{"id":43002,"date":"2018-09-11T11:32:11","date_gmt":"2018-09-11T10:32:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43002"},"modified":"2018-09-17T12:48:45","modified_gmt":"2018-09-17T11:48:45","slug":"billy-boland-creating-a-culture-where-quality-improvement-is-a-way-of-life","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/11\/billy-boland-creating-a-culture-where-quality-improvement-is-a-way-of-life\/","title":{"rendered":"Billy Boland: Creating a culture where quality improvement is a way of life"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/04\/billy_boland2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-41885\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/04\/billy_boland2.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/04\/billy_boland2.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/04\/billy_boland2-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a><span style=\"font-weight: 400\">I couldn\u2019t think properly as I had heart palpitations. I didn\u2019t 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The email came a few weeks later after my gruelling experience at the assessment centre. I\u2019d been given a place on the Health Foundation\u2019s <\/span><a href=\"https:\/\/www.health.org.uk\/programmes\/generationq\"><span style=\"font-weight: 400\">GenerationQ programme<\/span><\/a><span style=\"font-weight: 400\">. Selecting 18 fellows each year, the Health Foundation develops leaders\u2019 capabilities in leading quality improvement. As a member of the 8th cohort, I\u2019ve joined leaders working in all four nations of the UK, drawn from the NHS and charity sectors.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I wanted to take part as despite my enthusiasm for QI I\u2019ve had no formal training and I needed some fresh support with my leadership development. Its both a privileged and demanding environment. The <\/span><a href=\"https:\/\/www.health.org.uk\/news\/2018-new-fellows-selected-health-foundations-generationq-leadership-programme\"><span style=\"font-weight: 400\">other 17 fellows<\/span><\/a><span style=\"font-weight: 400\"> 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I\u2019d been keenest to learn about the technical aspects of QI, feeling that this was still my weakest area. But it\u2019s been the intersection between the technical and human aspects that I\u2019ve been most fascinated by so far. Health Improvement can\u2019t happen sustainably just by making people go through PDSA cycles mindlessly. It\u2019s not even really good enough to teach them the techniques and let them get on with it. It\u2019s about creating a culture where improvement is a way of life. It\u2019s about recognising the power of diversity and the different lenses that individuals see organisations through.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Take for example Gareth Morgan\u2019s <\/span><i><span style=\"font-weight: 400\">Images of Organization<\/span><\/i><span style=\"font-weight: 400\"> that we\u2019ve 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 \u201ctruths\u201d about an organisation while at the same time hide others. Two good metaphors are those of \u201cmachine\u201d and \u201cbrain.\u201d If the organisation is seen as a machine, every cog (person) in it has a role. Output can be controlled through modifying (controlling) \u00a0inputs, 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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\u2019s helped me get a deeper appreciation of how one size (or perspective) does not fit all.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Furthermore, it\u2019s 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">While I\u2019m currently bemoaning having to add \u00a0essay writing to my already long to do list, I\u2019m still thrilled to be here. I\u2019m being stretched and I\u2019m learning. Isn\u2019t that what all individuals, and organisations, need?<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">The next round of the<\/span><\/i><a href=\"https:\/\/www.health.org.uk\/programmes\/generationq\"><i><span style=\"font-weight: 400\"> Health Foundation\u2019s GenerationQ programme<\/span><\/i><\/a><i><span style=\"font-weight: 400\"> opens for applications on 27 November 2018.<\/span><\/i><\/p>\n<p><em><strong>Billy Boland<\/strong> 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.<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>:\u00a0Vice chair role at RCPsych as the faculty has been collaborating within the college to produce recommendations around outcomes.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I couldn\u2019t think properly as I had heart palpitations. I didn\u2019t know anyone and felt properly under the microscope. I was stressed out but trying to be at my best. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/11\/billy-boland-creating-a-culture-where-quality-improvement-is-a-way-of-life\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43004,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5751],"tags":[],"class_list":["post-43002","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billy-boland"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Billy Boland: Creating a culture where quality improvement is a way of life - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/11\/billy-boland-creating-a-culture-where-quality-improvement-is-a-way-of-life\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Billy Boland: Creating a culture where quality improvement is a way of life - The BMJ\" \/>\n<meta property=\"og:description\" content=\"I couldn\u2019t think properly as I had heart palpitations. 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