Give a man a fish and he eats for a day.
Teach a man to fish and he eats for a lifetime.
Show a man how to use a phone and he can order pizza. Who wants fish everyday?
How do you go about selecting a quality improvement coach?
A coach could be a mentor, guide, cheerleader, or teacher
(and probably all these at different times). The origin of the word gives insight into its true
meaning. “Coach”, in its original
use, refers to a carriage or means of transportation. Later, it referred to someone who helped students (or,
carried them) through exams. In
both usages, a coach helps someone reach their goal.
I distinguish a coach from a consultant. I see a consultant as someone who
assesses the problem and prescribes a solution. We were interested in working with someone who could help us
develop (or rekindle…) an independent capacity to identify and solve the
problems in our practice. Also, we
wanted to develop a sustainable quality improvement process.
While we wanted someone to help us eventually develop our
own capacity, we recognized that this coach would likely need to do some of the
initial diagnostic work to jumpstart the process.
In retrospect, after having been in the coaching process for
almost 9 months now, I judge the 2 key qualities of a QI coach to be patience
and breadth of experience.
Novices make mistakes; it’s a powerful way to learn. The coach may be tempted to curtail
exploration and experimentation, intending to speed the journey along. Feeding the student the “correct”
answer may shorten the process, but deprives him of the experience of
understanding what doesn’t work. This is particularly important in QI
work where the solution(s) may not be known and experimentation (PDSA cycles,
action research, etc.) is the only way forward. An experienced coach may have seen certain initiatives fail
in other settings, but must be patient in allowing students to conduct learning
trials and develop their own understanding about what works in their system.
The coach’s patience was particularly important as we
started to rank the importance of problems areas to be improved. I suspect our coach had preferences as
to which improvements would have the greatest impact on patient, staff and
physician satisfaction, but kept quiet about it. Instead, we were shown methods to reach a consensus around
which projects were our priorities. This has been an important factor in
maintaining enthusiasm around the work: The projects we’re working on are
meaningful for us, not ones foisted on us from outside.
This relates to the “give a man a fish” aphorism that I
tweaked at the start of this post.
The kernel of wisdom in the original saying is very much the philosophy
of coach over consultant. A
consultant may give you the fish/answer, whereas a coach will show you how to
get the fish/answer for yourself.
I think the next step in QI independence and sustainability is to give
the team the tools to decide what they want to have for dinner. And that means the coach has to give up
control of the direction of the work.
Therefore, we wanted a coach who was not personally invested in “fish
for dinner”, i.e. a predetermined direction that our QI work would take.
A coach’s breadth of experience is important when the QI
team wants to develop an independent, sustainable capacity. This relates most closely to the common
use of “coach” in athletic training.
Athletes who specialize in a particular event seek out coaches with expertise
in that area. A specialized coach
may help elite athletes reach their potential in individual events, but these
athletes may not have well-rounded fitness, may be prone to certain injuries,
or find that they cannot sustain that level of training in the long-term. A particular training technique may
work for some athletes, but a coach who is familiar with a variety of
techniques will be able to help many athletes achieve their goals.
In Saskatchewan, our health system has adopted Lean as our
quality improvement system and is investing heavily in training providers and
administrators. I’m excited that
we have a consistent method to guide our QI work. At the same time, I’m conscious that “when all you have is a
hammer, everything looks like a nail.”
Lean may not be the right hammer for all our nails. Rather than signing up our QI team for
Lean training, we decided to take a non-denominational approach that would let
us pick and choose from various QI models. That required a coach with broad exposure and experience
with different QI systems. Also,
we wanted to start our QI work immediately rather than spend weeks in formal
training. This approach demanded a
coach who was confident and expert enough to give us just-in-time training as
we proceeded.
Whew! That is a tall order for a QI coach. Where would you find such a person?
Right under our noses…
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