Building improvement capability is not only about skill building; it also includes creating an environment in which frontline staff can identify and participate in needed improvements. In this post, David Munch, MD, Senior Vice President and Chief Clinical Officer for Healthcare Performance Partners, argues in favor of better support for middle managers who lead improvement efforts by dispelling myths about building improvement capability. Dr. Munch is faculty for IHI’s web-based program, Leading Quality Improvement: Essentials for Managers.

I have the privilege of working with many organizations as they pursue efforts to improve the quality and safety of their care. I get to see what’s working and the challenges. Almost everywhere I go, I see organizations failing to adequately support the development and engagement of middle managers.

At the end of the day, a middle manager wants to see that his or her team is doing the right thing. Too often, however, teams struggle with a lack of clarity and barriers that are in their way. One of the most important ways to better support middle managers is to build an organization’s improvement capability. To make the case for this, it may help to dispel some of the myths about what building improvement capability really means.

Myth #1: Building improvement capability is all about learning a quality improvement methodology.
While it’s important to learn to use proven tools and methods to make improvement, building improvement capability is not only about skill building. It also means creating an environment in which the frontline staff can identify and participate in needed improvements. It’s the role of management and the executives to create this environment. This requires leaders to:

• Make improvement a priority
• Understand the development needs of the staff
• Provide support and training

Myth #2: A strong quality department is all you need to make improvement.
It’s extremely important to build improvement capability throughout an organization because we have so much we need to improve. As long as the ability to improve only resides within the quality department or with just a few people, you will never have enough change to get on top of all of the issues that we have in health care. You need to spread that capability so that the entire organization has the ability to engage in improvement. “All teach, all learn,” as we say at IHI.

Myth #3: Building improvement capability is too expensive.
It’s a misconception that improvement is costly. If you do it effectively, it costs less because it saves time and reduces waste. Think about it: When you don’t do something right the first time, you have to expend resources, energy, and effort to fix it and do it again. Design processes to be waste free, so that defects and rework don’t occur. Then, put in the management systems to support and sustain the improved processes.

Myth #4: The quality department should own improvement.
It should be the responsibility of hospital operations to own improvement. This means the frontline supervisor, the frontline manager, the vice president, and the executive. Why? Because improvement can be designed, encouraged, and facilitated by the quality department, but unless operations takes that handoff of responsibility and sustains those improvements, they will not last. If a defect or a problem occurs at the front lines of care, frontline staff and their supervisors are in the best position to identify such issues and determine potential improvements. The quality department can’t sustain this work alone over the long term.

Myth #5: Executives have the most important role in making improvement.
Executives and frontline staff are obviously essential to improvement. However, middle managers have a unique part to play. The middle manager is critically important within a system of improvement because they work on the units and are thus in the best place to observe issues from the front line, and help determine what frontline staff need. Their role is extraordinarily important because of their presence close to the point of care.

One of the biggest challenges for middle managers is that they are probably some of the busiest people in the hospital. To put the responsibility for improvement on their shoulders without relieving them of some other work will not be successful. Leaders need to work with managers to redistribute some of the work that doesn’t need their particular skills so they have the capacity and time to focus on improvement.

I feel passionately that we need to give middle managers more support for their role in leading improvement because I don’t see such support from health care leaders often enough. Leadership is about orchestrating the changes that have to occur for your organization to meet its mission as best it can. To do this, health care executives need to develop and support middle managers as one of the most important aspects of their leadership role.

Reposted from IHI