chief Quality Controller made many visits to the new vegetable garden, and held many meetings with the Chief Farmer. She researched the TQM method, and ran education for the orchard workers who had been selected by the Chief Farmer to fit the vegetable garden into their already full work schedule. She dutifully reported progress to the Prince every month via email, producing pages of colourful graphs and fascinating tables showing planting and growth trends, as well as tracking the rainfall and temperature. In time, there were photos of plump peas, long green beans, ripe red tomatoes and large potatoes. She also included a first-hand story from one of the garden workers in every report, usually discussing how the latest plant disease or bug infestation had been overcome. The Prince was impressed.

“I’m sure the Princess will be so excited when she sees these vegetables that she will forget all about her home garden in Transformania,” he emailed. “And these are beautiful reports. You are doing a fine job, Chief Quality Controller. You are in line for a promotion when I return! With your quality skills and our committed, hardworking garden staff, we have the perfect team.”

The Prince and Princess returned to Complia six months to the day from the Prince’s departure. There was much hustle and bustle to harvest vegetables for the welcome home first feast. Just before sunset the Chief Farmer received word that the Prince and Princess were on their way to inspect the vegetable garden. The Prince arrived leading the Princess, who was blindfolded. He whipped the blindfold off with a flourish as he announced “surprise!”

The Princess looked around, and smiled at the Chief Farmer and Quality Controller. “Surprise what?” she asked.

“Oh, er, this is where I was told to come – perhaps I’ve got the wrong spot. Chief Farmer, where should we look to see the surprise?”

“You are looking at it Sir,” muttered the Chief Farmer, who looked a lot older than he had six months ago. He exchanged a glance with the Chief Quality Officer.

Down the hill from the group was a large field, dug into rows. Some of the rows had been tended with care and were filled with flourishing plants. Some rows were almost empty, except for a lonely group of plants at one end.

Silence. Faces dropped. The Prince turned an unbecoming shade of purple. The Chief Quality Officer and Farmer edged away.

“This looks NOTHING like the Princess’ vegetable garden in Transformania,’ the Prince spluttered. “It’s in a FIELD. It’s not beautiful, it’s not planned, it’s not orderly – and I’m guessing it’s not producing very much – is it?’

More silence.

“Such beautiful reports full of good news! Month after month! The best garden staff with the best intentions, working hard every day, using the TQM method! Explain to me HOW it is that we do not have a magnificent vegetable garden?”

The Chief Quality Controller’s mouth opened, but nothing came out.

Eventually the Chief Farmer forced himself to speak, finding courage in his desperation. He was going to lose his job anyway. “S-s-sir. If I may. I told you I was no kitchen garden expert. So I did what you said: I researched vegetable gardens based on the TQM method, with the Chief Quality Officer. But I was also running the orchards and getting the new ones going – you’ve put a deadline on those as well, as you know – so I had limited time to run a new project. I fact, I did most of it at night. I delegated different vegetables to different workers, but they also had to do it in their ‘spare’ time. And some of them were more motivated than others…”

The Prince looked baffled. “But the reports. The photos! The stories! And I was told the TQM method was foolproof! What happened???”

Everyone looked at the Chief Quality Controller. She took a deep breath. “Sir, you asked for good news. So I gave it to you. I photographed the best looking plants, and interviewed only the workers who had had a triumph over a problem like an infestation. And to be honest, the TQM method was very confusing. I spent hours trying to work it out and…you know….I don’t think it’s a good fit for our climate and soil. Once we were sure we’d have the vegetables you’d requested, fighting with the Chief Farmer and the garden staff for anything beyond that just got too hard. I’m sorry…I gave up.”

The Chief Farmer broke in. “And I also mostly concentrated on the peas, beans, tomatoes and potatoes. Their quality was good but I didn’t know how much of each we were expected to produce. I was guessing. It looks like we’ll just have enough of them for the first feast though,” he added brightly.

“What about the aesthetics of the garden?” enquired the Princess, as the Prince appeared incapable of speech.

