Neurodiversity- why go from IQ to QI

Diversity in the workplace can only be achieved where we have equity. This is a step up from equality practices as it is about each person having an equal opportunity to showcase their talents.

Can we consider QI - Quality Improvement principles that have been considered in many health contexts and the rationale for this starting in education and ending in employment?

Quality Improvement is: 'about giving the people closest to issues affecting care quality the time, permission, skills, and resources they need to solve them. It involves a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement.'

This can start in school with finding ways to level the playing field and reducing inequality. The above project led by the inspiring Keith Fraser head of the Youth Justice Board is really making inroads in engaging with young people to increase participation in sport. He has neurodivergent talent himself and is a great example of seeing great skills and talents in action!

(If you want read about neurodiversity and youth justice I have written an article which was just published for Academic Insights?which is aimed at all those interested in research and developments in the evidence base for high-quality probation and youth offending services.)

Quality improvement initiatives in education and health reap benefits in the workplace as they will increase the quality of those who are moving into workplaces and reduce demand for support services.

Inequity happens when we do something for one group and inadvertently it excludes others. One obvious example is young people who are excluded from school who are more likely to get a diagnosis of 'behaviour' and less likely to be diagnosed with DLD; ADHD; ASC or TBI.. despite plenty of evidence of even higher rates (see ALSPAC study ) Those excluded are more likely to come from lower SES and specific ethnic minority groupings

Nearly 20 years ago there was a report from the Lancet Global Health Commission on what determines quality health provision. It concluded the most disadvantaged in society had the worst health outcomes. It may seem this is no surprise to you to read this. In 2020 they published a WHO–UNICEF–Lancet?Commission on Child Health and Wellbeing which highlighted that "All nations aspire to see their children develop and flourish as a human right and as the basis for a strong economy."

Time to focus on QI and not IQ!

Quality Improvement requires universal coverage and not a selected service that ends up being inequitable and better for some than others who can shout loudest. Ironically we have in the past framed ability by talking about IQ scores-which are represented by a composite score or single figure. Society often advantages those with higher IQ scores. When we look at people through a narrow lens we can miss out on crucial information including the context of that person's life, their opportunities, and past and present experiences.

Author Henry Neff correctly said: “Incomplete data leads to incomplete conclusions.”

In reality, we all have very spiky and complex profiles with strengths and challenges but it is important to see a more complete picture otherwise we can make wrong assumptions. Intelligent use of our intelligence!

What is equity?

The World Health Organisation describes it as:

"The absence of avoidable, unfair or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification".

Do we need to consider ways to remove bias that inadvertently arise in excluding some groups while focusing more on others? This has been seen in some health initiatives e.g. in the US when they introduced a Diabetic awareness campaign (QI collaborative) - this worsened the access to non-English speaking Latinos as it was less accessible. The result was great for some but even worse for others!

There are three potential outcomes of QI that can happen relating to equity:

1. Improvement for all but maintaining the equity gap
2. Improvement for specifically disadvantaged groups
3. Or ending up widening the gaps even more!

One example we need to consider in employment is that if we introduce hiring programmes for one specific group (which may be great programmes) we need to be sure that we are not excluding others inadvertently. Another could be excluding people applying for jobs based on spelling errors on their CV because we consider the person can't be bothered rather than is Dyslexic.

Awareness of neurodiversity helps and considering our biases ( and even the ones we are not thinking of).

QI has a far greater impact on a neurodiverse society as a whole. Let's start to measure what we do but ensure we have the right data to do so.

As Mark Twain said: "Data is like garbage.?You had better know what you are going to do with it before you collect it."

This week my book arrived and I was super chuffed as I had written with my friend and colleague Theo Smith during months of lockdown.

https://www.koganpage.com/product/neurodiversity-at-work-9781398600249