It might be cliché to use a sports analogy to talk about coaching, but having just finished both seasons of Ted Lasso, it resonated with me because of its relevance to coaching and leadership beyond the football (soccer) pitch.  Having a coach isn’t just for athletes — it can also help professionals, from surgeons to scientists to musicians, get better at what they do. Coaching isn’t meant to be a corrective or punitive one-way transfer of knowledge from an infallible expert to a humble disciple. The coaching relationship works best as a collaborative approach to help teams and individuals reach their full potential. I really enjoyed the way the show delves into the multifaceted role of a coach, showing Ted as a leader, teacher, communicator, problem solver, mediator, and mentor.

I'm sure there are numerous similar articles out there, but I am going to focus specifically on quality improvement in healthcare. Full disclosure, there are tons of spoilers here for seasons 1 and 2!

While I don't think every QI coach should emulate Ted, he uses some strategies that make QI coaches better.

Start by addressing pain points that are quick wins.

Ted Lasso starts by coming up with a suggestion box for players.  While many of the suggestions showed that they didn't take it seriously, one was about the water pressure in the showers. Ted improved the showers, and suddenly started catching the attention of the reluctant and cynical team captain, Roy. This is a critical lesson for QI coaches — start with what ticks off your key stakeholders. I cannot stress this enough. When prioritizing improvement opportunities with a new group, you need to address the, "what's in it for me," for your quality champions. Instead of chasing some poorly defined KPI or Byzantine systems-level project, QI coaches should prioritize quick wins with value for staff. This is how you build enthusiasm for QI. Defining the problems and opportunities should come before measurement. Start by asking what distracts from valuable work, what is frustrating on a daily basis, and what processes could work better. You may end up eliminating a report instead of a clinical priority, but that's okay at this stage. Bigger wins will follow when staff feel a direct connection to the impact of QI in their daily work.

Fun leads to an environment that breeds success

Ted celebrates a player's birthday after a loss. Some characters thought this sent the wrong message, but this is exactly the mindset you need to coach QI. It's obvious we need to celebrate the wins, but sometimes we need to recognize key contributors, even when tests go off the rails or our projects don't yield success…yet. Learning from missteps is ingrained in each iterative improvement loop. Making QI fun, and building team comradery is essential to keeping folks motivated in the face of challenges long-term.

Not reinventing the wheel, but making sure the wheel fits

Ted knows almost nothing about the game of soccer. He only got the job because he went viral celebrating with players and caught the attention of the team owner getting revenge on her ex-husband. While this premise seems ridiculous, we lose out on many valuable lessons because in health care there is bias to specialize. Sometimes, it doesn't really matter because teamwork is more universal than a specific league or sport. Other times, the right technical knowledge is needed. The show has an example when Ted is trying to rally the team with a speech from the classic movie, Hoosiers, and says the field is the same size as their field…however the fields, in this case, are NOT the same size. That scene reminded me of two kinds of organizations; those experiencing "not invented here" syndrome, and those suffering from "proudly invented elsewhere" syndrome. Organizations that will not accept the validity of any ideas that come from outside their field or specialty, or even sometimes their own organization, are in the "not invented here" camp. Conversely, when organizations don't bother doing the work needed to develop tailored solutions, and don't give their people the chance to apply their knowledge specific and relevant to their environs, they are experiencing "proudly invented elsewhere" syndrome. They always want the solution from somewhere else; a conference, literature, a change package. Despite some missteps, Ted is very successful with little technical knowledge because he sees the big picture, which ties into my next observation.

Being a humble servant open to learning

You don't have to be an expert to be a good leader or coach. That fallacy is hard to break, but a rational, reflective, team builder who can connect strategy to culture will outperform a specialist who honed their talent in a single process or sub-specialty. Thinking about the previous blogs about culture, those elements are very universal and missing them is more likely to halt QI than choosing the wrong clinical best practice.  While you certainly have to suspend disbelief that a second-tier amateur American football coach would be hired to coach a professional soccer team at the top level, I like the way the show demonstrated that a good coach needn't be an expert, and that some qualities and strategies of excellent coaches transfer beyond one setting or discipline. Thankfully, in my experience, I've seen the embracing of novel strategies from outside medicine and public health steadily growing. For example, seeing NICU units using Experience Based Co-Design (EBCD) methods to engage families as partners in quality. Designing products around the people using them has been a standard for over 50 years in manufacturing and software, and it's great to see it taking hold in health and human services. Also, seeing the response to COVID-19 unfold rapidly forced the healthcare system to innovate much faster than usual. I hope that the lessons learned by public health departments as they designed, built, tested, iterated, and integrated new systems for reporting and contact tracing are applied to their standard programming for community health, and other infectious and communicable diseases.

Reward process not outcomes

Ted often says he doesn't care about winning, which is the outcome of the match, and instead focuses on the process of preparation and team cohesion. While I don't love the choice of words, there is a QI lesson here for sure. If the only purpose of your QI project is to improve outcomes, or save money, and all efforts are aimed at it, it is likely that you will not be successful. Those things are more likely to happen when you approach every meeting, every phase of the methodology, every improvement cycle, every project, and every problem with a rational approach to improvement, based on the experience of staff and patients.

Nurture your talent and build a balanced team

Though the title focuses solely on the main character, I think the most important lesson in Ted Lasso is that building a successful team requires collaboration of specialists in defined roles.

