Why quality language is killing quality - and how the IHI governance framework can help...QNews2 2019

Many of you will know that a significant part of my role is working with organisations to define the high quality experience their consumers want and that they want to provide: two perspectives that dovetail beautifully.   I've had the privilege of developing this definition with thousands of people - consumers, managers, staff, boards, executives, clinicians - over the past few years.  And as most of you will also know, what people want varies little;  whatever the sector, human beings want to experience and provide care that is focused on their perspective and needs; keeps them safe; is right for them and gets the job done; and fits together like a jigsaw where everyone knows what the box-top looks like and is working together to construct it in a seamless and timely manner. Within that we can weave efficiency and equity, however, these are generally taken care of via funding and policy requirements.  Reducing variation and not letting people fall through the cracks of disconnected care fit perfectly into the goal to provide integrated care.  Personal, Safe, Effective and Connected care are goals that everyone can understand and aspire to - across services and sectors, and up and down hierarchies.   Within this model, you're either creating quality, by directly striving for  these goals with every consumer, or you're supporting someone else to strive for them through a management, governance, systems or back of house role.  That's it.

So you can imagine the kernel of hope I felt when the new IHI 'WHITE PAPER: Framework for Effective Board Governance of Health System Quality' was released recently, urgin boards to govern for safety - and beyond: 'The IOM report Crossing the Quality Chasm established six aims for improvement, a framework for health care quality in the US: care that is safe, timely, effective, efficient, equitable, and patient centered (STEEEP). Safety is an essential component of quality, and health leaders have become more consistent in the governance of the elements of safety (though many health systems still do not dedicate enough time to quality or are quick to push it to the bottom of the agenda).
Yet governance of the other STEEEP dimensions of quality beyond safety is significantly more variable, providing an opportunity for greater clarity and calibration across the health care organizations and leaders that guide governance of quality.'

Hooray!  We're back!  I have to confess I'm not a big fan of STEEP as the newest quality acronym - because whilst this will serve to define and broaden the concept of a high quality experience, which is great, it's not something that frontline managers and staff will relate well to, which is not going to help with implementation.  Staff like to know what they're going to work to do - and 'STEEP' doesn't really fit this bill in the same way that 'create great care' does. However,  it's a powerful first step that will greatly assist with cleaning up our language and getting us back on a clearer, more meaningful track. 

The 2019 language challenge

Regular QNews readers will know that I love to start a new year challenging individuals and organisations to make some small, practical changes, so we don't end up doing the same things for another year and expecting different results. At the end of 2018 I sent you two QualityClasses on how to achieve the concrete point of care results you want to lead, achieve and be known for over the next 12 months, where I described two accelerating actions you can take to turbo charge your progress towards great care in 2019: shifting your focus from compliance to results; and identifying the results your quality system should be focused on achieving. I also walked through my one page quality system performance assessment tool that you can use to assess how well your quality system is achieving those results.

If you haven't watched or listened to the QualityClasses, watch them here  or listen to the audio hereIf you don't have the free one page assessment tool, find it here.  

I also introduced you to my new book, The Point of Care, which gives a best practice case study of leading great care, incorporating my best tools and strategies and including the two accelerating actions.

So, my challenge for 2019?  Commit to clarifying the language of quality in your organisation, so it's as precise as accounting language.  We don't use 'cash flow' and 'balance sheet' interchangeably - without revealing we don't know what we're talking about, anyway - so let's not do it with quality.  Let's bring back what we're really talking about - either creating or supporting  the creation of  'quality care' at point of care: personal, safe, effective and  connected, or whatever variations of those descriptors work for your service.   Stop 'doing' quality in your organisation, or striving for 'safe, person-centred, quality care' or whatever it is that's currently holding you back, and start embracing the proactive creation of quality care - as defined. 

A challenging change - but one that has transformative potential.


Daley Ullem E, Gandhi TK, Mate K, Whittington J, Renton M, Huebner J. Framework for Effective Board Governance of Health System Quality. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available on ihi.org)

Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001