Leading for improvement.. (pondering)

Leading for improvement? What’s it really mean? Why has it gotten a different label to leadership? What’s special about it? What happens if it’s ‘missing’ and how does it differ from technical improvement expertise? And why does Prof Bob Emiliani go on about leadership for improvement so much and yet for the most part ‘normal’ leadership development and leaders don’t?

A few things came together for me in my head on this, and I’m going to try to use this blog post to help me articulate some of that, and get my head clear for a piece of more formal writing I am collaborating on. These are some of those things in no particular order, (and this list isn’t exhaustive, I might keep adding to this blog).

1. The improvement method olympics has been running over the summer, and this has reminded me of the leaders role in ensuring fidelity and use of such approaches and importantly the integration of different improvement tools, and the purpose behind all of them, (broadly speaking summarised imho as slow down and think together) into an improvement approach and system. Some of Julie Reed’s work really resonated on this again for me.

2. A paper talking about organisational failure and ‘why’ learning… and importantly the action(s) following the learning seem to not take place as often and need much more support from managers and leaders, particularly in so called ‘low performing’ orgs.

3. A blog by Davis Balestracci came to my attention describing why he feels improvement fails in so many ways often due to the way (for the most part) that leaders and managers ‘expect’ it will be enacted (even when unhelpful from a QI perspective) and how improvements specialists might be both complicit in this or unable/unwilling to rock the boat too much on it

4. I was reflecting on my first year in a new provider role ostensively to lead QI, but then a pandemic, where normal ‘rules’ for improvement went out the window and instead I have been much more exposed to the quality governance end of the quality management continuum than ever before. Quite an opportunity in hindsight. It has made me wonder why in previous roles How/why was/is the QI community a little separated from the safety improvement community? Sure we may have similar cultural aims and much the same improvement tools at our disposal. Yet ‘flow/access’ improvement is often separated structurally in healthcare organisation, from improvement linked to safety issues, whilst being inherently connected in practice and care. How has that come to be?

5. Finally I have been really thinking hard about what my role/improvement leaders roles is in reducing health inequalities and in supporting staff inclusion. What is it we need to do here to help ensure quieter or less heard/excluded voices are included and amplified? What is our role to ensure space for listening, to design inclusive processes (events, workshops, virtual meetings etc), to consider implications of possible solutions including possible inadvertent consequences. What bias might a Pareto approach to focus on the ‘biggest’ issues introduce here? Making me ponder on our responsibilities in the improvement space here.


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