Many of you have asked what you can do to learn more about healthcare quality and leadership. Here, in the last article of this series, we provide you with resources to help you do a deep dive into these topics. Remember, if EMS is to become a good partner in the healthcare world of the future, then those of you who are drawing the line for the cutting edge to follow will need to be able to think like hospital CEOs and chief medical officers. Here are a few suggestions to get you started.
BOOKS
Transforming Healthcare Leadership: A Systems Guide to Improve Patient Care, Decrease Costs, and Improve Population Health by Michael Maccoby, Clifford L. Norman, C. Jane Norman and Richard Margolies
If you read only one book on healthcare leadership during the next decade, make it this one. It synthesizes the best information available on extraordinary leadership, the science of improvement and the Institute for Healthcare Improvement’s Triple AIM and mixes it with a bit of Zen magic to create a wonderful read.
These authors are sought out by award-winning healthcare organizations worldwide for their expertise. Jam-packed with actionable wisdom, this book aims to help healthcare leaders “avoid imminent extinction, avoid threats that could seriously damage or destroy their organization, and to improve effectiveness.” Here are a few examples:
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“Making it easy to do the right thing and hard to do the wrong thing shifts efforts away from blaming individuals working in a poorly designed system to developing and managing a strategically aligned system-wide improvement effort.” It is time for us to quit having QI people sit in the corner with a red pen marking mistakes on patient care reports. It’s much more effective to focus our energy on changing the systems we work in to make it easy to do the right things.
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“What is leadership? Leaders are people others follow. If no one follows you, you are not a leader. If you have followers, you are a leader. Leadership is a relationship. Good leadership means people willingly follow a leader who is working to further the common good, the well-being of all stakeholders. Good leaders make followers into collaborators. Leadership implies a relationship that cannot be handed off to anyone else.”
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“Predictions are based on theories. Any theory we have represents our current knowledge about how some aspect of the system works or what we believe will happen in the future (foresight). When is our theory valid enough to begin testing our ideas for change? When leaders make theories (or hypotheses) explicit, this will guide people in an organization as they carry out targeted improvement efforts to accomplish the vision, which is a prediction about the ideal future of the organization. When leaders state their theories or assumptions, this also helps people design tests to validate these theories and make improvements from the results of these tests.”
- One of the most powerful things you can do as a leader is to point out that someone’s declaration of the way things are is actually a theory. For example, a paramedic FTO recently stated, “I know when someone’s manipulating the system with BS complaints to get pain meds.” Actually it’s her theory that it is possible to recognize drug seekers. Theories are testable, and it turns out that her theory did not hold up to scrutiny.
Think about all the theories you’ve heard declared as fact in EMS: Short scene times save lives; paramedics don’t diagnose; people who are hemorrhaging need IV fluids to keep their BP up, etc.
For more information, visit maccoby.com and pkpinc.com/index.html.
Out of the Crisis and The New Economics by W. Edwards Deming
My bias is that it is always a good idea to read the original source of the progressive ideas you’re interested in. Deming is the epicenter of and foundation for most of the performance improvement thinking in healthcare. Although he passed away 20 years ago, his ideas are still considered radical and progressive by many traditional managers.
Within these two books you’ll learn about his System of Profound Knowledge, his 14 Key Principles and his Seven Deadly Diseases. I guarantee that as you read, you’ll think about which of the deadly diseases your organization suffers from right now. For more on Deming, check out deming.org.
The Improvement Guide by Gerald J. Langley, Ronald Moen, Kevin M. Nolan, Thomas W. Nolan, Clifford L. Norman and Lloyd P. Provost
These are the guys who created the Model for Improvement that’s been adopted by the Institute for Healthcare Improvement as their core framework for improving healthcare worldwide. The authors of this book served as Dr. Deming’s staff/partners as he taught his principles all over the world. It’s considered by most people in healthcare quality management to be the bible of making things tangibly, measurably better. Visit tinyurl.com/k76499t for information.
Data Sanity: A Quantum Leap to Unprecedented Results by Davis Balestracci
When I introduce Davis at conferences I usually say, “If Deming and the Reverend Billy Graham had a child, it would be Davis.” His passionate approach to making data analysis simple and accurate is reminiscent of church revivals.
His book, Data Sanity, is written for physician practices but easily translates to the world of emergency services. It makes complex improvement statistics accessible to, entertaining and usable by “normal people.” Visit davisdatasanity.com to subscribe to his free Data Sanity newsletter.
The Fifth Discipline by Peter Senge
Peter is one of the most engaging speakers and writers I’ve ever encountered. He’s an MIT Sloan School of Management professor and is known for helping to introduce systems thinking to the masses. He’s also the creator of the “Learning Organization” concept. Several of his presentations are available on YouTube.
