Why So Much Healthcare Quality Work Fails to Change the System (And What You Can Do About It)

Why This Episode Matters

Many healthcare organizations say quality matters. Far fewer are built so improvement is part of daily operations. Too often, quality is treated as a department, a committee agenda, or a set of projects at the edge of the real work.

In this conversation, Dr. David M. Williams offers a different frame. He argues that quality should function as an organizational strategy: clarifying purpose, understanding the system, choosing the right work, building capability, and creating conditions for learning. For leaders trying to move beyond scattered projects and initiative fatigue, this conversation offers a more coherent way forward.

Key Ideas Explored

•  Quality is not a department. It is a way an organization pursues its purpose. 
•  Many “errors” reflect poorly designed systems, not isolated individual failures. 
•  Project work loses power when it is reactionary, peripheral, or poorly aligned. 
•  Leaders need a theory for how quality works across the organization. 
•  Shared methods make improvement more teachable, scalable, and reliable. 
•  Improvement capability must connect to governance, priorities, and daily work. 

Takeaways for Quality Leaders

•  Revisit your organization’s purpose and what it demands of the system. 
•  Examine whether your improvement work is focused on core work or safer side projects. 
•  Look for signs that quality is structurally marginal. 
•  Build a shared improvement method, not a patchwork of frameworks. 
•  Invest in helping teams get better at rigorous improvement. 
•  Treat implementation and spread as part of the work. 
•  Ask whether quality is changing how the organization actually operates.

Continue the Conversation

Connect with David M. Williams, PhD via his website or LinkedIn profile.

His next QOS Series starts in April 2026: 

https://davidmwilliamsphd.com/qos-series/

Resources & Frameworks Referenced

• Quality as an Organizational Strategy
• The QOS Field Guide
•  W. Edwards Deming’s system of profound knowledge 
•  Deming’s “production viewed as a system” 
•  The Model for Improvement 
•  IHI Whole System Quality 
•  The Chief Quality Officer Professional Development Program 

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

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Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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New episodes published every other Thursday at 7AM Eastern Time.

Credits:

Host, Writer, and Executive Producer
Jason Meadows, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Transcript

Why Quality Needs A Theory

SPEAKER_00 0:00

One of the reasons that we created the chief quality officer program in the first place is there was no theory. Everybody interviewed it. I'd say, Well, what's your theory about how to do it? And it was all kind of like, nobody's ever asked me that. Well, let me tell you what I do. So part of what I did is developed a theory and created a driver diagram. And a lot of it was rooted in what IHI was doing at the time. But there's a need for organizations to have a theory about how do they approach quality as a structure and across the system.

SPEAKER_01 0:28

Welcome

Meet Dr. David Williams

SPEAKER_01 0:29

to Leading Quality, the podcast spotlighting the people moving healthcare forward from the front lines to the C suite. I'm your host, Jason Meadows. My guest today is Dr. David Williams. David has spent decades working at the intersection of improvement science, leadership, and systems thinking, helping organizations move beyond isolated improvement projects to something much more powerful, building systems that are designed to learn and improve. His path into this work actually began on the front lines. Early in his career, he worked as a paramedic and later as a chief quality officer for a large metropolitan ambulance service, where he began to see a pattern that many of us in improvement eventually encounter. When something went wrong, the instinct was to investigate the individual. But when he looked closely, he discovered something deeper. The people involved were often just, as David puts it, the improvement canaries, revealing problems in systems that were never designed to reliably produce the outcomes we expected. That realization led him to a lifelong focus on how we design systems that actually work for most people most of the time. Over the past two decades, David has been deeply involved with the Institute for Healthcare Improvement, serving as a senior lead for improvement science and methods, and helping shape how improvement capability is built across organizations. He has worked with health systems, educators, and leaders across multiple industries applying improvement science to complex systems. More recently, he co-authored the book Quality as an Organizational Strategy, along with Lloyd Provost and Cliff Norman. The work builds on ideas from Deming and the Science of Improvement to explore a central question for healthcare leaders. What would it look like if quality wasn't just a department or a set of projects, but the core strategy that guides how an entire organization learns, improves, and delivers care? That is the question we explore in today's conversation. David, welcome to the podcast.

From Paramedic To Quality Leader

SPEAKER_00 3:13

So I went to college to uh for ambulance system design and uh ambulance management and was uh I worked as a paramedic for a number of years in cities in in the states. And then my first um leadership role actually was to be the chief quality officer for a large uh metropolitan ambulance service. Uh and uh part of the reason that I ended up in this role was that I was doing a graduate program uh in the management of um ambulance systems, and uh I took a uh a course uh that was related to quality um that was being taught by folks that had been trying uh similar to uh how folks in healthcare had been trying to bring quality into industry, the uh there was uh folks that were trying to bring it into the pre-hospital space. And I studied quality and uh ended up in this role initially. And then I I worked in um uh ambulance system consulting and quality for a number of years, and that's how I crossed over into healthcare. Uh my colleagues from Associates and Process Improvement who were uh really fundamental to developing the methods uh and early work at IHI um were from Austin, where I live. And uh they invited me uh to come and be an improvement advisor on uh projects at IHI, and that was about 17 years ago. So I've uh been collaborating. IHI has been one of my clients for about 17 years. I spent uh about five uh years uh on the leadership team there as the senior lead of improvement science and methods and leadership. And then I've been uh a faculty member um with IHI, I think for about six or seven years since since I left.

SPEAKER_01 4:54

Yeah, and you mentioned um having been a chief quality officer for an ambulance uh emergency management system, you said first of all, when was that role and and what was that like? Because I can imagine your your career has followed a uh kind of a progression towards uh from more frontline stuff to to more quality as an organizational strategy, which which we'll talk a lot about um as we go. But uh I'm curious what that job was like, and then maybe we'll contrast that with how your thinking has evolved over time.

SPEAKER_00 5:28

Yeah, so my role um as a chief quality officer was was 26 years ago. Um, and I was in it for about uh four years. At that time, it was still a heavy focus on um individual error and uh sort of investigating root causes. So so a big a big chunk of my work at that time was in that space where where either um we would identify our office would identify or people would self-report um that there had been some kind of deviation from practice or some kind of mistake that occurred. And then, you know, my department at the time was really focused on uh they called it kinder in gentler, but really it was investigating uh these events and uh trying to do a blend of of employee education with uh I call it an illusion of improvement, but uh uh you know, there was a sense that we were looking for ways that we could fix the system, but there was always a theory that the system was actually kind of okay and that just people uh forgot things or deviated or or did stuff. But at that time, one of the things that was sort of uh a revelation for me was that almost any time that I looked at any anything that was reported, if I you know pulled a sample of cases, I would find, you know, 20 or 30 uh instances that weren't reported that people didn't even know um where something similar had happened. So over and over again I was I was realizing that the the system was um was not built uh not fit for purposes, uh Jerron uh used to say. And so uh, you know, it it was uh these people were just the the what I call the improvement canaries. Like they were telling me about things that were uh happening in the system, and they were just the unfortunate person that uh happened to be either identified as making the the mistake or um or were raised their hand and said, I think I I I missed something. And they were just really the telling me that the system needed to be fixed.