“We didn’t really know what you meant by ‘aesthetics’,” the Chief Quality Control Officer muttered, cheeks blazing. “There are so many different ways you can lay out a vegetable garden…we just weren’t sure where to start.”

“Didn’t I supply all the materials and resources you needed?” the Prince spluttered.

“Yes – well – you supplied some resources,” said the Chief Farmer. Some were useful and some not. That robot hoe couldn’t dig a straight line if its life depended on it. We never got around to using the ladder. You see, we didn’t really know what you wanted. So I did what we thought was right, and what was easiest and quickest, which was finding a fallow field and allocating each worker a row for their vegetables.”

“So….you didn’t even try to design a beautiful garden with decorative motifs and raised beds and sharp edges and comfortable seats?” The Prince could barely get the words out. “No, don’t answer that. And, I imagine we won’t be seeing a comprehensive array of vegetables at the first feast, either. Do we have anything beyond peas, beans, tomatoes and potatoes?”

The Chief Farmer stepped forward and picked up a basket. He removed the covering cloth, revealing a motley mix of vegetables. “Sir, many of the ‘extra’ vegetables didn’t grow. We just didn’t have the time to work them properly. But we do have some for the first feast. Here’s the samphire, Brussels sprouts and parsnips that didn’t do too badly.”

At this the Prince put his head in his hands. “Brussels sprouts! Parsnips! I hate them! And what on earth is samphire?”

“Well…we heard it was hardy…”

The Prince held up his hand with a sigh. There was another silence while everyone gazed from forlorn basket to forlorn field. The Princess asked sadly, “Spinach? Cauliflower? Carrots? No?” She turned to the Prince. ‘Remember I promised I’d make you my world famous spinach, cauliflower and carrot pie as soon as we settled in? Well you can kiss that goodbye…you know, if you’d involved me I could have helped! As nice as surprises are, something as important as growing quality vegetables requires more than guessing and hoping. And it works a lot better when you can draw on real experience and knowledge. I could have told you exactly what we needed, and helped make it happen.”

The Prince groaned and turned his gaze on the Chief Quality Controller. “You’ve always been so good with the quality of the orchards: researching the best methods and developing useful tools. What happened?”

“Sir, we – we…didn’t know enough. We didn’t have a picture in our heads of what you wanted the finished product to look like and produce. We didn’t have a blueprint or a plan. With the orchards, we know exactly what the expectations are and what we’re trying to achieve. Without all that, we had to guess, as the Princess said, and use the resources we had, which were a bit random and not really what we needed…and this is what we got.

The other problem was…well, I have to be honest here…I don’t have any line authority over the Chief Farmer. I’m not his manager. I could make suggestions, but he wasn’t interested in my input. We ended up arguing about what was important and how to do things. It wasn’t like the orchards where we’re both engaged in working together to make the orchards the best they can be – because they benefit everyone. This project was really about… well…you, and no-one was excited about it. So we focused on the peas, beans, tomatoes and potatoes, because they were mandatory. Anything else was an extra, including the aesthetics, and in the end…didn’t get done very well – or at all…’ her voice trailed off.

The Prince took a deep breath and the Chief Farmer and Quality Controller braced for impact. But the Princess spoke first. “So – we ended up some of the things the Prince wanted, but not what we all needed.”

The Chief Quality Controller decided to throw herself on the Princess’ mercy. As she was opening her mouth to plead for her job, a surprising thing happened. The Princess winked.

“It seems the Prince assumed that you both knew what was important, and gave you instructions and tools that were less than helpful.” She glanced at the glowering Prince. “Might as well be brutal here, my dear, or we won’t learn anything. And you can be a bit vague with your instructions, and overly optimistic about how well people read your mind and have your best interests at heart. Everyone tried their best, but of course they focused on what was mandatory – and what else they could get done with the time, resources and knowledge they had. And, my dear, may I say that designing and growing a successful and beautiful vegetable garden is – like most things – a lot harder than it looks and takes constant oversight, which I’ve never felt you quite appreciated…” The Prince grimaced. “If you’re going to run a successful kingdom, it will be helpful if you could be a bit more specific and helpful. Even great staff are not mind readers – or superhuman,” she finished softly.

