My QI Mantra
Do you have any mantras for your work? Which statements, quotes, or slogans or words of advice do you find yourself repeating frequently to teams and colleagues?
Carved into a rock at the Pabonka Hermitage of the Sera Monastery near Lhasa, Tibet, are the Sanskrit characters for the mantra, "Oṃ maṇipadme hūṃ". It roughly translates to, “the jewel of the lotus”, “innermost heart”, or “the pure, heart of the matter”. This mantra is one of the most universally practiced distillations of Buddhist teachings.
Reflecting back on my time in Tibet, my guide shared that travelers on a path to enlightenment often come to this ancient place looking for some connection to long forgotten, secret knowledge, hidden away in a remote corner of the world to unlock wisdom. However, the irony, he noted, is the lessons carved into the stones were more about repetitively doing the simple things, continuously. I snapped this picture as my guide extolled the virtue of this condensed lesson of compassion, in contrast to the intricate statues, towering Stupas, and ancient texts seen in other temples.
I think that is also really true on a journey of quality improvement. Working on a particularly challenging project at the moment, this lesson came flooding back to me. Sometimes when communication, planning, and processes have a long history of dysfunction, it can feel like quality leaders and champions could be doing more, and that there is some secret we’ve failed to unlock that will solve a multifaceted root-cause to some systemic problem.
If I had to assign a super simple, all-encompassing mantra for quality improvement it would be, “quality improvement is respect for people”. That is the mantra at the center of it all for me. Much like the stones that populate the Himalayan countryside, you'll find that repeatedly on our website, slide decks, and blog posts. It is the foundational approach to our QI work. Quality is not about the most innovative tools, or some hidden secret that only W. Edwards Deming or Taiichi Ohno possessed. It’s more than a quest for outcomes, efficiency, or cost savings alone. I wondered if the answer might be listening to staff, patients, families, and the communities served, instead of trying to fill a cup that is already full with more new knowledge, skills, tools, and resources.
Repeating it is the easy part. Actually practicing it is a bit tougher. It can almost feel counterintuitive to tell teams the goal is not to manage QI projects, and worry less about meeting deadlines and goals (though they have been arbitrary to begin with). If we want to be transformational and sustainable, the goal is instead, to guide teams to manage their own work, and inspire them to collaborate with their patients and clients, even when you know their initial reaction to putting in the work on a co-design process won't be enthusiastic. We should practice servant leadership, and really listen to the voices of the people doing the work, and seek to understand the experiences of the people receiving services.
As a leader, or champion, it may mean you have to let go of control, and get comfortable with uncomfortable situations. It might be hard to reflect when the team is conditioned to jump into action. Ultimately, the goal of continuous improvement is to create an environment where no one has quality in their title, and certain activities are QI projects -- it is just the way everyone approaches everything, each and every day. It's tough to rationalize or accept ballooning backlogs, or missed opportunities, but the goal is a system built on informed, capable, empowered, and respected people.