SPEAKER_01 7:28

Yeah, I I think the you know the the tip of the iceberg is is something that uh that a lot of people in in this field could relate to, seeing you know the case that gets reported is is only one of many. How did you come to actually find that out? That's interesting that you were able to discover all of these underlying cases.

SPEAKER_00 7:46

There

When Error Reviews Expose Systems

SPEAKER_00 7:47

are a couple of different places. I mean, it was it was you know, when I started the role, it was already in this position that it was about um looking at individual error. So that was kind of the job that I entered. But over the course of my early career in quality, like I there were there were a number of different events that I that started small and then when I pulled the thread um created um uh bigger learnings about the system. So I mean, two in particular ones that really stand out is uh um in the 90s, there was um there was a movement uh in emergency medicine for years. If somebody was, you know, fell off a roof or if they were in a car accident and and uh uh their car rolled or something like that. The common practice at that time was to assume that they had um uh some kind of spinal cord injury. And so in the pre-hospital environment, what they would do is they would they would gingerly move people onto these long, uh oftentimes just wooden boards. They they innovated to plastic, but they were, you know, these hard, rigid boards. And then they would strap them down on these boards to hold them secure. And once that happened, you might be on that board for, you know, an hour or more while you were transported to the emergency department, while you were evaluated for the emergency department, while the emergency department took you to the uh to to have imaging, only to rule out that you, you know, there was such a small number that actually had an injury. And and sadly, in this time frame, then you're also uncomfortable. Um, you generate pain, you potentially have uh a risk for pressure ultrasound, all kinds of things that were going on. So, so there was there was a big study in the the 90s that um looked at the potential to be able to use some criteria to be able to figure out who should be evaluated or not, who's at risk. Uh it's called the Nexus study. And so there we were trying to figure out how to how to do that um in the field, the pre-hospital environment with paramedics, because if we could do that, we could dramatically reduce the if we could assess people around these evidence-based criteria, we could dramatically reduce the number of people that got um put on these long boards. And then that from a patient experience standpoint, they would just all the way down the pathway if um would be um having a better experience, lower cost, lots of less issues. And so anyway, we um we implemented a protocol and training program to do that. And just right afterwards, we just continually were having issues, uh, errors were being reported, people were saying that you know folks were following the guideline, doing all this stuff. And and it was it was fascinating because one of the hardest protocols that we had ever uh tried to introduce or changes to care. Um, we had done multiple um uh training programs, we had tried it in different vehicles, we had um, you know, different avenues for doing it. And what I discovered when I got into it, and especially when I started to pull records of these errors, is that, you know, I was I was getting one or two or three reported every day, but I could pull 20 and uh, you know, 20 cases and almost all of them had some issue. So so it was obvious that this was not working as we had designed it. And it was obvious that the the people, the people that were trying to assess and take care of patients were trying to do their best and didn't know what they were doing wrong. And actually, I'm not really sure that they were truly doing anything wrong. And it was a system issue. So, I mean, that was that was one of the first ones where every time I pulled a sample, I would find errors that were exponentially more errors, I say, in terms of a perception that things deviated from the standard we thought mattered. Um and uh and the reality was just that we didn't have a system that could produce good good results. And so that that was a a huge learning. Um I I did another similar project that was uh related to uh medication administration and and uh narcotic administration that just and actually it was really around storage of all things of proper storage and and sort of um custody of of narcotics because paramedics carry them. Um they they they so unlike in a hospital where there's a um you know, there's you go to a very locked box on the side and you have to enter in codes and there's all kinds of safety things. In some uh places, uh people physically carry them on their body. Uh sometimes they're carried in a bag or they're in some kind of locked cabinet, and there has to be a transfer of custody from you know shift to shift. And so there was a custody transfer issue that when I, you know, went to investigate this individual case, which uh were around individual providers that were actually at risk of losing their um position, I unpacked just system issues left and right of all kinds of stuff. And so every time one of these things happened, I would discover, if I looked, I would discover that the system was never built to produce the results that we wanted. And so that theme emerged over and over again. And uh I wanted to figure out how how do I uh improve systems that get good results versus try to investigate people that that are the you know that 5% that create errors and have issues.

SPEAKER_01 12:56

You know, you you describe again this this early role where it was very heavily project-based and an individual review-based kind of starts to feel like this initiative treadmill or you know, project IDIS, as I've heard some people refer to it. When was it that you kind of started to realize over this the course of your career that this was that there was something that needed at a at a higher level that you needed to be able to zoom out and and change the structure rather than focusing on individual projects?

Escaping Reactive Project Fatigue

SPEAKER_00 13:26

So um it was a couple things. So so actually um I will push back a little bit in the fact that um almost all improvement happens in the context of projects. Uh and so that that's actually useful. Um, I think what you're describing that's a challenge is that um very frequently, like in my my early experience, projects were um they were episodic and and emerged out of perceived events, not necessarily so they were reactionary um versus strategic. A lot of the fatigue you that you're describing that I see uh quite a bit is is absolutely right, that people um generate uh portfolios of efforts or initiatives of which are desired to be uh pursued, and they may not have been chosen based on looking at the system that you have and figuring out are these the most most important, impactful things that we should be working on? And then how do we how did we evaluate it in order to be able to figure out what to do and what needs to get done? And so, so I I I find today, I mean, I think that's one of the things that I that was sort of groundbreaking for me, and a lot came from from my early work with with my uh my mentors at associates in process improvement was this sort of shift of looking at and sort of investigating root cross to flipping and saying, well, I want to figure out how to create the system that gets the results that I want. And then if there's a gap between the system I have and the system that I want, then I need to work on that journey. How do I go from the system of today to the system that I should have so that I create a system that uh I like to say, you know, works for most people most of the time in human systems. So it's not perfect. It's not, you know, we're not manufacturing where we we can dial things down into very, very tight numbers. But in human systems, that that's my main goal. I'm trying to get it to work for most people most of the time. And that's where the shift really flipped for me is to say what we're trying to do is build a theory about what that system is, use techniques to understand the system that we have, and then also to try to test and adapt that system and see if what we're doing results in improvement. And that that that shift started, you know, probably 20 years ago and has been, you know, what what most of my time has been focused on, either at the the project level, like in terms of um initiatives where people were working on breakthrough series collaboratives and you know, very focused on specific things like infection rates or uh trying to impact cost and quality or um working on behavioral health or various things like that, and uh a lot of uh work in children's spaces, to starting to say, like, well, okay, great, how do we change organizations um and how do we um you know do uh quality across a whole organization?

