Effective quality improvement hinges on changing the behaviour of leaders

Author: Kim Hindle

The focus needs to be on changing the behaviour of those leading QI projects, as failure to do so could undermine success.

Understanding why QI fails

QI to create positive change is often challenging, as critical components are not explored in depth. In healthcare, this can be explained by scarce resources and hopes of quick fixes; however, from experience, these do not promote improvements. Understanding the problem as well as how to influence human behaviour change are crucial aspects that are often not given the attention they deserve by leaders and managers. Clarity regarding the specific problem to be addressed is often influenced by perceptions and assumptions instead of facts, with the focus skipping to the solution. Misconceptions that education alone is an effective strategy to change behaviour continue to exist, despite evidence consistently demonstrating that knowledge is not enough. Secondly, consideration of how behaviour change will be influenced to modify practice is often not clearly understood or neglected. Both aspects of QI are often challenging to explore, and behavioural change theory can explain why individuals driving projects often overlook them.

The COM-B model for behaviour change provides a framework for influencing behaviour and focuses on capability, opportunity and motivation. Similar models are used to design behaviour change interventions for successful QI implementation. This model can also explain why critical aspects of QI are skipped by project leaders. An effective root-cause analysis requires capable problem-solving skills, the opportunity to undertake a problem analysis, and the motivation to focus on the problem before moving to the next stage of QI. Similarly, designing behaviour change interventions can be complex in relation to supporting capability, capacity, resources and motivation in poorly resourced health services. Consequently, it is essential to support leaders of QI to undertake projects systematically for workplace change to be successful.

Strategies to support QI leaders

Develop capability: Knowledge and skills specific to QI methodologies are critical to drive projects successfully. Supporting learning and development to conduct a root-cause analysis, explore evidence-based interventions to address problems, audit and measure data, influence staff behaviour change, and continued monitoring of projects are essential to build foundation skills of QI project management. Should an individual not have the skills to support the trajectory of QI projects relevant to the setting, building a team that cumulatively can support different components can be an alternative approach.

Promote opportunity: QI requires time to do it well and needs to be resourced appropriately. Scheduling in set time to focus on QI alone can enable workers to explore complex concepts in sufficient depth. In poorly resourced health environments, understanding the benefits following successful intervention and the ability to communicate this clearly can incentivise appropriate resourcing.

Motivate: For leaders to continue practising effective QI methodologies, motivation is required while discouraging poor behaviours. This means the business needs to have a vested interest in the QI outcome and to provide the necessary support and empowerment of teams. Linking workers with a coach or supervisor who can help navigate the execution of a QI project can foster best practices. Consultation and collaboration can also promote inclusive leadership and provide valuable feedback to guide projects and establish peer support networks.

Real, tangible change is possible with QI; however, leaders need to embrace all aspects of the process and support teams to do so, which requires a shift in thinking. Equipping leaders with the tools and skills to change their approach to QI is a critical first step.

Kim Hindle RN, BN, MHSM, MAPN, GACN, Learning & Development Strategy Lead

Bolton Clarke, Brisbane, Australia