The Prince was silent for a long minute. Then – amazingly – he smiled at the Princess and turned to the Chief Farmer and Quality Controller.

“The Princess is right! – as always. Well, here’s my shot at honesty: I did not give this the time or attention it deserved. I didn’t work with you to develop the vision or the concrete outcome I wanted, nor did I bother to find out what the Princess wanted. I didn’t supply resources designed to achieve that outcome; in fact, I burdened you with tools and methods that looked good but didn’t help because, well, I thought it would impress the Princess. I didn’t make sure you had the skills and information you needed, nor ask enough serious questions about progress. I didn’t want the brutal facts about where things weren’t going well, or where the gaps were. Basically – I set you up to fail. I’m sorry.”

The Quality Controller and Chief Farmer leaned on each other, weak with relief – and admiration for their fabulous new Princess.

“OK,” said the Prince, taking the Princess by the hand. “Let’s start again. This time, the Princess will lead the project as I can tell she’s itching to get her hands on it.” He began to lead the Princess away, then stopped.

“And in six months, we’ll hold a second ‘first feast’, celebrating the Complia vegetable garden version 2.0. First, we’ll get clear about the food we want to serve and what we can produce in this climate. Then we’ll develop a shared vision, find the production model that best fits our situation, develop the plan for making it happen and supply the right tools, skills and people for the job. We might even instigate a vegetable sharing scheme with those who work on the garden, for a little added motivation. I can’t promise you’ll get all the resources you’ll need all at once, but you’ll get what you need to start off properly and I’ll commit to resourcing it as you progress.

“Speaking of progress,” he glanced at the Chief Quality Controller, who gulped – “this time I want the real story, so we will work together on how best to present it. Fewer selective photos and more facts, perhaps? Stories that cover both the successes and failures, so the Princess and I can do what it takes to guide the garden to success?

“And Chief Farmer? Here’s my first clear instruction for version 2.0: no parsnips or Brussels sprouts. I’ll reserve my decision about the samphire until I’ve tried it.”

And with a regal wave, he was gone.

If you enjoyed this ‘quality fiction’ as another way to explore quality issues, stay tuned for my new book coming out later this year – where a CEO has six months to take a health service from slump to success…

Five ‘trouble with vegetables’ points to ponder for creating great care in 2018
1. Do you know exactly what you want and need from your ‘great care’ garden in 2018? What it should look like and produce? Have you worked with those providing and receiving the care to design it?

2. Do your board and executive fall into the trap of assuming that everyone understands what great care looks like, how to make it happen – and wants to make it happen?

3. Is your quality system focused primarily on nailing mandatory requirements, with a range of other random initiatives added that you hope will add up to great care?

4. Do your point of care staff and managers think your quality system gets in the way of creating greatness at point of care instead of supporting and driving great care? Is it based on a theory or model that isn’t fit for purpose?

5. Do the leaders in your organisation not quite appreciate the challenge of creating consistently high quality care, and therefore don’t give this the attention and support it requires?


‘Without focusing and getting to clarity, you cannot lead. You cannot motivate. You cannot plan. You cannot communicate.’ (Bobb Biehl)


Build your quality intelligence

‘Quality Literacy’: ‘Knowledge of the components of an effective quality and safety system that support consistently safe, high quality care in complex organisations; and the will and skill to apply that knowledge to provide safe, high quality care for every consumer.’ (Balding, 2016)

My favourite creating great care in complex systems resources are listed on my website. All excellent Quality Intelligence Improvers! Find them here.



Is your quality system road leading you to greatness? Or are you stuck in the compliance carpark?

Here’s a simple question to ascertain if your organisation is on the road to consistently high quality care.

What does your organisation’s quality system manager/team spend most of their time doing?

No doubt many of you were hoping for something more inspirational; perhaps a question about culture or unveiling the secrets of data and reporting. But! – before you abandon this article, think about it for half a minute. The answer to this question is loaded with information about the quality of care your organisation provides.