SPEAKER_01 16:21

Yeah, and I appreciate the clarification there um of the the importance of the frontline projects um and that how that that persists, but that there's also this this need for structural change at a broader level. I'm assuming that you're when you say a 20-year timeline, probably a lot of that was um during your time working with the IHI and and were there other other positions that you held or was the IHI kind of your primary customer for for a lot of that time?

SPEAKER_00 16:49

So for the last 17 years, um IHI, at least for 12 of those, has been one of my customers. And then, you know, for for four or five, uh I was on the leadership team. Uh when I wasn't working full-time at IHI, I always had uh a portfolio of other other clients um that were working uh in improvement in quality um in health systems and education and in uh still uh sometimes in my roots with ambulance service. Um one of the things that I have always been interested in. So so while uh there's a common theme of health care in my background, I mean that I've always sort of had that thread. Uh, I've all also been curious about being able to do improvement in different disciplines. So, you know, I spent a good chunk of time working um in the education field when they when uh education was trying to learn from what healthcare was doing and apply improvement science uh to improve the outcomes in education. And I uh did some work helping uh the Carnegie Foundation for the Advancement of Teaching when they started to really uh take that on as their mission and purpose. Uh, worked with the Bill Melinda Gates Foundation in that regard. So I did a little bit in that space. I've always had a parallel where I've done a little bit, you know, maybe a project a year uh in the ambulance service space. And then I've had the pleasure of working in other spaces that are totally unrelated, you know, I've worked in roofing companies and other kinds of companies and anywhere that where there's process, improvement um can be applied.

SPEAKER_01 18:14

Yeah, and I'd like to maybe take that opportunity to kind of move into, I think what will be the bulk of our discussion today, which is your work in quality as an organizational strategy. And

What Quality As Strategy Means

SPEAKER_01 18:27

so you co-authored a book by the same title, um, as well as the QOS field guide. And uh I'm wondering if you can kind of just walk me through and walk our listeners through what quality as an organizational strategy means as a as a term and what that means in practical terms.

SPEAKER_00 18:42

Sure. Well, so so in a like from a definition standpoint, you know, organizations are um are all built for a purpose, right? That the the we are like uh we are delivering services to people to match some need in the world of which they have, right? So in healthcare, yeah, it may be that uh people have uh you know need for uh testing, or they have need for um preventative care, or they have need for very specific uh care. Um, you know, there's a need that exists, and our each organization is aimed at trying to do that. You know, as as I've already sort of mentioned, as a kind of a theme about organizations, is that these organizations are all systems um, you know, of people and processes and services that are aimed at trying to um uh provide things uh to match that need. And so part of what we need to uh be able to do is to figure out what is the system that best matches that need and can do it, uh, do it today and do it tomorrow and can do it to continue to get better. Um and in doing that, that means that we have to have some methods and ways in which we can learn, both about how we're working, but also how we might need to change. Um, and then uh we need an ability, and this goes back to improvement, to be able to pick the things that need to be changed and uh learn how to do results-driven improvement in a reliable way and you know, continue to get better at getting better. So that's the underlying bit of um what quality uh, you know, kind of at a at an organization-wide perspective is the the book, quality is an organizational strategy, actually has its roots um back in um some early work of uh Dr. Edwards Deming. I always uh like to point out there, you know, uh uh there's uh there's an image, it's in um his book Out of Crisis, and also in his um book, The New Economics, but it dates back to the 50s, uh 1950s. There, and it looks like an arrow with some lines that come off of it. And it's uh it's uh Deming's uh what he called production viewed as a system. And and uh in his book, he describes that uh back in the 50s, he was trying to explain actually to leaders in Japan, I think from the hotel industry, about how do you think about improvement at an organizational level? And so he points out uh uh back then that um that there had been some great progress at project-based improvement. Uh, so people working on episodic things like we've been talking about, where people are trying to figure out how to fix this or fix that, that there had been like a level up that was starting to occur where people were starting to work on like major business processes and kind of get into bigger initiatives that that weren't just these episodic little things, but were really something that was bigger and had more of an effect. Um, but but he argued that honestly to go to the full potential of the science of improvement was to to focus in on quality as your overarching strategy, and that that was where all the opportunity was and where it um um where it really made a big impact. So, so he he articulated this. The I think the the first published drawing was in 1950. There's a a paper, and then he just kept repeating it. Um would show up in various writings all the way through his book. And in the 1980s, my colleagues at Associates in Process Improvement, so folks like Lloyd Provost and Cliff Norman and Ron Moen and those guys were working with Deming when he was doing his four-day workshops and talking about these ideas and trying to get leaders and industry and anywhere. I mean, people like Paul Bataldon and Don Berwick to apply these theories and methods and the kinds of organizations that they were working in. And so the folks at API began to try to start to take his theory and put it into practice. And they started developing methods and uh strategies and actions that for leaders that were built on the four lenses of improvement science, but built on applying it at an organizational level. And this is what uh originally was called quality as a business strategy. Um, it was used with clients in the in the 80s and 90s, and it was first uh like published in the first edition of the the improvement guide in one of the chapters. There, there was actually the full method that is our book. And uh there was a case study of a school system right up the road from us north of Austin. Um, so so anyway, this this has been around um for a while in terms of the ideas and some of the methods. Lloyd and Cliff, to some degree, were always using it in the background anytime that they worked with clients, but it it took a little bit of a pause when there was such an um a growth of project-based improvement and healthcare and focusing in on things like uh you know, projects with the using the model for improvement or uh doing like collaborative style uh approaches like uh breakthrough series collaboratives and learning health networks. Um but right around the the time of the pandemic, right around 2020, actually just before that, uh, you know, there were a couple of things that were happening in the world that that prioritized us wanting to create a book. And so one obviously was that the world shut down, so uh provided a little bit of free time. But also um I had just spent a number of years when I had been on staff. I just left uh IHI, I think in 2019, but I had spent a number of years there studying how uh quality worked across the system, working with um different uh organizations to think about how to do improvement capability and quality across their system. Um IHI was beginning to articulate uh what they call whole system quality, which is kind of an adaptation of the Duran trilogy. Um they were still uh in that process. I had just um uh developed and and uh uh run uh I think it was two uh cycles of the Chief Quality Officer Professional Development Program. So for me, when there was a pause um for in 2020, I sat down with my colleagues, uh Cliff Norman and Lloyd Provost, and I said, you know, I I recognize that there's a need for people to be able to um approach building a system of improvement across an entire organization. I think that the more that we can build on the shoulders of what we've already been teaching people about the system of profound knowledge and improvement science and the four lenses and these tools and methods, uh like building on the shoulders of that is is the the proper way to do it. Um and I was very familiar with the the early work that they had established, and I said, I think that this work needs to uh be um built upon and evolved and and published, and especially uh before um uh you all you know uh retire and uh it it's you know, we we we lose that that sort of knowledge. And so we worked from 2020 through 2024 on writing the first book, uh quality as an organizational strategy, which was a book that described the theory. We said we we jokingly call it the airplane book because it would be the book that you would pick up in the airport and go, oh, this is really interesting. I want to learn about it. And then um we uh followed that up uh this past year with the QOS Field Guide, which is an equally sized book, but a workbook that involves uh more detail about the theory, but also includes uh lots and lots of examples and exercises and and and methods and things uh to apply the theory. But that that was the the background that led up to it, is that we wanted that desire and wanted that ability. And uh, and I really perceived that there was a need, especially with my work with uh healthcare like leadership groups and chief quality officers, that people needed some uh approach to look at and uh focus on improving quality across the organization, not just having it be a department or projects, but actually be the way that we work, the way that we do things. And that's where QoS came from.