- Personal Mastery: Clarifying personal vision, focusing energy and seeing reality.
- Shared Vision: Transforming individual vision into shared vision.
- Mental Models: Bring to the surface internal pictures and understand how they shape actions.
- Team Learning: How to suspend judgments and create dialogue.
- Systems Thinking: Fusing the four disciplines, from seeing parts to seeing wholes.
Peter is also the founder of the Society for Organizational Learning. Visit solonline.org.
Dr. Berwick is the founder and served for 20 years as the president of IHI. Most recently he served as administrator of the Centers for Medicare and Medicaid Services and is currently running for governor of Massachusetts. He’s without a doubt the most effective leader in healthcare worldwide.
This book is a collection of essays that were each delivered as the opening keynote presentation for the Institute of Healthcare Improvement’s annual National Forum. I’ve been attending this conference for 19 years and the crowd that gathers early to get a good seat for Berwick’s opening presentation is rivaled only by Grateful Dead fans. I was fortunate to see most of these presentations live and they are just as inspiring to read.
In addition to the book, there is a powerful movie based on Berwick’s views. Visit escapefiremovie.com for information, as well as the Escape Fire First Aid Kit, designed to help keep you out of the healthcare system.
Designing Social Systems in a Changing World by Bela H. Banathy
Dr. Banathy was one of my professors and this book was the text for my Systems Thinking class. While it is the most challenging book on this list, it is worth the effort, showing you how to look at systems from several perspectives. Each view helps you better understand how things work and how they might be changed for improvement.
I know some of you will see this title and think, “Yep, Taigman’s finally lost it.” While philosophy is not for everyone, this wonderful autobiography about a father and son’s motorcycle ride across America explores the concept of quality better than anything else I’ve read. It also teaches problem-solving and the philosophy of science.
Endurance: Shackleton’s Incredible Voyage by Alfred Lansing
This page-turner is a true story of polar exploration and survival. The leadership example set by Shackleton will inspire you, as the teamwork that his leadership produces resulted in one of the most remarkable survival stories ever written.
Organizations
The Institute for Healthcare Improvement is the gold standard for leadership and performance improvement in hospitals worldwide. You can spend weeks unpacking the information on their website: ihi.org. Here are a few highlights:
- IHI’s Open School provides the opportunity to learn about the science of improvement online with colleagues from all over the world.
- Held every year, IHI’s National Forum hosts thousands of healthcare leaders including hospital CEOs, deans of medical schools, presidents of all the colleges of medicine like ACEP, major insurers, representatives from more than 40 countries, and a small handful of EMS leaders, all of whom gather to learn about and create massive improvement in healthcare worldwide.
- IHI’s Improvement Advisor Course is a one-year course that is the equivalent of a master’s degree in the science of improvement. So far only a few EMS folks have completed the program, including consultant Joe Penner; Sheri Lambeth and Jonathan Studnick, Ph.D., from MEDIC in Charlotte, N.C.; Dave Williams, Ph.D.; and yours truly.
The Agency for Healthcare Research and Quality has a website that’s jam-packed with resources and information: ahrq.gov. You can sign up for their free Research Activities Newsletter, a great resource for what’s happening in all areas of healthcare quality, at tinyurl.com/mv6x997.
Journals
American Journal of Medical Quality
Journal for Healthcare Quality
Colleges
The strongest program in quality improvement is the Deming Scholars MBA at the Fordham Graduate School of Business in New York. Visit tinyurl.com/mj8ebes.
For EMS graduate education, I recommend the Emergency Health Services program at the University of Maryland Baltimore County. (In the spirit of full disclosure, I teach here.) For information, visit tinyurl.com/m8ja4ky.
Award Programs
The Baldrige Performance Excellence Program is the nation’s highest award for performance improvement/excellence: nist.gov/baldrige/. Most states have a state level version of this award; EMS systems in Florida, Oklahoma and California have been winners of state level awards.
Publish Your Work
One of the hallmarks of a true profession and a true professional is a growing body of knowledge. In medicine, research is published in peer-reviewed journals based on standards. Quality improvement projects can also be published in peer-reviewed journals as long as they follow the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines. Visit squire-statement.org/guidelines for information.
There are many more resources that were not included in this article. If you’d like help learning about specific things in leadership or quality management, I’m happy to suggest resources. Drop me an e-mail at mtaigman@gmail.com.
Mike Taigman is the general manager for AMR’s Ventura County and Gold Coast operations. He’s also part of the national leadership team for Caring for Maria, AMR’s national performance improvement collaborative.