Why? Because ‘every system is perfectly designed to get the results it gets.’ Sound familiar? An oldie, but oh, what a goodie! I’m resurrecting it because it reflects precisely what we’ve found in our research on what makes an effective quality system. Show me the quality manager preoccupations and I’ll predict what’s going on with quality at point of care. If it’s all about compliance, it’s likely that point of care staff see ‘quality’ as an extra set of tasks they must ‘do’ and that your care quality is comprehensively parked.

A compliance-based quality system does not promulgate the mindset or behaviours required to provide consistently high quality care. Even if managers and staff are using compliance intelligently and applying it to improve, you might have safe, accessible care, in partnership with consumers, as these are the areas targeted by compliance requirements. No complaints if you’re achieving these consistently with every consumer, of course. But beyond these there will be gaps in your high quality experience jigsaw puzzle. Gaps that consumers – and staff – would rather not be there, such as care appropriateness and effectiveness, and coordination and integration of care.

Consumers and staff cannot live by compliance alone.

It is impossible, in the complexity of health and aged care, to provide consistently high quality care through compliance alone in a complex health or aged care organisation; it’s just not the way these organisms work.   Of course compliance provides significant jigsaw pieces for our puzzle. It’s not an either/or. But without the box top that provides the organisational view of what consistently high quality care looks like, designed by consumers and all levels of staff; and an executive-led strategy for making it the reason people come to work every day, you’ll never complete the ‘high quality care’ picture. If your quality system is mostly about compliance, you’ll have wins in some areas, but will not create an organisation that provides consistently high quality care as business as usual.

Executives will get exactly what they prioritise 

The quality manager and team role often reflects the executives’ understanding of what a quality system should deliver. This is a big statement, especially as this understanding is often linked to funding and political requirements, rather than a clear and consistent vision of what boards and executives want to achieve for their consumers. It seems that these external expectations have narrowed over the past decade as we seek to plug the safety gaps we lived with for too long.  Our focus has zig-zagged from clinical outcomes to compliance audit; from safety and risk to consumer participation, in no apparent order.

The potential of the quality systems manager role appears to be restricted by the knowledge of those doing the hiring. If boards and executives don’t know what they don’t know about creating consistently high quality care in a complex environment, they’re unlikely to go looking for a person with the skills that can help them to pursue this. If they see ‘quality’ as the mechanics of quality: the audits, incidents, reporting and committees, rather than the point of care purpose, then that’s what it will be. From my perspective this is a significant contributor to the slow pace of improvement and change in the quality of the care health and aged care services; while we’re focused on the governance engine room, there’s no-one on the bridge steering the ship towards a designed destination.  So we are blown about by the winds of fad, fashion and funding, and a lot of the hard work and good intent gets lost in the sea of confusion.

Consistently high quality care is harder to achieve than a balanced budget

Our research into what makes an effective quality system highlights this. Too often the board and executive beliefs about the quality of care are overly optimistic, because ‘good staff are out there doing a great job’, with their successfully ticked compliance activities supporting this. If only that’s how it worked! Our complex organisations are as far away from that as Pluto is from the Sun. Consistently high quality at point of care is an ongoing challenge, every bit as tough as keeping the budget in the black – and look at the focused work that goes into that. Finance plans, systems, budgets, committees, lots of board and executive time, training for managers, reporting, accountability. It’s viewed as a vitally important and ongoing pursuit, requiring knowledge and technical skills across the board and executive, with specialist expertise in the finance team. It’s difficult to imagine a CEO appointing a finance manager on the strength of them ‘being organised’ or ‘good with numbers’.

The pursuit of consistently high quality care is the same – but harder. It requires everything that well-managed finances requires – and more. In the same way as managing the budget happens, managing the quality of care is a line management responsibility. The quality systems manager provides systems and technical support, as the finance manager does, but they can’t create what’s required at point of care. The senior and middle managers’ job in any service is not just to provide a service and get their staff through the day – but to provide a high-quality, well managed service. This bit is not an optional extra, but fundamental to consumers receiving consistently high quality care. All consumers receiving consistently high quality care requires a whole of organisation approach; and you can’t achieve that without the whole of the executive, and managers at all levels, having the ‘will and skill’ to deliver it.