SPEAKER_01 26:44

Yeah, and and I can understand probably a lot of people listening are are familiar with the quality department model of things. And it sounds like what you're proposing is a is a kind of in stark contrast to that, to have this way of working be the way we work in you know in every aspect of our work. Who is the audience for for this work, for this book? I wonder if you can speak to that.

SPEAKER_00 27:08

Uh the audience for the for qualities and organizational strategy is uh are people that are in in a leadership role. And mainly that is because leaders are the ones that that are responsible and own the system that needs to be changed. So this is this is uh uh very much focused at uh the C-suite, uh at chief quality officers, um, chief operating officers, chief financial officers, whoever it is that o wants to build the system and make it work so that it produces the results that you want and wants to figure out how to uh continually learn and get better and create a learning organization and uh in a results-driven improvement organization. So that that's the target audience. It's different than say people that might be in a microsystem or at the at the point of where um uh service is delivered and are are changing the processes is uh at the point of care. This is a uh a book that's targeted at the leadership level. And that's that is a difference. That's a a little bit um unique, but that's the group. And you know, part of it going back to the comment about uh quality, you know, uh Jim Reinertson, who used to be uh one of the leadership faculty at IHI uh years ago, uh drew this great picture for me one time. And it was like a big circle that was your organization, and then in it there was a little circle. Um, and he said that's um the qual that's quality problems. And he would describe that, you know, in many organizations, there's this little circle of which there are what are defined as quality problems, of which we uh apply improvement science to and we do project-based improvement to. And then he would say, Well, what do you do? What's your theory about how you fix everything outside of the definition of quality problems, the rest of your organization? And and and what I find is that, you know, and uh the start of quality and and improvement thinking in healthcare um has called certain things improvement problems and certain things not, or certain things quality problems and certain things not. And you hear that all the time. People say, well, that's not a quality thing, or that's not, you know, and and my bias is that um it's artificial to make that distinction. Deming never made that distinction. Nobody in industry never uh they didn't make that distinction and say, well, something's a quality problem, or um uh something is a clinical problem, or something, you know, it the organization is the thing you're trying to create, and it's made up of a bunch of process that has to work reliably to get the results that you want. Now, it's not unreasonable to have a dedicated person whose job is to be the steward and leader of quality in the organization. So uh having a chief quality officer or having a chief quality department is not an unreasonable thing. There, it's helpful to have somebody who might be helping with building capability or focusing in on certain things or helping to align. But the underlying theory should always be that our goal is that the whole organization operates well, uh, not just certain parts of it. Um, and this is our theory about how we improve the whole organization, not just things that have been designated as um in alignment with our definition of what uh is a quality issue.

SPEAKER_01 30:20

Yeah, there's there's probably a lot of kind of distinctions without a difference um when it comes to separating, you know, quality problem versus not quality problem as you're as you're saying. I I'm curious, um, and I I do, you know, I look forward to reading the book, though I haven't had a chance to to read it yet. But

Board Focus On Purpose And Need

SPEAKER_01 30:36

I'm curious when you zoom into governance, what is the role of the board in making quality real rather than symbolic?

SPEAKER_00 30:46

Well, I think uh the the board and the leadership team have a responsibility to ask, and I go back to, you know, what what's you know, what's the purpose of this organization? Right. Um, so so why are we here? What is the need in which we we are are driving to fulfill with our services? So when you're very, very clear about what the need is your organization is is um uh trying to uh deliver services for, then the second question is well, how do we build a system that delivers those services right to match the need for the patients or for our clients? And so having that laser focus is really important. Now, that then gets us down to saying we want to understand the system that we have to recognize why are these services the ones that we choose to focus in on? How is the system built to produce those services with uh reliability and effectiveness and uh meeting the things that matter to our patients and clients? And then how do we continually gain intelligence and uh learn and figure out how to get better and better at uh improving this system to keep matching the need uh or to um to change it if we need to or change what we do. So the board for me should always be hyper focused on wanting to make sure that's where the attention is and that the activities and the things that people and leaders are doing are in service of either understanding whether we're in alignment with the need or are trying to continually figure out where do I need to improve the system uh to get better at getting better in in uh providing our services to the people that we serve.

SPEAKER_01 32:34

Is in healthcare organizations, since you've you've had such a broad experience, is that laser focus on on purpose and how we you know our mission and how we deploy that mission? Is that uh the commonly laser focused on on this? Is that an easy thing to orient people to?

