QI things that excite me

Photo by Andrea Enríquez Cousiño on Unsplash

Learning from failure…

Whilst ‘excitement’ is not an emotion everyone associates with Quality Improvement, it’s something I’ve come to value over several years. For me, it plays in as people take their first steps in a structured QI journey and it sustains their interest in the science and practice of QI over a lifetime of improvement. It’s certainly influenced me as I often start emails with the phrase ‘QI things that excite me!’

Recently I was intrigued when a ‘failure’ got me revisiting ‘excitement’. I was mentoring a learner and they’d formulated a change idea they thought might work. They tested it using Plan-Do-Study-Act to see if it would generate an improvement and it was rejected in the most spectacular fashion! A threatened resignation of a staff member is not something we’d ever encountered (or even close) and so once they, and we, had recovered from the shock, there was a pause for reflection for them, their mentor and our QIClearn teaching faculty too.

Spotting the link between Excitement and Failure….

Whilst they were seeking an alternative way forward I wanted to understand and learn why this change idea had failed SO badly and so I went looking for any ‘wrong turns’ and this is what led me to revisit ‘excitement’, an element in key activities I’ve designed.   Over the years I’ve observed two behaviours that can accompany excitement, one more helpful than the other. The first looks like an excited puppy bouncing towards a problem, landing in a tangled heap, getting up and repeating the experience until they are asked to leave; The second is more positive: It looks like someone invested in a course of action, anticipating some ups and downs, and taking time to use what’s available to them to get a better outcome.

It was this second behaviour that drew me to include ‘excitement’ in a score that I created to help learners on our Improve ONE thing: the full QIP course toto select their first test of change. With just three criteria and three simple scores Choose ONE thing to test first™ has helped over 300 people people select their first small scale test of change using Plan-Do-Study-Act (PDSA).

So what went wrong for our learner this time? Choose ONE thing to test first™ is designed to load the dice favourably. Our learner wanted to understand why their first idea had ruffled feathers so badly it was dropped at the first hurdle. I wanted to understand what had happened too.

They reflected that their impersonal approach to someone outside of their team via email might not have been the best way to go about their first PDSA. Their mentor and faculty agreed: The ‘technical’ tools we use in QI are only part of the story and never trump the softer skills of communication and engagement.

An absence of Excitement

But what about the score, why did this fail our learner? To find out I turned to our online learning space where we can see learners’ work in real time. The lack of ‘excitement’ was there in plain view with a score of Zero but alas, human error had crept in, elevating the final score to 4. The Zero showed that they were not invested in the ONE thing they selected to test first. The absence of ‘excitement’  reduced the time and thought put into Plan and Do, with an unfortunate outcome, and some hurt pride.

Despite this, with the support of their mentor and teaching faculty, they picked themselves up, smooth ruffled feathers, and chose other change ideas to pursue. They shifted their focus for change, achieved their aim, completed their QI project and have a poster and learning to show for it.

So what have I learnt and what will I do next? Well I am reassured that excitement IS a useful dimension to include in our Choose ONE thing™ tests and am now certain that scoring needs to be automated to avoid predictable human error. And this learning is definitely the kind of QI thing that excites me!