Quality Improvement and Digital Innovation: A Conversation with Deirdre Stewart

I recently had the privilege of engaging in a conversation with Deirdre Stewart, a Luminary advisor at St. Vincent's, who shared profound insights into quality improvement through the lens of digital health.

Deirdre has a clinical background with over three decades of digital health transformation experience, two decades of which were in the Middle East and Asia. The last decade has been in the UK and Europe.

Our discussion touched on the evolution of quality frameworks, the impact of digital systems, and the crucial role of face-to-face engagement and the big picture in transformation.

Digital Transformation in Healthcare Quality Improvement

Deirdre began by reminiscing about her experiences, working with clients in the Middle East pursuing the Joint Commission International Accreditation (JCIA). She emphasised the challenges in a paper-driven world and how the introduction of Electronic Patient Records revolutionised compliance and quality control. Deirdre noted though, that implementing these solutions and tools is only part of the story.

"What became apparent was the gap in understanding. Explaining the 'why' behind a workflow to healthcare staff and patients is crucial. You need to lay out the value of the solution from their perspective. It's not just about having the framework; it's about fostering comprehension to ensure advocacy and a seamless integration into daily practice. This helps staff and patients to see exactly how the technology saves lives and makes their jobs easier."

Leadership Lessons and Storytelling

In discussing her role in various projects, Deirdre emphasised the importance of leadership in creating a vision for the future. "It's about showing what the future can be, identifying constraints and selecting the right people for each role. We then need to step back to let them excel while still being visible, vocal and supportive."

She also stressed the power of storytelling in connecting with people, saying that "sharing experiences from different places helps individuals feel less alone in their transformative journey."

Closing the Loop: The Lifecycle of Quality

Deirdre highlighted the importance of connecting the dots between standards, system design, and real-world application. She remarked that "the most expensive system is the one that nobody uses." Bridging the understanding gap not only ensures compliance but also enhances staff satisfaction and patient safety.

How Quality Frameworks Can Save Lives

Our conversation delved into Deirdre's involvement with the HIMSS certification programme, citing the transformative journey of the Children's Cancer Hospital in Egypt.

This hospital is a charity run on private donations, often individuals walking dozens of miles to offer their life savings, which could be $5.

“It is one of the most incredible hospitals in the world and it was a humbling place. To help them on their HIMSS journey and to be sitting there in the in the auditorium when they were told that they were HIMSS level 6, to be included in the celebration of what that meant to them was like nothing you have ever seen in your life. And I knew all our efforts were going to help extend the life of children dying from cancer. Their survival rate increased rapidly within a number of years, moving from 40% to 71%, very close to the Western rates of 75-80% overall survival. That’s a powerful example of the effects of harnessing quality frameworks.” ?

Effective Approaches to Change Management

Deirdre shared practical insights into change management, emphasising the significance of boots on the ground. "Understanding the daily challenges by walking through the wards and identifying bottlenecks allows for a more empathetic and insightful approach to change."

"Aligning the benefits of a programme with the daily experiences of staff ensures they feel understood and listened to," she added. "It's not just about telling them it will be better; it's about showing them how it will improve their day-to-day operations."

New Hospital Programme

The future holds many challenges, Deirdre explained, we will have an older population with fewer young people to look after them. There's going to be a lot more co-morbidities amongst the patient population, plus, smaller facilities for acute care and more care moved out to the community.

This needs to be taken into account in the New Hospital Programme (NHP).

"As a big picture person, I love understanding every piece of the puzzle and applying quality frameworks. The NHP is a culmination of everything I've learned over the past 20 years. To me it's joyful to be able to work in an area like that and contribute."

Deirdre’s Top Tips for Successful Change Programmes

1. Prioritise People and Engagement: Recognise that end-users are at the heart of any organisational change. Engage with them, create a compelling vision for the future, and foster a sense of ownership.
2. Leadership Responsibilities: As leaders, it's crucial to showcase the future, identify controls, constraints, and standards, select the right team members, and provide support when needed. Balance visibility and vocal leadership with giving your team the space to excel.
3. Knowledge is Empowering: Instead of providing fragmented information, empower your team by ensuring they understand the bigger picture. Knowledge is the key to making informed decisions and feeling valued within the larger context.
4. Storytelling Builds Connection: Leverage the power of storytelling to connect people across different experiences. Sharing success stories from various contexts helps individuals feel less isolated and more connected to a broader community.
5. Build Networks and Connections: Act as a connector and networker. Facilitate connections between individuals who can share experiences and solutions. This collaborative approach helps alleviate stress and provides valuable insights during transformative journeys.
6. Understand the Before and After: Take a hands-on approach by spending time on the ground, understanding daily challenges, and identifying bottlenecks. This first-hand knowledge is essential for tailoring change initiatives to align with the everyday experiences of staff.
7. Communicate Benefits Effectively: Clearly articulate how the benefits of a change will be perceived on the ground. Acknowledge that not every aspect of the transformation may be pleasurable but emphasise the overall positive impact on the organisation and its members.
8. Highlight Collective Expertise: Emphasise the collective expertise within your team. Use exercises that reveal the cumulative years of experience, reinforcing that the new system is a tool to enhance their capabilities, not a challenge that surpasses their collective wisdom.
9. Assure Staff: Foster a supportive and encouraging environment. Assure your team that, with their wealth of experience, they are well-equipped to navigate and implement changes successfully. This instils confidence and reduces anxiety within the team.

Conclusion: A Vision for the Future

As our conversation concluded, Deirdre's passion for combining healthcare, technology, quality improvement and, importantly, hands on staff engagement shone through. The integration of her experiences into the New Hospital Programmes reflects a commitment to building a future where technology and understanding work hand in hand to enhance patient care.

In a rapidly evolving healthcare landscape, Deirdre Stewart's journey stands as a testament to the transformative power of digital health when coupled with a deep understanding of the human element in healthcare. As we navigate the challenges ahead, her insights provide valuable guidance for those leading the charge in healthcare quality improvement.

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