SPEAKER_00 32:51

Yes and no. So I mean, I I will say that uh in most organizations uh that I go into healthcare organizations, uh, there there is um a heavy focus on being purpose-driven. And people either will be purpose-driven in terms of I really care about taking care of patients and I want to do evidence-based care and I want to do the right thing, and I never want to harm them, right? And uh there are there's there are varying degrees in terms of where leadership or boards are driving with with mission focus or not a purpose focus. Um so uh, but I think it's always present. In every organization that that I encounter, though, there's always a really um good opportunity to to revisit it and reflect on it. Because I think um that sometimes it's uh well, like with anything in the world, um, sometimes things get into a routine of saying them, but we we don't actually pause and say, well, what does it mean to actually do that? And so it's it's it's part of it uh why we uh focus on it so much. That one of the first activities that uh, you know, when we um start working with any uh health system focused on on kind of moving from where they are to really uh trying to adopt quality as a strategy, there's there's really two things that we we do together almost immediately. And one of them is to ratchet up your ability to do results-driven improvement work, because if you can't figure out how to do uh improvement in a reliable and effective way, you know, working on quality is a strategy is kind of a moot point. And then in parallel, we often start leadership teams by having them go back and and really uh reevaluating and thinking about what's our purpose, what you know, what it what are the needs that we're trying to satisfy, what are the values that either we espouse, we say that we we um desire, or actually that that the organization conveys back to us that like we see this in our people and in our culture. And and then how does that how do I actually describe that and put that into practice? So what does that look like? You know, if I say that I'm team based, how can I show that every time? If I, you know, if I if I say that I'm gonna be patient-centered, well, um uh, you know, it's one thing to say I want to be patient-centered, it's another, it's as you know, it's very, very hard and it's a different thing to actually bring patients into every conversation or trying to uh get them involved in the way that you design or redesign the way that you deliver care. So, so that often is a is a big focus. I would tell you, many organizations will um try to, I don't want to say deflect, but they'll try to say, oh, we're fine there. I don't want to work on that. And I've never found one that actually didn't benefit strongly from revisiting those two those two areas from the beginning, uh, figuring out whether they can actually uh efficiently uh uh do rigorous improvement and um looking at are we clear on our purpose and and the elements of of uh our purpose so that we can then refocus in on thinking about the system that achieves that purpose.

SPEAKER_01 35:55

About I can kind of I can wrap my head around the a lot of what you've said so far with with respect to um quality as an operational strategy and how we allow the thinking around quality to permeate everything that we do and and have that aligned with our you know our North Star.

Signs Quality Is Truly Embedded

SPEAKER_01 36:14

When you're looking at a new organization, what are the are there structural signals that quality really is embedded into the strategy or structural signals in the organization that tell you that quality is is more peripheral?

SPEAKER_00 36:29

Well, I mean there what I I think I the way I look at it is that there are there are organizations that are that are on different places in in their journey. There's there's things that I'm I'm sort of watching for. So so I'll give you a good example. Uh recently I went into a health system, I I delivered a keynote for their their quality week, and um I got to sit through and and like uh listen to reports about various um improvement efforts that have been going on. Um they have uh an internal advanced training program, and so these were projects that have come out of that. And you know, one of the things that was just so apparent right away was uh, well, a few things. One, I could see a shared method across all the projects. So even though I could maybe uh I well, I could critique the way in which the project was done and I could kind of gauge like the level of rigor that exists in their program. I saw the model firm proven in this case was used in every project. I saw uh a utilization of very similar tools to kind of break down what was going on, how things were going. Um, I saw teams that uh that uh were teams. It wasn't just an individual and that they were learning from interacting with different uh folks that were involved in the microsystem where they were working. So, so like to me, there was tons of I call it like the ingredients of goodness, right? So there's a tons of stuff here that I can see that is obviously um the result of them having focused on uh trying to build capability and try to create their own systems. And obviously, the fact that I'm sitting in this room watching them on a broadcast, it was uh in-person across multiple different cities, because it's a big health system, um, uh, you know, the and there's hundreds of people uh that are participating, there's some really strong evidence that this particular place is is um yeah in the right direction now also has a lot of opportunities uh to be able to take it to the next level. Um and and I see that uh in in a lot of the organizations I go into. This is probably the most common theme. You know, when I started in quality 25 years ago, the model for improvement and project-based learning and all that stuff in in um and some of the basic tools in healthcare was um kind of novel. Uh as a matter of fact, a big chunk of my early career in healthcare was going around and teaching uh improvement, the basics of improvement all over the place. Um, and I mean I did a ton of that, of which today I do almost none of that. Um, but partially because a lot of the people that we taught uh 20 years ago are now in leadership roles or have created their own programs or teaching, which is fantastic. I'm such a good sign on building improvement capability. The thing that is not there yet is that there aren't as many that have gone from what I would call the foundational level to kind of an intermediate or advanced level of improvement. And that's much more episodic. And that's not a that's that's a lot of like in this organization, that's where they have the this huge opportunity to go is from frontline foundational episodic improvement work to moving to more systematic and rigorous and spreadable improvement work. Um, you know, there's uh places to gain. Folks that aren't at that level that I see, um, and there are some organizations where it's I would call it kind of the a potluck version of quality, um, which is where they've got some of the structures and maybe leadership, but they're outsourcing all of the activities. So maybe they hire people that have credentials, and then what you see is a mashup of different methods and credentials and experience. And so um, when you look at their work, you see those, you know, that variation in methods, that variation in in um uh results, uh, not a lot of systemization where each everything is based on the individuals that were involved, not as a group. So it's really hard to scale. Um, there's often a lot of friction trying to figure out what works or doesn't work. That I that typically is where you know I'm always encouraging people, you got to pick something. You got to decide, you know, what's my faith tradition of improvement? How and then how are we gonna figure out how to make that the way that we work together so we can communicate and reduce a lot of that friction to get better, like the the organization that I was recently visiting. You know, they had made those choices and so they were seeing a lot of those benefits of having a shared method and having an internal advanced training program that they were working on and having a structure that invited people uh to learn from each other. You know, you want to get to that, and then from there you want to build on it to try to get more systematic and and uh more efficient at getting results.

SPEAKER_01 41:04

Sounds very certainly relatable to to my experience and probably to a lot of others. This um the presence of frontline episodic quality improvement happening, and then not as many organizations having shifted to that kind of uh medium or or advanced level of of having more structural quality improvement. Have you seen organizations uh actually make that shift to seem to go from from less just episodic quality improvement up to something that really you know is is genuinely more kind of structurally uh ingrained?

