What would you pick as sector quality system mistakes to avoid? (Part 2 - the second 5)

In a previous article, I gave my take on the five strategic quality system evolution mistakes that are too easy to make when trying to evolve organisation or sector quality and clinical governance to be more effective. This month I look at five operational aspects. What did we do wrong in the acute sector when trying to evolve our quality systems to have more impact on care?  What should other sectors avoid? As the recommendations and implications of Royal Commissions in aged care, mental health and disability roll out over coming months, we have the opportunity to do things differently.

I acknowledge that I'm but one lens - also that I'm guilty of perpetrating many of these mistakes myself!  More than once I've found myself stuck in a mangrove of busy - but ultimately not very useful - activity, watching others more strategic sail past on their river of progress.  The only thing standing in the way of smarter, faster quality system development is a lack of willingness to learn from each other.

In my experience, the healthcare sector did not (or did not enough of):

5. Position consumer and staff leadership and engagement as a cornerstone of success.

Result: consumers and staff not seen as the creators of the quality experience. Disengaged staff who view 'quality' as a chore, rather than something they are supported to create every day, and take pride in. Only seeing one-third of the quality experience (the 'objective' data) if not consulting staff and consumers as equal partners.   Not tapping into what consumers want from their own care and from the broader service; or into what motivates staff to work in human services. Good care is reliant on the 'good staff' who are self-starters. Leaders not strategically developed and equipped with the right skills to support great care as business as usual.

6. Invest in getting measurement right. 

Result: over two decades later the acute care sector still argues about whether data are valid and reliable and whether we're measuring what we think we are. Limited improvement progress due to misleading or inaccurate data that jeopardise, rather than support, effective change and improvement. Lost time spent in collecting and presenting data of dubious usefulness. Not enough expertise developed in collecting, analysing and reporting data. Can't tell when the quality system is ineffective. Big problems with care quality not detected until it's too late.

7. Understand the impact of complexity on the daily work of creating and maintaining high-quality care and experiences.

Result: Inability to provide the right support and guidance for staff to provide consistently good care in a challenging environment. Not equipping staff with the permission, leadership, resilience and systems required to actively pursue high-quality care and reduce risk in real-time. Quality becomes something discussed in retrospect that may drive incremental change, rather than a dynamic daily pursuit. 

9. Develop and apply expertise in improvement science to support staff to do well.

Result: quality directors and managers working hard but ineffectively. Defaulting to accreditation success as the purpose, rather than high quality at point of care. Putting improvement effort into the wrong areas due to poor problem analysis and diagnosis. Change and improvement achieve change that is incremental or not sustained. Problems are addressed via tweaks to procedures and forms, training and meetings, rather than using 'strong' actions. Issues not resolved, resulting in long-term, impenetrable blocks to progress. 

10. Make accreditation achievement a means to a meaningful end.

Result: It will always be difficult to motivate staff if quality is all about the 'how' with no 'why and what' you're trying to achieve as a result.  Accreditation standards are a series of 'hows': useful if implemented to support creation and maintenance of great care and services, but as an end in themselves, they can generate a lot of work that staff struggle to see the point of.  Accreditation should support strategic goals for high-quality care - not be the goal itself. A culture of compliance can also drive out learning from the things that go wrong: we get into a 'fix and forget' mindset, rather than appreciating the power of understanding, learning and evolving to make care safer.

And here's a summary of my first five from Part 1, which covers bigger picture issues. In my experience, healthcare, when trying to evolve its quality systems, did not first:

?1. Get clear about what an effective quality and clinical governance system comprises.

?2. Differentiate between quality of care and the quality system.

?3. Set clear goals for high-quality care and services as strategic and business priorities, central to sector and organisations' success. 

?4. Link quality and clinical governance so it's clear that CG must be implemented as an enabler for staff to create the quality experience goals.

?5. Expect executives to develop an understanding of how to manage quality effectively, in the same way they are expected to understand financial management.