Personal qualities of an improver

Anna Burhouse
DIRECTOR OF QUALITY, WEAHSN
VISTING SENIOR RESEARCH FELLOW, CHI 2
Are improvers born that way?

© inarik
 Did you automatically get a
cape when you qualified as
a health professional,
started to work in
healthcare or became a
patient?

© jayfish
Why do we need to look at things in
this way? • Healthcare is such a complex
system that no single superhero
can 'fix' all the issues that need
improving
• Instead we need to take a
distributed leadership approach,
where everyone has a role to play
as an improver
• Where you do your job and
improve your job and see this as a
© BraunS process of continual learning, your
very own PDSA
The Health Foundation’s 15 Habits of
an Improver 2015
Professor Bill Lucas describes 15 common 'habits' or qualities which
healthcare improvers regularly use. These fall into 5 broad categories:

• Learning
• Influencing
• Resilience
• Creativity
• Systems thinking
Learning is at your heart
• Improvers are good at asking questions and
listening to others.
• An improver tries to discover why something is
not working or how something went really well
or how to embed learning from elsewhere. They
don't do change just for change's sake but,
equally, they are not happy to have to 'put up'
with something just because 'that's the way we
always do it around here'.
• An improver knows how to use tools like the 5 © hanohiki
whys, fishbone diagrams, process maps and
others to investigate, discover and stimulate
debate.
Improvers learn to get better at
influencing • They practice empathy and regularly think
about things from other people's perspectives,
appreciating the richness of thought diversity
• They learn how to engage others in the task of
improvement and can facilitate individuals and
groups, using techniques like coaching
conversations and group exercises
• They are comfortable with not knowing and can
help others stay with ambiguity and the 'mess'
of complexity in order to better understand the
underlying issues requiring improvement
• They can hold difficult conversations when
© sezer66 needed and can reflect and learn from conflict.
Improvers try to practice resilience
• Improvement journeys are rarely straightforward.
Things often go differently than planned.
• Improvers need the ability to be resilient and
continue to be curious about what has gone on,
to find out what can be learnt from the new
situation. Then, with this new data, and resilience
the improver can adapt their thinking, suggest
new changes to test and try again © artisteer

• Bill Lucas says "Simple or even complicated

situations call on reliable responses, but many
things in health are inherently complex and call
on adaptation." (”The habits of an improver: Thinking about
learning for improvement in health care” 2015, p14)
Creativity
• Improvers don't have to be a really creative person
themselves, but they often are good at helping groups to
generate ideas and creating the environments where people
can begin to imagine a different way of doing things.
• They can draw upon a range of tools and techniques to
stimulate creative problem solving, visioning of the future,
helping others to start to imagine what their common
purpose could be, the end goal of the improvement journey.
• They are good at helping to think through the relative merits
and drawbacks of a particular idea, using tools like a SWOT
analysis, De Bono's Six Hats exercise or methods like
appreciative inquiry
• They are good at drawing all of the team into discussions
about what is needed and how to get there. They recognise
the strength of thought diversity and the individual
contributions of all the team members. © pepifoto
Systems Thinking
• Improvers understand that “Every system is perfectly designed to get the
results it gets,” Paul Batalden, Patient Safety & Quality Healthcare blog
August 3, 2015.
• To do this improvers have to be good at seeing the overall system and how
it is made up of a complex set of interrelated microsystems. Most patients
in healthcare have to relate to multiple microsystems throughout their
treatment and the way they link together, communicate, pass on information
can impact on the overall experience of the patient.
• Often the task of the improver is to share the experience of teams in their
different Microsystems with each other to generate empathy, understanding
of each other’s challenges and ways of joint working that will result in
improvements for patients.
Conclusions
• So, in conclusion, Bill Lucas (2015) helpfully reminds us that habits can be
gained, can grow in strength as we practice them and can be refined and
polished.
• As you look at this long list, don't be put off if you don't yet have all the
habits. You and I and everyone trying to do their best to be an improver will
get it right sometimes and spectacularly fail at others. The habit of an
improver is to pick yourself up when this happens, learn from experience,
reflect on what you could have done differently and have another go.
• Being an improver is a state of mind, an outlook and a collection of habits
which can't be captured in a job description.
• Good luck on your journey!
© The Open University
Distributed by UNIVERSITY OF BATH and FUTURELEARN under licence
Acknowledgements
Academic content for Quality Improvement in Healthcare:
© Anna Burhouse, Dr Patricia Woodhead, Dr Christos Vasilakis, 2016

Production:
© University of Bath 2016

Images:
© istockphoto.com#70109873/gerenme/26-07-15 © OpenLearn Works via www.open.edu [CC BY-NC-SA 4.0
© istockphoto.com#17687419/inarik/13-09-11 © istockphoto.com#63226387/artisteer/02-05-15
© istockphoto.com#60911430/jayfish/30-03-15 © istockphoto.com#85442089/pepifoto/08-02-16
© istockphoto.com#66895921/BraunS/11-06-15
© istockphoto.com#67908251/hanohiki/30-06-15
© istockphoto.com#90920799/sezer66/28/04/16
© Bill Lucas, Hadjer Nacer (2015) “The habits of an improver:
Thinking about learning for improvement in health care” P14