SPEAKER_00 41:42

Um yeah,

Rigorous Improvement That Spreads

SPEAKER_00 41:43

I think I've seen it in in a number of different organizations. You know, typically what ends up happening is that leadership who has always been support uh supportive of improvement in the way that it is, starts to recognize that uh they they look at it and they go, like, okay, here's the great things that I have. I've got um when I get people working on improvement projects, they get excited and fired up. They um they when they start uh doing stuff where they can actually uh test changes in their work environment and they see either they learn are flooded with learning because they're uh they're you know altering the system and that that gives them feedback, or they actually see like movements of dots in the direction of goodness on their charts and they see improvement, uh, they get excited, like they they recognize that potential. But what the they often will see, this is uh a lot of leaders will recognize, is that these projects are struggling because they're in competition with the daily work. And to some degree, that is often because we didn't choose the projects that needed to get done. We chose ones around the periphery of the thing that mattered. And so, and and you know, we've even promoted that. We've said, oh gosh, you know, tell us what you want to work on. Well, a lot of times when people say, I want to work on X, they they don't pick the stuff that's right in front of them that's causing all the challenge because they think I'm not gonna be able to change that. So I want to work on my project over here that I've always kind of been interested in and nobody's uh as interested in. And then that struggles because it competes with the actual work. So so leaders start to recognize I need to help, I need to figure out how we actually solve the core work um together. Um, and uh, you know, I hear time and time again of people saying, I had this fabulous team, they worked on it for a really long time, they got to something and either they stopped the project and the they lost the results, which is a sign that they actually didn't finish the project, they didn't, they didn't install it to the degree that that uh it held uh because they didn't change the system. Maybe they were, you know, kind of paying a lot of extra attention or measurement, and or it worked in this one spot and uh we we can't scale it to anywhere else. We can't we can't spread it in other places. And so that seems like a waste. And and you know, there's a lot of this conflicting comments around the burden of improvement, or it takes so much time, or the cost, all of those things. I find are side effects of not having it embedded in doing the right work in the right way. So if you look at the work that you're supposed to be doing and you say these are the things that are the core to our our uh unit and that are not working in the way that we want them, and now it's doing permanent work on that. Well, that's part of the daily work. It's already there. I don't have to make it, it is. Um, so so that's gonna reduce the competition. And if I'm getting to make my work easier and with less friction, then that's gonna make me happy and and desirable. And I'm gonna become an expert in my my space because I'm gonna learn all the things that work and don't work. And so the next thing that leaders want to start doing is how do I look across the organization and recognize there's a finite amount of time and attention and resource. Where am I gonna get the biggest impact in the core to uh move move our organization towards where we want to go? And I think that's that a lot of folks sort of conceptually get that. They struggle with they don't have a method or or uh an approach to be able to do that. Um and that's where I think there's been a lot of attention on this idea of quality across the system and wanting to think about like how do we plan and decide on what's the right portfolio of projects? How do we um how do we resource that appropriately? And and one thing I don't think is focused enough on is how do we get better at doing improvement work. So my my common experience when I look at people's uh work is they they have projects that are all over the organization that have and many of them are taking way too long. And partially it's not it's not because of lack of of good people or or um wanting to do good work. It's just that that people don't know how to do rigorous improvement. And so they're um they're just working really, really hard to do uh the work that they have, and they're they're just inefficient. Uh uh sounds terrible, but they're they they don't they're not applying the methods in a way that they can learn quickly, make changes that get results, and then see those results in a timely fashion. And so projects tend to stretch and take longer and they they don't progress. You don't you don't get to have as much impact as you you could. And that and that's just a bit, it's like anything. It's like building up a discipline. If you've ever tried to run a marathon, for example, I don't know about you, I'm not a runner, but if I tried to run a marathon today, it'd probably take me three or four days to get across 26 miles and I'd look really bad, right? But I I bet I'm capable of it. But what I need is the discipline to figure out, well, how do I run a mile? And what are the things that help me be efficient and how do I get better at that? And then once I do that, I bet I can get to three miles, and then I bet I can get to five miles, right? And improvement's kind of the same way. You know, a lot of projects are like people trying to run a marathon without the sort of the discipline and the skills and the routines in place to do it well, and so it just takes a lot longer and or it it doesn't get completed fully. Uh, and so part of that real initial stage is how do I get into helping people get better at getting better on improvement projects so that I can do more improvement projects and I can see results more often and faster and be able to make a bigger impact.

SPEAKER_01 47:16

There's a lot that that comes to mind from what you just said. Um you mention projects that that maybe have some staying power locally, but then don't have the ability to to spread well. Is that part of the work of the the quality as an organizational structure consulting when you go into a new a new place? You're talking to them about doing these projects better, getting better at, you know, getting improving at improving, getting better at getting better. But also how we take these effective frontline projects and scale them better. Is that an explicit part of the work?

SPEAKER_00 47:53

It isn't it isn't a um part of quality is an organizational strategy for sure. It it actually it's rooted more in the basics of of um improvement work and and spread. I mean, if you go back to the improvement guide, for example, there's you know, uh after you finish an improvement project, part of your goal is to then implement it or install it. And then if it's something that should be replicated in other parts of your organization, you got to figure out how to spread it. And so I think one element that's often not included, well, there's several elements that that can be embedded in the way that we do our improvement work that facilitates other objectives, right? So one might be, for example, that we if we have a desire to um uh implement, we should always be thinking about uh we're building towards implementation, right? So not only are we trying to improve, but we're also trying to figure out how am I gonna finally install whatever I discover at the end, right? So so many times people were uh they might be doing improvement work, but they don't, they can't connect what they did with what seems to be making an impact. Um, and that may be part of the rigor in the end. If eventually I want to get to being able to tell you uh, you know, we moved the dots on sepsis because we did these things reliably and our data shows it. And if we were to take this to another unit, this is what would happen. This is what we would do. Or if we want to hardwire this into our unit, if we want to install it, make it permanent, and pull this team away, then these are the things that we think uh need to happen. And so and some of that becomes a new project of installation, right? So there's a there's getting it to the to the degree of improvement that you want and sustaining it. The second is then installing it to make it part of business as usual. And the third is saying, well, how do I do that installation in multiple places, right? That replication. Um, so that you know, that is a an uh an important element of quality in general. I think it's uh it's something that when when I'm working with leaders to think about things that they need to improve or change in their organizations, it's one of the questions I'm gonna ask is is this something that happens in more than one place that you know you you always want to have a mind on how am I gonna how am I going to spread it and scale it? And becomes part of the thinking that has to go into the the continuation of that specific project.

SPEAKER_01 50:21

Uh

Why CQO Structures Limit Impact

SPEAKER_01 50:22

as you're approaching a new client and you're you're you know, some of those, a lot a lot of organizations now will have uh chief quality officers and you know, including you, you know, a number of people that I've uh interviewed for this podcast have have roles of you know, CQO or or similar role. Do you notice that the the structure of organizations often limits the impact that the CQO or the quality department more generally can have because of the way they're set up and other other kind of common uh uh shortcomings in the in the organizational structure that you know in theory could unlock a lot more potential in those in those people?

