Quality Improvement (QI) — a systematic approach that uses specific techniques to improve quality — is rightly seen as the way forward for leaders in healthcare, who feel that it should be embraced to boost effectiveness and enhance care for patients. With healthcare settings facing constant pressures and resource constraints, QI has growing recognition as a beneficial approach to achieving quality and effective patient care.
There is much feedback on the benefits of using QI for healthcare teams and also a general feeling that quality care can be achieved if our healthcare leadership embrace quality improvement.
Types of leadership in healthcare
There are many types of leadership styles evident within healthcare, but one thing seems clear: great leadership produces great teams with lower stress levels and higher quality patient care. When reviewing evidence compiled over recent years, researchers have discovered a resounding message: ‘Healthcare staff often have a positive experience of quality improvement (QI) compared with the daily experience of how their organisations are led and managed.’
It has been quoted that staff prefer non-hierarchical approaches and ‘Clinicians often perceive managerial interactions as authoritarian and lacking patient-centredness and see QI as inclusive, bottom-up engagement’.
Firth-Cozens and Mowbray reviewed evidence and concluded that: ‘One important way in which leaders affect patient care and satisfaction is through their management of teams.’
One thing is clear: great leaders who invest in QI can set the tone and transform the culture of an organisation or team. If we want QI to become widespread and the norm in healthcare, management and leadership need to be willing to change.
QI as the basis of management
The report by the Health Foundation ‘What’s Leadership Got to do with it?’ seeks to understand the links between leadership and quality improvement in the NHS. The document summarises that there is enough evidence from a wide range of sources supporting the idea that effective QI is attainable with the right leadership and culture.
To quote John R Drew and Meghana Pandit in their BMJ article: "QI needs to become the basis of how organisations are led and managed, replacing traditional, hierarchical structures and incentives."
What’s already known about links between leadership and QI?
Leadership style strongly influences organisational culture, which can itself have a huge impact on that organisation’s performance. Other studies highlight the link between leadership approach and compassionate care and patient safety. For Quality Improvement to be embedded within a healthcare organisation, QI needs to be both embraced and advocated by leaders.
How can we help leaders get on this path?
In order to help leaders, follow the path to quality improvement, a focus on relationships and culture needs to be a priority for those at the highest level. Staff should feel secure raising concerns and putting forward ideas for improvement. Improvement needs to be embraced as a core element of the organisation’s culture and be commonplace in conversations between staff at all levels.
What are the links between leadership and improvement in healthcare?
While there is only emerging evidence currently on the links between leadership and QI, there is a growing body of thought that culture plays a vital role in the quest for QI. A strong focus on groups and teams rather than individuals, and leaders who seek to engage with teams enable quality to become embedded in the culture.
Qualitative data provided by participants for the top 10 ranked leadership behaviours, ranges from identifying and nurturing talents to showing commitment to innovation. The study shows that with a shift in leadership thinking, leaders can give patient-facing teams the backing they need to enhance patient care. By trusting their team’s knowledge, creating a no-blame culture and by supporting for innovation and QI.
In summary, in the study of whether healthcare leaders should embrace quality improvement one thing is certain: good leadership is critical for strengthening quality and boosting the integration of care, while embracing QI can in turn support leaders to achieve great things.