Quality is not an act, it’s a habit Aristotle

Aristotle’s message encapsulates the approach that many organizations attempt to take to quality, and fail. When we view quality as a checklist, an alarm, or a campaign, we fail to see why quality should be an overarching mindset and not a task. The subject of how organizations approach quality has occupied my thoughts for several months. Not only is quality a key area of practice for me, but also because I am still suffering the results of a medical error, and can’t help but to analyze why this occurred. The short story of what happened to me is that I repeatedly told the clinical staff what was wrong but no one listened.XFI Project Competency

I’ve always been interested in the area of quality improvement since the beginning of my nursing career. I suppose it’s the forever curious, always analytical aspects of my personality that I have to know why something happened. That hunger to know why isn’t about blame but the need to find answers; to find a root cause. This quality management journey led me down a path of working with technology, becoming a Lean/Six Sigma Black Belt, and certified in Quality from Harvard/IHI. Never in a million years did I think I would be addressing this topic from a very personal perspective. I always believed that people don’t fail but our systems do. I’ve come to the conclusion that yes, people do fail when they stop paying attention, and stop listening to what’s being told to them. Ironically, in my cathartic process to discuss what happened to me with my friends and colleagues, I’ve learned some of this issue, that seems to have plagued healthcare, exists in other industries as well.

One of the most fundamental problems in our society is the complete lack of engagement in the present. We are not engaged with one another when we speak – we’re thinking about the 10 other things we need to do or we are thinking how we’ll respond to what they are saying. We’re not engaged when we’re pressured to fit an incredible amount of work in a short period of time. We are not even engaged on the highway when driving a car. Too many people are busy looking at their phones and not the road. I was driving down the road recently and saw a sign that warned drivers to stop texting and just drive. If you began driving before the age of smartphones, could you ever imagine a time when we would have to remind someone to just drive the car? We’re having difficulty just being in the present. In 1957, Harvard Business Review published an article simply titled “Listening to People” and yet 60 years later we still struggle with this concept. Why is this so difficult for individuals to do especially when the impact of not listening is so severe? When we are not engaged, we cannot effectively listen, we’re unable to learn, and recall of the conversation is almost nonexistent. Given this, it’s no wondered there are risks to patient safety.

Healthcare has attempted to address quality and safety issues through technology decision support, clinical pathways, and checklists, but for many organizations their quality scores are no better. A friend, and Healthcare Quality expert, suggested that perhaps our desire to improve quality through the use of checklists has had the opposite effect of what we intended by removing critical thinking and engagement in our surroundings. Again, we go back to this idea of not being engaged per se but an automaton completing tasks without listening, engaging, and critical thinking skills. Perhaps compounding this is the level of specialized education clinicians have received and specialization in practice. You may wonder how specialized education can ever be a bad thing in healthcare yet the expression “when all you have is a hammer everything looks like a nail” comes to mind. Are we fostering skill sets that promote the intense examination of a few conditions while failing to acknowledge others? If we are singularly focused on a few conditions we know best and not fully engaged in what else could be wrong with the patient, we create the perfect conditions for something to be missed.

I mentioned earlier how the very concepts that seem to be hurting the healthcare system are hurting other industries, like our elementary school systems. Two friends, each with a child with special needs have encountered these same challenges with the school system. For the sake of clarification, these are not children with a diagnosis but rather a specific concern requiring attention. For both parents, the frustration is with teachers not knowing how to address a child without a diagnosis but with special needs. In addition, the parental guidance offered to the teachers is quickly dismissed and devalued as the teacher believes they are the expert. Are any of us really experts of someone else’s body? I would say, no.

Healthcare organizations need to examine their current quality practices not from a procedural perspective but from an employee perspective. What about your environment supports the safe delivery of care? Do you acknowledge and process what the patient has to say in a respectful, careful way that allows for further investigation? Do you remove distractions and allow individuals to focus on the task at hand? The next time you or someone else “zones-out”, remember someone’s life could be in the balance.