Improvement Work Is About Ownership

29 Nov 2016

Dr Peter Lachman, M.D. MPH. M.B.B.Ch., FRCPCH, FCP (SA), FRCPI, Chief Executive of ISQua.

In September this year, Kevin Hardy had the pleasure of spending some time with Dr Peter Lachman to talk about some of the ideas he is personally sharing since becoming CE of ISQua.

PART 1 of a three-part series: Kevin Hardy talks to Dr Peter Lachman.

“Problem solvers are the key for change and a transformational organisation is full of problem solvers – but, who know what the parameters are. – Dr Peter Lachman, Chief Executive of ISQua”

Peter: In healthcare, the idea is that when you have got some ideas, that you spread them and share them. That’s what ISQua is about – a network of ideas that are shared around the world.

When you come to Sydney (to the APAC Forum) to sessions it’s a chance to share and give of the experience one has had. I was fortunate to have that experience. I have been in the improvement business a long time. It’s important to spread what one knows and to learn.

Kevin: The fact that you are open to learning, as a leader of an organisation, it is critical these days.

Peter: Yes, I think that with all this comes humility. One has to know what it means to improve. I’m a disciple of Deming, I’ve never met Deming, but I’m two degrees from Deming because I was taught by Lloyd Probus who was one of his PhD students. When Deming spoke about ‘Profound Knowledge’ he called it profound for a reason. It took me a long time to work out why it was called profound, because if something is called profound, it means you never understand it.

Those who think they understand it, don’t really. So, I’ve learnt that if you don’t have the humility to understand that you don’t understand everything all the time and that you can’t instantly learn everything. It’s the same thing as being a doctor. Because a doctor who thinks they know everything, obviously doesn’t know everything.

Kevin: Yes, and as a leader your capacity to be able to listen and hear what people say becomes really critical.

Peter: Yes, I think that leadership is a buzz word now. You hear that they want more leadership around the world in Quality Improvement. I think that leaders are important, but it’s not in the leading, but how they lead. There are different types of leaders – leaders who lead from the front and those that lead from the back. But in improvement work, it’s really about enabling people to feel they’re in control, even when you’re in control. Give them that sense of ownership.

Kevin: Ownership and the scope to do it.

Peter: Yes, when I look at the theories that go around now. There’s one called Front Line Ownership. That’s very popular, from Canada and now it’s been taken up around the world.

(The authors of Front Line Ownership contend that: In healthcare, the need to improve patient safety has become a global imperative. Often neglected, however, have been strategies to engage the healthcare workers, those at the front line, in the cause. In order for healthcare to function error free, organisations must assume the characteristics of high-reliability. Those working at the front line may have the answers. Editor)

When you look at Lean Theory they talk about the worker Stopping the Line – isn’t that ownership?

(Stop the Line manufacturing is a technique introduced by Taiichi Ohno (Toyota Production System)  in which every employee on the assembly line has a responsibility to push a big red button that stops everything whenever they notice a defect on the assembly line. Editor)

Deming spoke about it and he got it from a series of theories of theories and that really front line need to own the problem in order to solve the problem. I think that is one of the key things we need to look at.

Kevin: And the permission to own is so important because the front line can be great advocates for the change and find ways to slow the process down.

Peter: Problem solvers are the key for change and a transformational organisation is full of problem solvers – but, who know what the parameters are. So that you don’t have total chaos but rather that you have an organised process of continually questioning and solving questioning and solving.

Kevin: Yes it’s an interesting segway because lots of systems talk about transformational change but it seems to cover a lot of different sorts of territories. So, if you are talking about transformational change in health systems and things that really, truly make a difference. What does that mean to you?

Peter: Actually I don’t think we’re doing transformational change at all. Because what does the word transform mean? It’s to change to some other form and what we tend to do is to try to fix the current form, the current construct without really changing to the new form. So I am yet to see something really transformed. We still have medical schools where they are doing the same thing. They provide us with doctors for the future. Real transformation would require major change.

Part 2 in the Series of conversations with Dr Peter Lachman will be published in the December edition of HGIinSIGHT

Dr Peter Lachman M.D. MPH. M.B.B.Ch., FRCPCH, FCP (SA), FRCPI was appointed Chief Executive of ISQua on 1 May 2016. He has extensive experience as a clinician and leader in quality improvement and patient safety.

Dr Lachman was a Health Foundation Quality Improvement Fellow at IHI in 2005-2006, and developed the quality improvement programme at Great Ormond Street Hospital where he was the Deputy Medical Director with the lead for Patient Safety. Prior to joining ISQua, Peter was also a Consultant Paediatrician at the Royal Free Hospital in London specialising in long term conditions for children.

Dr Lachman has been the National Clinical Lead for SAFE, a Heath Foundation funded RCPCH programme which aims to improve situation awareness in clinical teams. In Ireland he is Lead International Faculty at the RCPI in Dublin, where he co-directs the Leadership and Quality programme to develop clinical leaders in quality improvement. He is co-founder and Chairperson of PIPSQC, the Paediatric International Patient Safety and Quality Community.