Sunday, January 8, 2012

Clinicians and administrators need to share the sandbox

Thanks to Trish Livingstone for helping me clarify my thinking on starting quality initiatives at the grassroots level.  Trish (Director, Health System Quality and Efficiency Management for the Government of Saskatchewan) left this comment:

Agreed, Kishore, don't wait for permission - start now! As administrators, we often create barriers but our role should be to facilitate these changes at the front-line by providing support, incentives, opportunities for training, etc. In the words of Berwick, the administration's role should be to "help those who help patients." So, start without us but even better - let's do this together!
You can't go wrong by quoting Berwick!

This comment illustrates the tension between letting front-line workers initiate improvement work and needing some degree of administrative support and coordination so resources aren't wasted and efforts aren't duplicated.  We definitely need to work together and cooperate.

But, frankly, it doesn't feel like an equal relationship (yet!).  I think many clinicians feel that the administrator/manager/director's job is to say "No." Are managers actively soliciting ideas from their staff?  How much time are managers spending walking around the wards, visiting clinics, talking with support staff, or asking clients about their experience?  How much enthusiasm and expertise is being wasted because managers are in meetings with other managers, rather than being available to "help those who help patients"?  How many managers are encouraging their staff to try something and give permission to fail (AKA: learn)?

I had a taste of this earlier in the week.  As part of our clinic's new improvement project (to which I alluded in the last post), I visited nurses at an outpatient treatment clinic.  I wanted to find out if they had any ideas on how we could improve delivery of a certain cancer treatment.  Did they ever have ideas!

I thought I would have to drag suggestions out of them, but instead I found that they were brimming with ideas.  They showed me system dysfunction that I was unaware of.  Plus, they had already been thinking of ways to fix the problems.  But, they had no mechanism (no invitation) to communicate the problems or initiate improvement.

They were thrilled that someone was actually asking for their insights into this part of patient care.

How much missed opportunity exists in wards, clinics and care homes?  How much potential could be tapped by (as Trish says) "providing support, incentives and opportunities for training"?

You're right, Trish.  If we're going to start quality improvement work at the front-line, we need help from administrators.  So, managers and directors, please be part of this grassroots work.  Trish has challenged you to "help those who help patients".  Will you say "Yes" to trying an improvement suggestion rather than waiting for approval from higher up?  Will you weigh the value of attending another regularly scheduled meeting vs. visiting the ward to solicit change ideas from your staff?

Vive la Revolution!


  1. I love the idea of soliciting ideas from the frontline/voice of the customer/people with the knowledge (whatever you'd like to call it). Once you have those ideas, it's important to act on at least some of them and then go back to the "knowledge holders" to test success at multiple levels. It's also critical to communicate what's happening, why, and what's being learned along the way. There's nothing more frustrating than filling out surveys or giving feedback that no one acts on if it "doesn't align with my thinking." I thought the purpose of surveys and feedback is to learn to think and act in new ways, not necessarily validate what we already think we know. The latter approach is a self-serving feedback approach that disengages people and damages relationships. It's "faux data" for accountability purposes, as opposed to value-added learning for meaningful change. Very exciting if we can do this.

  2. nice sharing i really like it please share more knowledge