OD, QI or both?

Matthew Mezey from the #Qcommunity has been begging me to write something on OD and QI, ever since we chatted about it at the Health Foundation annual reception last year. It has been something I have been thinking about for a long time, and when I tweeted a similar question during the summer it was one of my more actively engaged with tweets. Yet, I have hesitated writing something, because I’m not sure how this might be received, and that asking these questions may not be welcomed, and maybe I am just imagining something that isn’t there. So, this is a first attempt, and there might be another one.

What is it about OD (organisational development) and QI (quality improvement, including patient safety) that seems to raise interest and engagement, why do I feel it needs talking about? Why do I think it is important? Based on many conversations and private responses to me on Twitter and over coffee, there seems to be a fault line, a schism, hidden just beneath the surface of much organisational change, patient safety, service and quality improvement work.

I hear this in many ways… different groups who talk about culture, improvement, patient safety and leadership in different and separated ways. We have separate ‘networks’ like the Qcommunity, and DoOD, arguably emphasising separate professional identities. Phrases get used to separate like ‘QI must be clinically led‘ (as opposed to whom, and where does that leave patients? Why does OD not have to be clinically led?), ‘we need to focus on the cultural work because the improvement programme doesn’t do that, it doesn’t reach enough staff‘ (why not?), ‘we don’t want to do the – where are we going and what are values stuff – just teach us the QI tools, it’s faster‘ (why?). Yet, people ask me frequently how to join up OD, patient safety and QI work as though they are mutually exclusive, have different views and underlying perspectives, or as though one is ‘better’ than another. Increasingly, I rather feel they have more in common.

So, whose job is it to lead such efforts? Who gains from creating a schism? Why? Does driving the efforts also mean a chance to control and influence the narrative, have exclusive access to the decision makers, influence the resourcing decisions and protect professional identity and groups? Yet, this is by no means everywhere, many stories I hear are of teams who bring all their skills and knowledge together and transcend the divide, so I’m wondering how they do that, and what has helped them to that, and why the schism felt elsewhere appears to not affect them. As a medic said to me in a direct Twitter message… ‘they must be synonymous’ (must they?).

What do you think? Do you think there is a difference and how are you overcoming challenges? Or am I imagining something? I’ve been trying to look through the roots of where the different approaches came from and if you have ideas please let me know, I would love to hear from you. I might try to write about that next.


  1. I think opening up the discussion is critical. My experience of working in public services suggests that whenever you put ‘science’ into dialogue you elevate the importance it recieves. True OD from my perspective is an ingrained curiosity to understand the impact individuals have on each other and ultimate influence that has on organisational culture and delivery of objectives. So, relationships between people have less recognition than the science of tools and interventions. The ability to reduce change to ‘interventions’ which can be seen as separate from those enacting them is flawed and a reflection on the lack of emotional intelligence we have in a system which values targets over outcomes. I want to continue underpinning Improvement science through a lens’s of compassion and care for those required to make change happen.

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