Last fall, I wrote a note on my phone when I was lying in bed, unable to sleep, creating to-do lists, and reflecting on my job. It’s time-stamped 1:43 AM.
The note reads: “I only have time to do. I don’t have time to think.”
It’s clear to me now that this was not a moment of brilliance, but rather an experience shared by many of my colleagues. We’re desperately trying to keep ships afloat and don’t have the time, resources, or capacity to do the necessary — and often exciting and gratifying — work of improvement and leading change.
Reflecting a few weeks later, I thought back to my experiences in college when I felt impassioned and full of potential. I believed I could change the world alongside my peers. Did I feel that way because I was young, naïve, and bursting with energy? Or, was I simply intrinsically motivated and appropriately encouraged and supported by peers to lead this work?
Improvement as Community Organizing
I work in health care because I want to help people. This is true for most of my colleagues. The specific intrinsic motivation varies for everyone, but my desire to improve the lives of others was inspired by health care professionals who positively impacted me.
The “helping professions,” as they’re often called, tend to attract high-achieving, compassionate people who often become bogged down with paperwork, bureaucracy, and organizational or systemic politics. Recruiting our colleagues to join us in improvement efforts can feel like a daunting task.
Community organizing skills have helped me to push past the paralysis that can come with tackling quality improvement projects. This spring, for example, the IHI Open School team applied community organizing principles to redesign our team structure and strategy. In doing so, we’ve been able to tackle improvement projects that have made our work more efficient, meaningful, and enjoyable.
Others in health care are also making progress by working at the intersection between improvement science and community organizing. For example, Christine Miller, MD, Co-Director of Wound Care and Limb Salvage at the University of Florida College of Medicine, worked with a multidisciplinary team to reduce patient wait times in a high-volume safety net urban care center. According to Miller, “[Organizing] focuses on building ‘power with’ your team. It concentrates on the connection between people with shared values.”
Reflecting on the experiences of community organizing learners, the Open School has identified three key tactics that will help you strategically push past inhibitors to making change:
Listen and learn — Valuing the people leading the work to improve health care is fundamental to W. Edward Deming’s System of Profound Knowledge. One of the first steps in community organizing is to understand the strengths each person brings to your team. This process involves thoughtful, active listening. It also requires a collective belief that a shared leadership structure that values each team member’s assets will help you work smarter and harder.
Share stories — To create meaningful change, you must recruit others to join you in the effort. Community organizers use compelling “calls to action” by sharing personal stories to spark others to join an effort. Ricarven Ovil, a medical student and IHI Open School Chapter Leader at the Universite Notre Dame d’Haiti, connected with local stakeholders such as the university’s administration and deanship and the Improvement Department of the University Hospital of Mirebalais. He used storytelling to mobilize fellow leaders to join him in his efforts. Storytelling can also be used as a tool for ongoing relationship-building and motivation so that the team is constantly reminded that we’re making a difference together.
Tap into intrinsic motivation — Calls to action are most effective when an organizer taps into the fundamental reasons each of their team members is involved. Are they interested in the improvement project because a successful result will make their job easier or more efficient? Are they passionate about the project because it allows them to act on their personal values, such as justice or equity? Successful organizers know the answers to these questions and use them to craft a motivating vision to sustain long-term engagement.
Convincing others to join our improvement efforts can often feel like a burdensome task. However, organizing strategies teach us how to place people at the heart of improvement. Using a shared vision for change helps collaboration feel empowering rather than exhausting.
As Dr. Miller so eloquently noted, “Change is contagious! Once you start seeing progress, it energizes your team to keep on improving care quality.”
By: Hannah Lee Flath, an IHI project coordinator.
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