Our research indicates that both the understanding and messages around this are very mixed. Most clinical managers and staff would like more help with understanding how their consumers are travelling – beyond the constraints of accreditation and other external compliance. Achieving both compliance and support for clinicians to progress their standard of care can be done. But it requires a strategic, planned and systematic approach that embraces both standardisation and clinical judgement; responsivness and proactivity,  to achieve a defined view of high quality care for every consumer.

To the consumers, boards, CEOs, executives, quality systems managers and bureaucrats out there valiantly striving beyond compliance to create a strategic and comprehensive great care experience – I salute you! And those still thinking about it? Make 2018 the year you make your mark on the ‘great care’ map.


‘Every system is perfectly designed to get the results it gets’: variously attributed to Arthur Jones, W. Edwards Deming, Paul Batalden and Donald Berwick.

Leggat SG, Balding C (2017) A qualitative study on the implementation of quality systems in Australian hospitals. Health Services Management Research, Volume: 30 issue: 3, page(s): 179-186, August, 2017.

Juran Institute:

Further information on strategic quality systems:

Does your quality system detect neglect?

Does it? And – if you’re running an acute healthcare service, how long could a consumer go without being offered a wash? These questions have been exercising my mind lately, as I see more and more quality systems focused on risk and compliance, with a bit of improvement thrown in to meet accreditation standards. And reactive risk and compliance at that. Of course standards must be met and risks managed – but driving and supporting the whole consumer experience requires more than that. Imagine the elements that would be missing from other people-related industries such as hotels and aviation if they only met technical standards and managed risks.

We’ve evolved risk management to identify and name key risks, such as pressure injuries and consumer identification, so we can detect, report and count when these things go wrong – and do something about it. This has transformed staff understanding of risk and the need to manage it to prevent harm. But instead of taking this process and applying it to other aspects of care, we seem to have plateaued.

It’s time to move on!  – to getting the care basics right – consistently. There’s no doubt that this happens in every organisation – in pockets. But very few health or aged care services are confident of it happening for every person, every time. What if we applied the same focus to this as we do to risk?; identify the basic care components that need to go right, increase staff understanding of why they’re important, work them into the fabric of daily routines, and detect and report when they are not happening.

Many people say that basic care components are – or should be – self-evident, so we don’t need to be explicit about identifying them. Well, we used to say that about risk and harm too; before the Quality in Australian Healthcare Study showed us that we didn’t know as much about the scope of harm – and why it was happening – as we thought we did.

We don’t need to develop key care components from scratch of course. It seems to me that the US Institute of Medicine (IOM) got it right all those years ago by identifying the dimensions of healthcare quality: safe, effective, patient-centred, timely, equitable, and efficient.  Interestingly, these were expressed as aims for every healthcare episode, not just dimensions. They are meant to be proactive guides.

Many of you will know that if you ask the right questions of any audience – healthcare professional, manager or consumer – about what’s important in a health or aged care episode, they identify these dimensions. Not in these words at first – generally, they’ll describe the actions within each of these dimensions that they want from a healthcare experience. Safety is a critical dimension, of course – but, interestingly, actions related to effectiveness are almost always discussed first, closely followed by issues describing responsiveness to the individual. Continuity and integration of care, seldom seen in current quality systems, also features in what people want from their healthcare. Discussions about aged and community care identify the same dimensions, but the actions within them differ, relative to the sector.

What’s this got to do with a quality system detecting neglect? Everything! Lately, I’ve taken to asking workshop audiences and quality managers one critical question to ascertain where their quality system is up to:

‘Would your quality system detect and prevent a Mid Staffordshire – like decline into poor bedside care and neglect of patients in your organisation?’ (see

This turns out to be a great question because it makes people stop and think – ‘would it?’ If your quality and risk system relies mostly on incident reporting and accreditation, the honest answer is probably ‘no’.   Clinically-related accreditation standards certainly help – such as the National Safety and Quality Standards in Australia, as they set a high bar for key clinical processes, requiring changes in staff behaviour and proactive monitoring and review.