SPEAKER_00 51:01

Uh yeah. I mean I so well one of the biggest uh learnings that I had actually when I uh was doing uh my research seven or eight years ago on on chief quality officers is I it was a little bit surprised. I was surprised to learn how the roles were defined or not defined. And actually, I I I still to this day remember um I interviewed a great um improver named uh Skip Stewart from Baptist uh healthcare. I was interviewing him and I was telling him why I was trying to learn from him. And he had come from from uh kind of a deming base and came from industry. And it was really fascinating because at one point he stopped me, he said, Oh Dave, I should clarify, I'm not the chief quality officer, I'm the chief improvement officer. And I said, Well, well, what does that mean? What's the difference? And he says, Well, I improve stuff and they they do all that quality stuff. And and I was I was like, What are you what? Um, but what I learned as I as I you know got more into it, because I was coming from an improvement background, right? So I obviously I'd had a role as a chief quality officer and kind of in the emphasis of the movement, but when I my work as an advisor in healthcare and my work um as a as a leader at IHI was in the improvement space, not necessarily in the what sometimes is defined as the quality space. So by definition, improvement is changing something to get a better result. Um, when I started interviewing chief quality officers, I think that there were there were a number of things that emerged that just kind of were real revelations. And one was that almost every chief quality officer that I talked to was either the first one in their organization or they were the second one. So if you were the first one, your role and the structures were almost completely built around you. And so that it was, it was a role that was developed. And they, you know, if you were a physician, then maybe you got credentialing. And, you know, if you had a you know particular passion, maybe you got some of that stuff. It typically was built around the individual. If you were the second one, you inherited what was built for the first one. Um, and then you were you know grappling with the fact that you had to try to build a system. And so actually a lot of, well, in both cases, both first generation CQOs and second generation CQOs, they were having to either build the system from scratch and often around them and taking it to the next level, or they were building a system that was built for somebody else and now they're having to try to adjust it or fix it or sense make it uh for its next generation. And so that was the thing, you know, like there were a lot of common themes. Like if you pull up all the job descriptions of chief quality officers and look at systems, there's a lot of commonality. There's a lot of uh stuff that's similar, but then there's also a lot of stuff that's all over the place where people have, you know, one person might have accreditation. I've run into people that are in charge of safety and emergency management, uh uh security, um, you know, like there's some weird stuff that's in there. I would say one thing that's not always consistent is that quality and improvement are together. Uh, another thing that, you know, this came up later when I, when I was uh uh after I designed the chief quality officer program and we ran the first couple of cohorts, one of the things that really stunned me was that many of the participants in the first cohorts with, I think that was about, I think we had about 80 people that went through the first couple of years. Most of them didn't come from a background of doing results-driven improvement. And and when I asked them, like, well, what by what methods are you are you changing things? It was sort of like uh like they'd mentioned it off to the side, like, oh, we've got lean, or we do some Six Sigma stuff, or um, you know, and I I don't know what that means. Like it was sort of like, you know, uh, well, I also subscribed to the New York Times and like, you know, like it was, it was not like I am somebody who this is the method of which we use, and you know, this is how we get results. It it they were much more experts at what are the various measures that I'm held accountable, what are the tricks and tips to try to close the minute gaps on those measures? You know, how do I how do I do root cause analysis? And then I but when I asked them like, well, how do you change your system going forward? It the the improvement side was kind of off uh uh as a side hustle or you know, something that wasn't as integrated. So, so I think uh that's a sign of the infancy of these structures. Now, today, uh, you know, going on, you know, almost 10 years uh after that early research, there's many more chief quality officers. And and when I look at organizations, there are there are many that are more similar to like the one I just described to you that had an advanced training program and a shared method. There's a lot more of that kind of stuff uh that's happening. I still feel like there's quality, and then there's everybody else. I mean, Jim Reinerton's drawing to me of you know, here's my quality bubble, and then there's a bigger bubble where, you know, people either have various theories or different ways of doing things. I think there's a lot of variation of whether quality is in those other areas or not. And uh I think that that uh shifts a lot. So I think that's an opportunity. Uh, you know, I I think that uh, you know, going back to what we talked about earlier, I think there's still some degree of a need, and I watch for where chief where you know a chief quality officer sits in an organization. So a lot of organizations I go to, they're not in the in the leadership team. Like there's the chief financial officer and engagement officer and the you know, the chief medical officer and all these uh chief operating officer, all these people, and there may or may not be a chief quality officer. And that's probably a red flag for me. Uh, if I'm looking for where you fall in the hierarchy, if you're, you know, many times they're behind the below the chief medical officer, that may be okay. Maybe they're blended with the chief medical officer, that may be okay. But I I look for that placement. If if I start going like more than a layer down from the ones that are on the webpage, it's probably a good sign that the structure's uh weak and that it's not uh it's not a quality as quality uh embedded as it could be. And and I think that that's a place of influence, but I also think it's a place of development. So one of the reasons that we created the chief quality officer program in the first place is there was no theory. Uh nobody had a theory. Everybody I interviewed, I'd say, well, what's your theory about how to do it? And it was all kind of like nobody's ever asked me that. Well, let me tell you what I do. You know, and so so part of what I did is developed a theory and you know, created a driver diagram, and a lot of it was rooted in what IHI was doing at the time. But uh there's a need for organizations to have a theory about how do they approach quality uh as a structure and across the system. And then there I think there is a need for an individual who is the steward or lead of that, whether that's the chief quality officer or another C-suite person. And I think there probably needs to be a dedicated team of people whose role is to help that permeation throughout the system. They shouldn't be the ones that are relied upon to do it, but that uh they should be helping it out there to uh help people at the point of care and in these microsystems do improvement work and embed it in their work and make it part of uh day-to-day work and leadership. Um, but in early stages, and we talk about this in the book, many times in early maturity of an organization, they need some kind of leadership, some kind of structure in order to make quality part of the way that we do stuff. And then as you get more sophisticated, uh maybe you can dial that back. But I haven't seen that happen in healthcare very much.

SPEAKER_01 58:22

Yeah, and I should I should pause to uh to offer a debt of gratitude to you. I I unknowingly was the beneficiary of your work in 2022 when I took that uh CQO uh professional development program out of the IHI. So uh thank you for the driver diagram and everything that you did there. I'm sure others listening will either have have gone through the program or or perhaps be interested in in doing it in the future. Is there anything that I haven't asked you about quality as an operational strategy that uh or as an organizational strategy, sorry, that you would like to speak to?

