When it comes to quality improvement, veteran improvement advisor Jane Taylor, EdD, has likely seen it all. For more than two decades, she has been advising teams across the country on how to overcome barriers to system level change and then how to make change stick. NICHQ recently caught up with Taylor to talk about trends in the quality improvement field.
What is a top trend you are seeing in quality improvement work?
There is a need to understand all the data that can help further improvement. The focus used to be more on quantitative data, but now people are collecting more qualitative data, such as stories from patients, and they are also using focus groups and interviews to understand both staff and user experiences. Qualitative data is important because there is always more going on than what we know. If you ask what the changes mean to people you get more insight into results.
How do you handle conflicting data?
My first response is simple curiosity. What is going on? Why is there data from one source that conflicts with another? What is not yet understood? It is possible for numeric data to tell me one thing and qualitative data to tell me something else. That may indicate that some assumptions about the work are faulty, so that is the first thing to look at. Then you start to ask: is data being collected properly? Is it representative? I get curious and try to understand more about what’s going on.
What do teams struggle most with when it comes to quality improvement work?
The hardest things for many teams, once they figure out what they want to work on, is conducting small tests of change, known as Plan-Do-Study-Act (PDSA) cycles
, in a rigorous way – that is, getting tests small enough and frequent enough to be useful. The rigor of small tests of change is the hardest thing to grasp because we have a culture where being busy equates to being productive. We’re impatient and when we have a good idea we think we should implement it immediately. Doing small tests of change is a cultural challenge. And doing sequential tests that continually build confidence in change is even harder. Often teams will do just one test and go to premature implementation. They don’t understand that it is very important to test a change under a wide range of conditions to make sure the change will really work.
Why is premature implementation detrimental?
Having to undo something is much more work than creating it as you go. Unraveling a bad change is always much more costly on all levels, especially in terms of the will of the people. If you make changes that don’t work or changes that make things worse, people may become more resistant to change in the future or worse yet, cynicism sets in.
Where do you see the most progress in improvement work?
The medical home
arena has delivered some of the most transformative work I’ve seen because parents and families are involved at the ground level of the improvement work. You can predict that when families are involved in a project and on the improvement team you’ll get much better result.
Why are the results that much better?
W. Edward Deming
reminded us that profound knowledge comes from the outside and by invitation only. Parents bring an outside perspective. Medical home design is useful for families and their children and they have a stake in it. Because they aren’t employees, families can advocate for projects in a way staff can’t. Family advocates have a different kind of voice, unique experiences and access to influence. When teams realize how to become truly collaborative and take advantage of what families bring, they become very powerful forces for change.
How would you end this sentence? If you don’t improve…
You become obsolete. Other people around you learn very quickly how to become better. If you are not improving and others around you are accelerating to discover what the consumer finds more useful, the gap gets bigger and bigger and it gets harder and harder to catch up.