Mid Staffordshire showed that good care is about much more than this, however. We know staff are pressured, rushed and, at times, frustrated with their jobs.  This environment favours task completion, rather than care. Things get missed and corners cut in the complexity and the rush. But which ones? Would your quality system detect if patients weren’t eating and drinking? Being washed and taken to the bathroom? Having their pain relieved? Understanding what was happening to them? Feeling respected and consulted? Being treated according to best available evidence?

Some people respond that their death review process picks up a lot of issues. And done well, it does. After the event, unfortunately. Is this process working to identify care issues as well as technical clinical issues, however? I wonder how much general ‘poor care’ contributes to preventable deaths.

My motivation for wanting health and aged care services to be as focused on components of care as they are on key risks is mostly about improving the consumer experience. But that’s not all. For me, it’s also about health, aged and community organisations having the satisfaction of moving beyond monitoring and reacting, to achieving their potential for doing good. It’s about healthcare professionals and quality managers enjoying being proactive and making a real difference. I’m not seeing as much of that as I used to. Many quality managers, in particular, are looking more like administrators that technical experts. This does not make for great job satisfaction, as evidenced by the revolving door of people moving in and out of quality roles (which in turn, does not build a solid base of technical expertise…)

Have a think about your bedside/chairside care, beyond clinical standards. Are the key components and expectations of basic care clearly defined with staff? Have consumers had input into what’s important to them? Are you proactive in detecting care ‘slippage’? Or do you only know when it turns into a complaint, or you hear about it at the local supermarket, or in the press? How does your organisation respond?   Sighing about the staff? Or developing a better system of care that guarantees the basics of care for every consumer?

Oh – and how long can consumers go without a wash in the acute sector? Can’t answer that unequivocally. But so far the record is eight days.

Using quality data to drive a successful mission

Monitoring – and Response.

Data, data everywhere… some of it useful for improving care, some of it not and a whole lot in between. Never before have health services collected, studied and discussed so much data about care safety and quality…and yet, the mindset and strategy required to make this a useful exercise are often missing. The health services in my part of the world are about to be supplied with more and better data, courtesy of a recent state-wide review of quality and safety. This is a good thing, if course – but if that’s all it took to create great care, well… The way data are reported, and the mindset of those who rely on reports to govern the quality of care, determine whether the hours spent preparing and discussing the information are worthwhile, or wasted. In my experience there are five (at least) distinct data report types at the highest levels of governance that differently influence how governing bodies respond to the information, and the impact on care. Which one is yours?
The Work of Art: the report presentation is so dazzling and multi-factorial that the board just sits back and admires it. Anything that looks this impressive must be good! And any quality manager and executive who can produce it must know what they’re talking about. No need for scrutiny. The result? A superficial understanding of the quality of care and a false sense of security. May lead to nasty surprises and lack of understanding and appropriate response when a sub-optimal care issue bursts the bubble.

The Terminator: a relentless focus on the things that go wrong. The emphasis is on key risks and compliance breaches. The board doesn’t realise there are many other aspects of care that are equally important to monitor, discuss and improve. The result? Many blind spots about the true quality of care, and other issues of importance to consumers and clinicians are ignored. Key risks may be well managed, but there’s little significant improvement in overall care.

The Rinse and Repeat: the same stuff is reported over and over and over… useful or not, often with more or less the same ‘average’ results. Data are used for reassurance that everything is OK, rather than to inform a drive towards excellence. The board may be frustrated, but not know how to ask for a broader view of the quality of care provided, or for significant improvements to be made. The result? Mediocre care may be seen as acceptable or normal, and a narrow view of what constitutes high quality care is perpetuated.

The Politician: reporting is designed to draw board attention away from results that indicate that all is not well. ‘Nothing to see here – and if there were, we’d have it under control.’ Frequently accompanied by ‘boards should stay out of operations’. The result? May contribute to catastrophic failures, severe harm and generally poor care, and associated dereliction of governance duty.