SPEAKER_00 58:54

I

One Integrated Framework Not A Potluck

SPEAKER_00 58:55

guess the you know the only thing I I was just thinking about this because I I'm writing uh paper on um QoS. And uh as you know, if you've ever written an academic paper, like uh it's such a great exercise because you often have to uh think about how you're how you're describing things and and your argument and whatnot. And one of the one of the questions that came back from the reviewers was like uh was a little sort of like, you know, why bother uh with uh QS? There's all these things, and you know, it's fascinating. I I recently um I bought a book that was um it's the the study guide for one of the major um quality credentials and I was fascinated. Uh it's actually inspired upcoming article that uh that I'm gonna write. But um when I went through it, I think there were over 25 different models mentioned in this book that quality professionals should know. And it was fascinating to me because um I was familiar with most of them, but one of the things that I learned whenever I went into looking at any model, and I'll I'll pick them on like uh the IHI patient safety model or um uh or the model for improvement or um the Baldur's framework, all these are you know frames that each one of them was created at a particular moment in time to serve a particular purpose and may or may not have been created with the others in mind. So they they're not meant to work together. So, so so a lot of times they were uh I needed to create something because something else didn't fit. And so I created my version of things, right? You know, IHI created the whole system uh quality framework because they loved the the ease of explaining the Durant trilogy, uh, but they didn't actually adopt the Dran trilogy, they adopt, they they created their their version of it. Not judging. I'm just saying that that a lot of these models come in that way. So one of the things that's that's really tough is that they don't, you know, a common problem that I used to run into and still run into when I go into organizations is people will say, well, how does this fit with that? Or how does this fit with lean? Or what about this with agile or what, you know, and and they're always trying to sense mix, especially if they have preferences, because people will gravitate to little things that they like. And so they might grab a tool from here or they like things, but it's it's sort of when you you know do a potluck and you've got you know Mediterranean and Italian and and some Spanish food, right? They weren't all meant to go together. You just happen to grab all your favorite things and put them together, um, and now you've got this mashup. So one of the things that's a little bit unique about, I think is unique about um what what we um uh wrote about in the book and the the way in which we approach things is is we created a framework, one that built on the shoulders of the science of improvement. So we built on the shoulders of systems thinking and understanding variation and um uh our theory of knowledge and psychology and human behavior, the right, the four lenses of profound knowledge. And this real deep focus of needing design, test, implement, and spread uh improvement, right? So the application of that science to fixing things, working with people who are subject matter experts in something and trying to figure out how do we change it and and uh do projects to get better results, right? So so quality is an organizational strategy built on the shoulders of taking that, but taking it to the organizational level and to the way in which we work. Um and in doing that, one of the things that we focus a lot on is the integration. So, so you know, when if you, you know, we've talked a good bit about purpose, we've talked a good bit about systems. Those are parts of the of the uh activities for leaders that that QS encompasses, right? So being uh clear, defining and communicating a purpose is one. Uh two is uh appreciating the organization as a system, which includes having a systems view, like creating a physical map of the organization so you can see it as this interdependent uh linkage of processes. It includes having a vector of measures, like having a you know a set of uh measures for the entire organization that um uh are uh presented together that are displayed in true heart charts so that you can understand variation and see how they interrelate. It involves uh building a system for gathering information so we can continually learn about the organization and whether the organization is fit to meet the need or whether there's things that are happening in the world like AI or uh new technology or changing workforce or generational changes in our patient population that'll affect how we do things. And we bring that all together into some kind of process that helps us plan for what we need to do. What do we need to change? What do we need to design or redesign to make the place better? Or what do we need to uh resource and continue to operate to continue to do what we do now well? And then how do we manage improvement efforts? All right. So we plan, we identify what to work on, then we got to work on it. And we gotta, and that's where rigorous improvement comes in. So, you know, that's uh I just took you through the journey of uh QoS. In some ways, people say, well, that doesn't sound that different. Well, the thing that I think is unique is that it's built to work together. So uh there's actually an awful uh busy drawing that nobody likes uh that we include in our book that has these five activities. A lot of times people, when they used to um make graphics, would take out all the arrows because they just want to call out these five components because then that makes it easy. It's kind of like the Dran trilogy, but the arrows are where the where the rubber meets the road because the arrows draw the linkages and connections between these different activities. So when you're doing it, it becomes this sort of systematic uh approach uh of which when you start, you do it at the level you're ready to go, and you get uh more sophisticated at it as you get better and better at doing it. And and that's one of the things I think is is useful is it's it's a little bit agnostic in terms of how you go about it. We have some firm beliefs. I mean, we're deming people and we you know use the model for improvement and things like that. So there's certain things that we gravitate to within it, but it's not an absolute. But um the framework enables you to look at where you are, figure, kind of get a sense of where things are, get started on working on uh getting better at getting better on your improvement work while you clarify the purpose and understand the system. And then it becomes these continuous learning cycles of getting better and getting better and learning more and getting more sophisticated and kind of uh improving your uh your capability over time. And uh part of the, you know, one of the questions I always get asked is why don't people more people do it? And I say, because it's hard. Like improvement and and leadership is hard. Um, and so it doesn't work for the easy button people. If you're if you're looking for a quick fix and whatever, uh there's a good chance you're not gonna find one. But if you're looking for the way that you learn and and the way that you get better and the and the way that you really kind of um build up your own professional development, uh I I can't find a better place, better way.

SPEAKER_01 1:05:59

Yeah, Dave. I mean, I think so many people will relate to this feeling of having different frameworks that can be applied with different levels of rigor and and like you say, not uh not well integrated into uh you know, not not designed to work well with each other. And and so the idea that this would would bring some of those together and make it, you know, easier to easier to apply, easier to kind of create, weave into the DNA of your organization, uh, sounds like something I could really take a bite out of. I'm I'm really excited actually to finally get a chance to read your book. I want to thank you so much for your time today. We went a little bit over time, but um I really enjoyed learning more about what you're doing and and how this fits into the broader landscape of quality improvement. For

Where To Find The Books

SPEAKER_01 1:06:46

uh listeners who would like to follow your work or connect, what's the best place for them to do that?

SPEAKER_00 1:06:52

Well, the uh the easiest way, I mean, obviously the the books are available. Um uh I always encourage people to start with the quality as an organizational strategy book. And then if you want to go further, you can uh think about the QS field guide. Those are available at your favorite booksellers. My uh website, davidmwilliamsph.com, is where I uh uh write pretty regularly and and post things uh you know both to to my newsletter and to um my blog that people are going to. And then actually in uh in April, I'm gonna have an open program for for leaders that are interested in um learning about thinking about their organization through the um quality as an organizational strategy lens. And I'm I'm gonna um share uh information about that on my my website and on LinkedIn and other things. And I always encourage people to connect with me on LinkedIn too. Um you can find me at David M. Williams PhD. And uh I love uh just uh learning from people and and making connections there. So that's probably the easiest way. And I'm uh thank you for inviting me to be uh part of this conversation and I appreciate uh getting to chat with you and and uh share with your your audience and your community.

SPEAKER_01 1:08:02

Yeah, likewise the pleasure was all mine. And I I will uh make sure to include those um those different links to your website and to the LinkedIn um and other resources we've mentioned in the uh in the podcast today in the show notes. Again, thanks so much for for an insightful view into quality as an organizational strategy, both the book and kind of this broader set of ideas that you and your co-authors have been cultivating for so long. Thanks so much for the conversation. I uh look forward to seeing you again. Thanks so much for listening to today's episode of Leading Quality. If you enjoyed the show, please take a moment to like, subscribe, and share it with someone who might find it useful. You can find all our episodes at leadingquality.budsprout.com or in your favorite podcast app. The show is written and hosted by me, Jason Meadows, edited by Milan Milostavievich, and produced by Thrive Healthcare Improvement. See you next time.