Obviously as the lead for Improving Quality Together, I would say those words ring true in the framework’s underpinning principles. Maureen Bisognano used them in her opening keynote address to set the tone for this year’s International Forum.
The importance of seeing the impact of the system on staff and patients was underlined with Maureen’s call for empathy. Until we truly see what is happening, we cannot even move to being able to ‘do’ something and therefore we need to ‘understand’ our role and our ability to make the improvements that will have an impact on patient care. Improving Quality Together is precisely about that – moving the NHS Wales workforce from hearing and seeing what quality improvement is, to doing it in practice and therefore understanding all our roles in improving patient care.
Empathy is a word often overlooked. We know, following Francis and the Mid Staffs enquiry, that a lack of empathy can become inherent in organisational behaviour far too easily. However, the key question is how do we encourage and enhance it? There are three broad competencies that the Improving Quality Together framework for quality improvement is built upon: Listen to your patients; Listen to your system; and Listen to your staff.
Listen to your patients – The Forum focused on patient experience in a number of its sessions, but the clear warning was to ensure that this doesn’t become just another process, that we don’t become immune to hearing and seeing what our patients are experiencing by the system of care in which we work. Experience care from the patient’s perspective, don’t just read someone else’s interpretation of it, or even hear it – get out there and experience it!
Listening to your system – Of course, we need to look at data to understand our systems, and ensure we are looking and interpreting the data in the right way, but are we looking at the reliability of our systems with a whole system approach? Are we focusing on past harm, or are we taking a broader approach to integrate the learning? And is clinical time being used for measurement seen as wasted time?
Listen to your staff – A powerful video from Cleveland Clinic was shared in the plenary session which encapsulated the importance of empathy with patients and staff. Unfortunately, NHS Wales IT policy won’t let me access the video, but if you have time do look at it outside work.
Empathy is key in the arena of care, but not just for understanding the patient journey, but also to engage with staff. Key learning from one session focussed on engaging clinicians – as with all staff – involving them in identifying the problems, agreeing what we should be measuring to be able to listen to the system. As one presenter said: “You can’t control variation without physician involvement … quality can no longer be delegated to others in the system.” My time at the Forum has surely strengthened my resolve that Improving Quality Together becomes integrated in all we do (I would say that though!)
To reach the Mayo Clinic’s success – 32,000 trained in levels of QI – we need to be focussed on the long game, and see what a powerful resource we have in the workforce. We need to make improvement a habit! And to achieve that we need a combination of reliability and resilience, and above all empathy.
Dominique Bird is the programme manager for Improving Quality Together.