Engaging Boards in Quality Improvement
“Culture eats strategy for breakfast.” So what can the board do to cultivate a culture of continuous improvement? In our latest podcast episode, host Brenda McLeod dives deep into the board’s role in shaping vision and culture, championing innovation and improvement, and keeping patient care at the heart of everything we do.
“I actually do entitle it a leadership challenge,” said Professor Andy Hardy, Chief Executive at University Hospitals, Coventry and Warwickshire NHS Trust. He stressed the importance of modeling by people in leadership positions. “We set culture in the way we behave and what we do. People watch what leaders do: how we spend our time must be important, and so we need to change what we do and how we spend our time.”
Hardy hosts an improvement meeting every Tuesday in the hospital’s main reception area where staff from across the organization make “short, sharp presentations” about their improvement work. He sees this as an important element of demonstrating that quality management is not something apart and separate from everyday operations: it is, simply “the way we do things around here.”
Anita Day is currently chair at East and North Hertfordshire Teaching NHS Trust and a non-executive board member at Lincolnshire Integrated Care Board. Prior to joining NHS she worked in improvement in the private sector, with IBM. She says the most powerful transformation can happen when you’re able to bring together the management system and organizational culture.
She also stresses the importance of building improvement into everything she does. “You just make it part of everyday conversation. And I think if all members of the board executives and non-executives have that top of mind, you create a really powerful culture, which then reinforces the kind of more formal parts of the system.”
Part of that comes from making the system your own. “It has to feel like it belongs to the organization…We call it the ENH Production System. It’s based on VMI principles, but it’s ours, and I think that culturally, it sits better. If it doesn’t feel like, ‘oh yeah, some American hospital is going to tell us how to do stuff.’
For Adam Sewell Jones, Chief Executive at East & North Hertfordshire Teaching NHS Trust, learning is central to improvement, at every level: “We need to role model this and put the execs through the training.” Involving board members in training early on is, he says, an essential part of getting buy-in early on in the process.
“Boards are kind of guardians of the quality of care patients receive,” said Virginia Mason Institute Executive Director Wendy Korthuis-Smith, “and this means not just reacting to opportunities and failures, but actively driving the systems, behaviors and innovations that prevent them. And when boards are involved in improvement, they’re investing in their people.”
Ultimately, for Professor Hardy, the challenge and opportunity for leaders is to shift from being ‘problem solvers’ to ‘problem framers,’ “those who do the work know the work, those who know the work, improve the work. So let those people get on then, empower them, give them the tools.” Go See, Ask Why, and Show Respect.
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