Leadership for Quality

A general definition of leadership is ” working with people and systems to produce needed change” every system is perfectly designed to produce the results it gets, so if better results are to be expected, systems and the people in them must change. Leadership is essential to quality improvement, whether at the level of the small team of clinicians working to improve care for a particular condition or at the level of an entire organization aiming to improve performance on system level measures such as mortality rates or costs per capita.

Effective leadership at both the individual and system of leadership levels is essential to quality improvement. If improvement did not require people and processes to change, leadership would not be needed. However, change often deep, transformative change is a part of virtually every quality improvement activity, whether at the level of a small project within an office or department or a massive improvement effort involving entire communities. Leadership is therefore necessary.

We think of leadership as the responsibility of those at or near the top of organizations, departments, and other structures. This hierarchical view of leadership is natural and, to a certain extent, useful. The CEO does have a larger system view and can accomplish some improvements that an individual nurse, administrator, or physician cannot.

The CEO’s leadership opportunities to influence the system are greater, and so are his or her responsibilities for system-level results. Healthcare organizations are large, complex systems and cannot be led effectively by a few senior executives. These senior leaders do not have a deep understanding of the quality issues that frontline staff faces every day. Facing, understanding and improving performance at the critical interfaces between clinicians and patients is work that must be done by hundreds of capable individual leaders throughout the organization, supported by a well-aligned leadership system.

Finally, there is no simple formula for successful healthcare leadership or for specific strategies that, if carried out, will result in organizational quality transformation. Care delivery systems are complex adaptive systems and therefore behave unpredictably, in large part because of the powerful influence of the professional, community, and macrosystem (regulation, policy, markets) context of each organization and care system.

Keys to successful Quality Leadership

 Transform Yourself

A leader cannot lead others through the quality transformation unless he or she is transformed and has made an authentic, public, and permanent commitment to achieving the aims of improvement.

 Adopt and use a leadership model

 Grow and develop leadership skills