Care Design 2016

Thinking the Unthinkable - Asking the Unaskable

An important path to advance the Care Design 2016 principles will be the asking of the wicked questions that will lead to a deep exploration of assumptions held. Without exploring  assumptions, you will continue to be hostage to your indifference to failure and be unable to reach your improvement potential. Questions to the main protagonists.

The Role of All Health System Players 
  1. Do we play it safe by setting easily attainable goals? If so, why? Do we treat vision   and mission as noble ideas that we ignore in our everyday actions? If so, why? 

  2. Do we bury or spin bad news to avoid internal and external transparencies that could provide a compelling case for change, and suppress truth in the organization? If so, why? Do we congratulate ourselves based on short-term results achieved at the expense of long-term sustainability? If so, why

    3. Do we ask ourselves this key question: What behaviour have I tolerated in myself or others that conflicts with my commitment to patient safety and quality of care?

The Role of Governments 
1. To what extent do legislation, high-level policy documents, accountability frameworks and funding mechanisms incorporate quality targets and expectations? Has government signalled that quality is a core value and aspiration? Are these expectations enshrined in effective legislation, regulation and policy? 
2. Once quality-enhancing tools and techniques have demonstrated their value, is there a strategy to ensure their spread throughout the system within as short a time period as possible? 
3. Have governments communicated to regulatory, licensure and accreditation authorities the importance of making quality a core expectation and requirement? 

The Role of Accreditation, Regulatory and Licensing Bodies
1. How robust are the quality requirements and practices? Are there meaningful sanctions and remedies in the event of substandard quality performance?
2. Do licensing and accreditation bodies require practice audits, feedback and responses at the individual and unit levels in healthcare organizations?
3. Do professional licensing bodies incorporate quality principles, tools and techniques as part of their core knowledge requirements? Do licensing bodies require continuing education on quality enhancement practices as a condition of continued or renewed licensure?

The Role of Organizational Governance 
1. Do boards make it clear that the adoption of quality improvement practices is a core expectation? Do they drive improvement beyond the requirements of government and external accreditation, regulatory and licensing bodies? Is quality a core element of boards’ own continuing education and professional development agenda? 
2. How do boards articulate their quality goals and expectations? How do they communicate their commitments to their organization? What information do boards request and receive on quality performance and issues? What do they do with this information? 
3. To what extent are board resource allocation priorities and decisions focused on improving quality?
Health Science Education Programs 
1. Do health science education programs require that practicum and apprenticeship sites be committed to a quality improvement agenda and model behaviours consistent with a quality culture?
  1. Do health science education programs emphasize inter- 
    professional collaborative practice and teach quality theory and practice from the perspective of teamwork and interdependency? 
  2. Do health science education programs ensure that students acquire information technology skills and view the analysis of clinical data as fundamental to their professional development? 

Health Services Executives and Managers 
  1. When quality incidents occur, are there formal processes for turning them into learning opportunities? Does the organization walk the talk of a non-blaming culture that seeks lessons for improvement from quality incidents rather than perpetrators to punish? 
  2. Do organizational leaders invest adequate resources to support quality improvement? Does the culture signal that improvement is a core organizational value and an integral part of front-line work? 
  3. Are there processes in place to identify and address unjustifiable variations in practice? Are clinical peers jointly accountable for overall performance within their control? Are all clinical occupations equally valued and integrated into the quality improvement culture? Do measurement, evaluation and feedback systems focus on team performance and processes?
  Professional Cultures and Values 
  1. What is the hierarchy of values among professionals? Does quality trump other professional values such as autonomy and group loyalty? How is clinical autonomy defined, and is it consistent with a systems view of quality and accountability? 
  2. Are professionals concerned about broader unit or organizational performance? Do they view variations in practice as inherent danger signs? Are they willing to adopt proven practices and standards in service of better performance? 
  3. Do professionals perceive advanced health information gathering and analysis as core elements of their identity? Do they advocate for an information-rich environment and embrace performance measurement as a prerequisite to improvement? 

Every element of what is set out has been uttered a thousand times in cafeteria conversations and behind-the-back lamentations. Time ASK LISTEN TALK ACT



Gillian J Nov 17, 2015

I believe these views have been presented very eloquently indeed while staying on topic.

Ask Listen Talk Act - is great way to see things providing people/bureaucrats in charge of 'the system' are brave enough to put patient's values above budgets because budgets can be worked out - but only when you know it is that you need to deliver. 

I sincerely hope that a lot of people read and re-read your comment because it is only when such frankness is openly shared that people will eventually have no choice but to sit up and listen and then (as you rightly said ) act.

Your article was well written in plain language while getting the points over. I hope it takes up pole position for the benefit of all.