Preaching to the Choir

Sing. Sing a song. Sing out loud. Sing out strong. - The Muppets

This is a graph of reckless exhibitionism:

It is the weekly tally of hits this blog gets. It makes me break out in a cold sweat. People are finding out about this project. If we fail, we fail very publicly. "Specialists' waiting lists down to 2 weeks? Hah! I knew they couldn't do it..."

When we started, my first instinct was to keep things quiet. Let's be sure this is going to work before we spread the word. Then I mouthed off at a committee meeting. And got invited to present our project to another committee. And another. Then HQC asked me to write this blog. WWW = cat out of the bag.

Now that the word's out, I want to take advantage of it. I don't want to get carried away, but I have big expectations for this project. Way beyond improved access for the patients of one urology practice in one city. We're just the guinea pigs. If we can do it, why can't all specialists do it? And family physicians? All over the province! (Even WW! Read, wide world) Spread the word!

Who do we need to tell? Everyone reading this blog? Well, it's a start, but I suspect I'm preaching to the choir. (I wanted to say "QI-er" but a pun that bad is a sign of the Apocalypse.) Many people who follow this blog are already part of the Quality Improvement community. So, who else needs to know about this? How can we leverage publicity into action? Psst. Lean in close to the screen and I'll tell you: Grassroots. Forget top down. Let's go bottom up. Get the word out to the public, the people who are waiting for doctors’ appointments. Let everyone know that access can improve, and that it's already being done.


It's natural to resist change. Doctors are especially conservative. Remember when having your gall bladder out (cholecystectomy) meant a big abdominal incision? Then someone figured out how to do it using a few small cuts and some telescopes. For general surgeons, it meant learning a new way of doing things. Initially, many were skeptical. There was resistance. But soon, there was a critical mass of public demand (and professional acceptance). Now, virtually all cholecystectomies are done laparoscopically. (Q: What do you say to a general surgeon who doesn't learn to do laparoscopic cholecystectomies? A: Yes, I'll have fries with that. ) Once enough people demand (demand!) better access, we'll reach a tipping point after which resistance is futile.

Publicly-revealed plans are also a great personal motivator. It's easier to get the job done rather than have to make up excuses. Here's my little project this weekend: I'm going to make up a notice for our reception desk announcing our Access project to our patients. I'll provide some pamphlets with the blog address and encourage people to tell their friends. I'll have this up by Tuesday morning. Here's your project: Tell one person (email counts!) outside the QI community about Advanced Access. Give her this blog's address. Do it today.

Sometimes the choir needs the chance to get to know each other. Telling our stories helps build a community of change. Last week, I had the opportunity to attend the HQC Chronic Disease Management Collaborative (CDMC) conference. It was exciting to see 200 people - improvement teams from all over the province - sharing their work. Project story boards stretched down a hallway. Many were slickly-produced, full-color posters, but the one that caught my eye was decidedly low-tech. On one piece of poster board, the title hand-lettered with black felt pen, it told the story of a small medical office trying to log on to the CDMC tools. They spent the whole day trying to get the program running. And then admitted it publicly! Six months ago, I would have sniffed at that effort and moved on to look at multi-colored run charts. But now I understand the courage it took to display that homely little poster.

Sing your song.