• Coach Beard - Ted's loyal sidekick isn't nearly as loquacious as the head coach, but is often the one doing the research, and always has important facts and stats on the top of his head. It's fitting that Coach Beard is shown to have an affinity for chess in season 1. Noted as a game of strategy, it is definitely fitting for all coaches, QI included. QI is tough work, which requires decision making from documentation, data analysis, and prioritization using specialized tools and graphs. A good QI coach can help structure your improvement ideas and theories, ask the tough questions, and provide just-in-time insights from a broad knowledge base. Strategy also comes into play when a QI coach assists teams and clinicians in strategically developing an organization-wide QM vision, QM plan, master implementation work plan with detailed milestones, and defining roles/responsibilities. As I previously discussed, culture, strategy, and respect all go hand in hand. The right coach can help your team focus on implementing tests of change, and putting your expertise to knowledge, instead of getting bogged down in methodology.  Much like coach Beard does for Richmond AC.

• Coach Nate - Starts out as the timid equipment manager, but his keen insights and knowledge lead him being promoted to assistant coach. He may not possess the qualities that come to mind when thinking of leadership. He's not vocal, or articulate, or decisive. Although unassuming, “Nate the great" is the catalyst for many of the team's most impressive plays, including new defensive schemes, and novel strategies that confuse opposing teams. A QI coach can learn a lot from the wünderkind. It's important to sometimes quietly lead by example, and promote QI activities. A coach assists leadership to maintain momentum. A coach embraces data-informed and creative opportunities for improvement using iterative tests of change. In Nate's case, he doesn't go back to the same play that worked in previous games, he evolves his unusual 3-player defensive substitution into a more permanent strategy that completely foregoes an offensive player for an additional midfielder. QI coaches should promote development of QI infrastructure, and establish evidence-informed interventions that enable the QI team to achieve their goals. Quality improvement is about the team, not the coach. The team has to own its performance, but the coach can provide analysis and direction.

• Roy Kent - Roy begins the series as the veteran captain of Richmond AC, is forced to retire after an injury, and after a brief stint as a television analyst, he returns to the pitch as a coach.  While Roy's demeanor isn't in line with the traits of a great QI coach, he has knowledge of the game and experience with what the players are thinking and feeling. Since he has done the work first hand, he has both respect and keen insights about a players’ needs. As it relates to quality in healthcare, Roy is like the clinician who provides input and rationale for selecting goals, projects, and measures, while the coach can help connect the team to evidence-based interventions or clinical research. They can be someone who presents topics at training, holds office hours, or just has a great simulation, exercise, or story to keep the team motivated.

• Rebecca - The team owner who initially wants the team to fail to get revenge on her ex-husband, who she felt cared more for the team than her. Initially, she sabotages Ted at every step. I especially liked the growth in the dynamic between Ted and Rebecca because it is relatable to me, for sure. I have met with senior leadership who focus on QI because they think it is rooted in compliance, assurance, and QI as a means to find and address the "bad apples", instead of a defined and continuous framework for problem solving. Some are skeptical, at best, that quality improvement is little more than a flavor of the month. As a coach, you need to persevere like Ted does. He brings Rebecca freshly baked biscuits (cookies on this side of the pond) each morning. I'm not saying that a QI coach needs to bake anything (although it might not hurt?), but if you can stay visible to leadership, and consistently share the outcomes of projects, improvements in survey results, and the development of staff, that can be even more fulfilling than a sugar fix.

Ted Lasso is definitely a sympathetic main character. There is a temptation to paint him as the perfect coach however, I think it is overly simplistic to think that the main character does everything right. Ted operates under the assumption that doing the right thing always pays off.  However, that unfortunately isn't true in the complex landscape of healthcare and public health.

Learning from Mistakes

Ted advises a player having a hard time earning the respect of some teammates to be a goldfish. He explains that a goldfish is the happiest animal in the world because it has a ten second memory. The idea is that you need to shake things off and try again. While it is true that we can't let mistakes, failures, or difficult feedback derail our progress, I actually disagree with this idea quite a bit. Though having a short memory means you don't let past failures hold you back, it also sacrifices the important gains from failures. Instead, this instance is probably a better place to address the process and adjust, based on what you've learned, instead of just letting it slide and moving on.

Recognizing Contributions

In the later part of season two, we see Nate beginning to become resentful of his role being diminished by Roy, who has the more traditional resume of coach, and he also becomes aggravated by Ted's sudden success, when his tactics are responsible for wins. The way it unfolds with Nate and Ted having a showdown, and Nate becoming a new antagonist as a head-coach on a rival team makes for great serial drama. This is another place where Ted missed the mark as a coach. In the outset of this post I defined the role of the coach as a collaborative effort to reach their full potential. While I think Ted could've done more to acknowledge Nate, and clearly Nate handled it poorly, as a coach, we have to remember that talented people are the most valuable inputs our system has. Ted should've moved him to a General Manager or Director of Analytics role. Sometimes as a coach, you're going to see people outgrow their role on the team. Being a coach not only means planning for turnover and sustainable systems built on clear and standardized work, but also supporting high-performers to move on to reach their full potential.

If you haven't seen the show, you should check it out (if I haven't spoiled all the twists for you). If you have seen it, I wonder what your impressions are of Ted as a coach? I’m sure there are plenty other relatable moments I missed.

As I'm continuously working to be a better QI coach, it was an entertaining way to reflect on how I deliver on key activities such as being:

• A sounding board for project ideas and QI experience

• A mentor in quality improvement skills and applications

• A resource for tips, tools, and templates

• A thinking partner with an outside perspective

• Another set of eyes and ears

• A champion for individuals, teams, projects, and organizations