Billy Boland: Creating a culture where quality improvement is a way of life

I couldn’t think properly as I had heart palpitations. I didn’t know anyone and felt properly under the microscope. I was stressed out but trying to be at my best. I hoped it was worth it.

The email came a few weeks later after my gruelling experience at the assessment centre. I’d been given a place on the Health Foundation’s GenerationQ programme. Selecting 18 fellows each year, the Health Foundation develops leaders’ capabilities in leading quality improvement. As a member of the 8th cohort, I’ve joined leaders working in all four nations of the UK, drawn from the NHS and charity sectors.

I wanted to take part as despite my enthusiasm for QI I’ve had no formal training and I needed some fresh support with my leadership development. Its both a privileged and demanding environment. The other 17 fellows are all senior leaders already deeply engaged in quality improvement and acutely aware of the challenges that exist in creating value in the current economic climate. One of the key resources at our disposal are the minds of each other. We are encouraged to contribute reflections, challenge the ideas of others, and create new dialogue and meaning that we can all learn from.

I’d been keenest to learn about the technical aspects of QI, feeling that this was still my weakest area. But it’s been the intersection between the technical and human aspects that I’ve been most fascinated by so far. Health Improvement can’t happen sustainably just by making people go through PDSA cycles mindlessly. It’s not even really good enough to teach them the techniques and let them get on with it. It’s about creating a culture where improvement is a way of life. It’s about recognising the power of diversity and the different lenses that individuals see organisations through.

Take for example Gareth Morgan’s Images of Organization that we’ve been discussing. He makes the point that there are metaphors that can be used to consider organisations like NHS trusts. He uses these as they can reveal certain “truths” about an organisation while at the same time hide others. Two good metaphors are those of “machine” and “brain.” If the organisation is seen as a machine, every cog (person) in it has a role. Output can be controlled through modifying (controlling)  inputs, and commands are executed without question. Higher order machine operators have ultimate power and need to ensure all areas of the machine function properly, or fix things when they go wrong.

The organisation as a brain however has a unique capacity for learning. It constantly makes sense of the world around it. It works hard at understanding and making use of new knowledge, puts primacy on adapting to new environments and creating new networks and seeks to get perfect up to date information to areas that need it.

How do you improve quality in a machine? Or a brain? Of course most health organisations have elements of both of these metaphors and many others besides. It’s helped me get a deeper appreciation of how one size (or perspective) does not fit all.

Furthermore, it’s helped me gain new insights on working with others. If we are more prone to see the organisation as a machine or a brain how does that shape our expectations of each other, and our relationships. New possibilities for networking and influence are occurring to me.

While I’m currently bemoaning having to add  essay writing to my already long to do list, I’m still thrilled to be here. I’m being stretched and I’m learning. Isn’t that what all individuals, and organisations, need?

The next round of the Health Foundation’s GenerationQ programme opens for applications on 27 November 2018.

Billy Boland is consultant psychiatrist in community psychiatry, Hertfordshire Partnership University NHS Foundation Trust, Deputy Medical Director, Hertfordshire Partnership University NHS Foundation Trust, and Vice Chair (elected), Faculty of General Adult Psychiatry, Royal College of Psychiatrists.

Competing interests: Vice chair role at RCPsych as the faculty has been collaborating within the college to produce recommendations around outcomes.