Editorial

Citation

Jackson, S. (2001), "Editorial", International Journal of Health Care Quality Assurance, Vol. 14 No. 4. https://doi.org/10.1108/ijhcqa.2001.06214daa.001

Editorial

In March of this year I was fortunate enough to attend the 6th European Forum for Quality Improvement in Health Care in Bologna, Italy. Whilst there were many thought-provoking and stimulating sessions during the three days, I did find one presenter's view of the world particularly interesting. In essence the session was about leadership, more specifically about front-line staff taking the lead on certain quality initiatives.

The presenter took great pains to explain that if senior managers wanted front-line staff to lead on quality improvement projects, the staff needed to be given the time to do so. What was implied by this comment was that senior managers had to be encouraging and a little directive in releasing individuals to undertake quality improvements, as front-line staff would not have the commitment or organisational skills to do it themselves. I disagreed with this presenter's view for a number of reasons.

First, I feel front-line staff do not need to be encouraged to embark on quality improvement projects as they all have the Will to do so. However, what is lacking is a real commitment from senior managers to provide an environment conducive towards continuous quality improvement. As a consequence, front-line staff keep their Will under lock and key for fear of wasting their time working on a quality improvement project that will go nowhere because of a lack of real senior management commitment. There is only so much front-line staff can achieve by themselves. Therefore what senior managers need to do is unlock that Will by creating an environment that truly supports quality improvements in healthcare. This may mean becoming personally involved or diverting financial resources to ensure the quality improvement aims are realised.

Second, I felt the comment was a little condescending because in my view front-line staff are more than able to arrange their workload to make time for quality improvement projects. But they choose not to because they believe their efforts will be in vain. As a consequence, they choose to deploy their energies on direct patient care knowing that this is the only approach to quality that they feel is sure of achieving the desired results i.e. completing the necessary tasks to provide good care and to ensure a happy patient, carer or colleague (external and internal customers). Hence system changes are often not achieved because front-line staff choose to avoid a scenario whereby history will only repeat itself.

My personal views stems from a couple of observations during my time as a senior manager within a UK hospital. Early into my time at the hospital I embarked on the journey of implementing the European Foundation for Quality Management (EFQM) Excellence Model within a particular department. As a result of the self-assessment a number of areas for improvement emerged. I then asked if there were any members of staff who were interested in transforming the improvement areas into strengths. I was extremely encouraged by the keenness of the staff within the unit, many of whom expressed that they felt so keen because they could see that I was committed actively to helping them make their improvement ideas work. They knew that I would do all I could to help them achieve their goals whilst at the same time promoting empowerment and freedom to pursue their activities in a way they preferred. I do not feel that this was anything special as in my view it should be the normal approach of any senior manager.

By encouraging an environment welcoming of innovation I found I did not need to ensure they had time to do the projects. Instead the front-line staff were more than equipped to manage their time in such a way that they prioritised time to work on the quality improvement projects. Furthermore, they encouraged wide involvement of the different areas within the department, which aided communication and dispersed the tasks into a manageable workload.

Within the space of two months one improvement group had collected the numerous customer perception questionnaires distributed by the different areas, analysed them, undertook a literature review and produced a draft questionnaire suitable for the whole department. Once this work had been done they also agreed a project plan for piloting the questionnaire, refining it and producing a final version suitable and acceptable to the whole department. A second group wanted to work on reducing the number of customer complaints by eliminating the common causes of the complaints. They did this by ensuring relevant corrective actions were identified, put in place and reviewed. This group experienced some difficulties in undertaking their work, which were mainly due to the unavailability of information and a little resistance from some key personnel.

Both groups did some sterling work and all I had to do as a senior manager was oil the wheels occasionally and praise them for their hard work. To explain, on one or two occasions the team members experienced resistance, displayed by reluctance to release information, from some senior personnel within and outside the department. The senior personnel within the unit were of a more junior grade to me and outside the department of a similar or more senior grade to me. Hence I had to use my negotiation skills to enable the quality improvement team to effectively undertake their work.

I never had to be directive in ensuring that time was made available for the project teams to pursue their goals. However, when I informed the presenter of the session of my experience he took great pains to express that his experience was very different to mine. This being the case it made me wonder about the experiences or views of the readers or previous authors of the journal. I would be keen to publish articles whereby senior managers had provided time for staff to undertake quality improvement work or where front-line staff felt supported enough by their senior managers to see a quality improvement project through to a successful outcome. Do any of you have such experiences that you would like to publish? Please let me know.

Sue Jackson