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by Dr. Joshua Tepper

Seven Competencies for Quality Leadership

Improving the quality of health care involves many factors.

Probably the most commonly discussed enabler of quality is data and the associated issues about quantity, type, accuracy, etc.  The role of standards and guidelines are also often referenced. And let’s not forget patient and public partnering as a critical element in quality improvement.

One element that has not had as much attention is the role of leadership. From local quality improvement (QI) efforts to broad system efforts, leadership is a key element needed to enable and sustain quality improvement.  To this end QI training programs like IDEAS includes leadership as a component of the curriculum and in the United States, the Institute of Health Care Improvement has a CEO leadership alliance focused on health care.

The need for effective leadership in promoting quality care is part of a broader conversation on the need for proper leadership in health care as a whole.

There has also been much written lately about the soft skills required to be a good leader and the ability to make positive changes in people's lives. These skills are being given more emphasis as important skills for a health care leader in today's world. But to be a truly transformative leader such skills must be accompanied by a good understanding of the complex, changing and changeable realities of providing health care in partnership with patients, using technologies that did not exist even a few years ago.

This type of leadership is essential if we are to build and maintain a quality health care system. And in acknowledging the importance of leadership in quality improvement a natural question arises about what type of leadership skills are needed.  I would suggest there are at least seven core competencies to enable leadership for quality improvement:

1)The ability to lead change. At its core, quality improvement is about change. As quality expert Dr. Don Berwick once said, “not all change is improvement, but all improvement is change”.

2) The ability to work and engage with doctors, nurses and other health care providers. Quality improvement efforts can easily become “top down” initiatives that are ‘done to’ front-line providers rather than engaging them and even having them champion or lead the initiatives.

3) Knowing how to partner with patients. A fundamental goal of quality improvement is better patient care and there is a growing acceptance that patients need to be participants in improvement efforts. Knowing how to partner with patients is still an evolving field, but there are a growing number of national and provincial centres with the expertise to offer guidance (e.g. Health Quality Ontario, the Canadian Foundation for Healthcare Improvement, the British Columbia Patient Safety and Quality Council)

4) Comfort with using data for improvement.  As the American-based National Quality Centre is attributed as saying: “Only data can tell whether improvements are made.” A leader must understand different sources of data; how data for quality improvement may differ from data for research; and different analytical means of managing data.

5) Familiarity with social media.  A leader need not have an affinity or competency for a specific social media platform, but they must understand how the growth of social media platforms is transforming traditional communications hierarchies, means of information sharing and participation.

6) Knowing the basics of quality improvement. Run Charts, PDSA (Plan, Do, Study, Act) Cycle and Fishbone Diagrams are all part of the lexicon of a health care leader’s committed to improvement. A PhD or Masters in QI is not a requirement, but basic training and some lived experience should be.

7) Accepting and working with failure. A leader in quality health care must have resiliency and learn to deal with failure, and accept it as a part of the process of building a better system.

Not your traditional leadership skill set for sure, but one well suited for building quality health care today and tomorrow.


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