The Action Hero: reporting is organised to inform and guide the action required to achieve and maintain high quality care. Action heroes know they can’t save everyone at once, and the data are crafted to help the board prioritise precious resources to maximise impact where it counts – at point of care. As with all action heroes, sometimes action is taken precipitously, or not where it’s needed, particularly if the action hero is employed without their trusty ‘understanding of variation and complexity’ side-kick. The result? A shared and balanced view of the components of high quality care, are actively monitored, managed and improved; with occasional reactive and wasted actions which don’t help anyone improve anything.

Ten Practices for Great Care Leaders in 2017

‘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.

Good luck! Get the summary version of Ten Great Care Leadership Practices here.

When we hear what we wish we didn’t.

Recently on a plane I pricked up my ears to this conversation  – roughly paraphrased – going on behind me:

Passenger A: ‘Bob’s just out of hospital again.’

Passenger B: ‘How is he?’

Passenger A: ‘They stabilised him and changed his medications, so he seems much more comfortable. Not sure I’ll be able to convince him to go back there next time though.’

Passenger B: ‘Really? What happened?’

Passenger A: ‘Oh, you know, the usual.  Nothing too bad – it’s just that he’s getting sick of it.  They got his name wrong on the bracelet again and we had to complain long and loud to get it fixed.  I know our name isn’t the easiest to get right – but that’s no excuse.  Of course this meant that we had all sorts of fun and games with medications and tests – the staff listened to us even less than usual because half the time they thought Bob was someone else or they couldn’t find him in their records. It’s a miracle something didn’t go wrong.

‘And those staff!  Some are nice but most of them don’t give you the time of day. So how good the care is depends on who’s on.  He even had a fight with the weekend physio this time.  I don’t know what that was about. There was the usual drama with trying to work out when he’d be discharged – this was really tricky for me – as you know I’m travelling all over the place for work at the minute.  And I wasn’t able to get in to see him every day because I’ve been away so much – and when I did, he didn’t look – or smell – very clean – said he hadn’t had a proper wash since he was admitted – but surely that can’t be right.  And the food!  Anyway, it’s a pain, because the clinical care is good, and it’s close to home – but Bob is very unhappy with everything else about it.  He thinks the sicker he gets, the worse they’ll treat him as he won’t be able to stick up for himself.  I don’t know what we should do.’

Passenger B: ‘Have you talked to the GP?’

Passenger A: ‘Yes, but she thinks that it’s all fine because they manage his condition well – she doesn’t understand how important all the other stuff is to him. Oh good – food.’

At this juncture, our snack was served and their conversation turned to airline food – also interesting but perhaps not a topic for QualityNews – although not unrelated to healthcare quality and this story.  (How was she rating the airline snack compared to Bob’s hospital fare, I wondered?  And how different is the relative importance of food in both settings?)

What’s your response to Passenger A?

Leadership under pressure

I’m fascinated by what makes leaders tick – particularly in the challenging and messy world of health and human services where nothing is easy. My new interview seriesQualityTalks – endeavours to get inside the heads of leaders, with many different roles and perspectives, to find out.  Many thanks to all those who gave feedback on the interview with psychologist Julie Warnock – seems the concept of respect among staff fostering respect  for consumers made quite an impression!

In this new interview, hear Jacque Phillips, CEO of Numurkah District Health Service, discuss what goes through a leader’s mind when flood waters are lapping at the door of her hospital.  Subsequent to this interview, Jacque was awarded OAM for services to the township of Numurkah before and after the floods.   A great yarn and – as always –  lots to learn.  Enjoy – and tell me what you think!

Healthcare Leadership from the other side of the bed – Julie Warnock

Listen to my interview with Julie Warnock, an organisational psychologist who develops leaders in many different sectors, including healthcare.  Struck down by a sudden illness, Julie got to experience healthcare leadership first hand over four weeks and two campuses of the same h…

Source: Healthcare Leadership from the other side of the bed – Julie Warnock