Leading Quality
Welcome to Leading Quality, the show that dives into the real-world stories and strategies of healthcare quality improvement leaders at all levels, from Frontline Champions to C-Suite Executives. Each episode uncovers how these dedicated professionals tackle complex topics in real healthcare environments. Discussion range from QI fundamentals, to leadership, technology, AI, and beyond. If you’re passionate about elevating patient care and want practical insights that go beyond the buzzwords, this podcast is for you. Tune in for inspirational conversations, innovative frameworks, and the behind-the-scenes details you won’t hear anywhere else, and discover how you, too, can lead quality improvement from wherever you stand in healthcare.
Leading Quality
Change Happens at the Speed of Trust: Lessons from a Decade of Physician-Led Improvement
As Stephen Covey once wrote, "Change happens at the speed of trust." This simple yet profound insight applied by this week's guest, Dr. Curt Smecher captures the essence of how British Columbia's Physician Quality Improvement program transformed healthcare from the ground up. Affectionately known as "Papa QI," Smecher shares the remarkable journey of creating a physician-led improvement movement that has trained over 1,600 clinicians across the province.
What makes this story exceptional isn't just the scale, but the approach. Rather than following the conventional wisdom of starting with executive buy-in, PQI began with frontline physicians and built upward. This counterintuitive strategy created a powerful foundation of clinical expertise while gradually earning administrative support through demonstrated results. The program's governance structure – with physicians, administrators, patients, and Doctors of BC as equal partners – represents a radical departure from healthcare's typical hierarchies.
Perhaps most revolutionary was the early decision to include patients as full participants in all aspects of the program. When questioned about involving patients in budgeting discussions, Smecher's response was telling: "Most of our patients know more about budgeting than our doctors do." This authentic partnership approach has been central to PQI's success and sustainability over its decade-long existence.
The program's impact extends beyond clinical improvements. Physicians trained through PQI demonstrate 40% higher engagement levels compared to their peers, suggesting that meaningful involvement in improvement work serves as a powerful antidote to burnout. Protected funding ensures resources remain dedicated to improvement rather than being diverted to immediate clinical pressures – a recognition that investing in system improvement requires dedicated space and time.
Looking ahead, Smecher describes PQI's evolution from building capacity to effectively utilizing that capacity, with the ultimate vision of "whole system quality" that addresses upstream factors rather than playing healthcare whack-a-mole. For anyone seeking to create lasting healthcare transformation, this conversation offers invaluable insights into building improvement capability that outlasts any single leader or initiative.
My entry into quality improvement was all self-taught. When we started the program, we recognized that we didn't have the skill sets within the doctors. I'm focused on training and creating capacity. We've done, I think, an outstanding job of creating capacity and now we're trying to make the transition from creating capacity to actually using the capacity that we've created.
Speaker 2:Welcome to Leading Quality, the podcast spotlighting the people moving healthcare forward from the front lines to the C-suite. I'm your host, jason Meadows. Today's guest is Dr Kurt Smetcher, a retired anesthesiologist and one of the original architects of physician quality improvement in British Columbia, also known as PQI. If you've ever tried to move QI from a slide deck into day-to-day practice, you know it takes more than enthusiasm. Slide deck into day-to-day practice, you know it takes more than enthusiasm. Kurt helped design a program that gave physicians practical training and protected time to use it, so improvement work wasn't just something squeezed in after hours.
Speaker 2:What I appreciate about Kurt is the way he leads without fanfare Clear governance, so good ideas don't stall. Shared ownership instead of top-down edicts and a steady focus on outcomes that matter at the bedside. His colleagues affectionately call him Papa QI, but the real story is a decade of careful, repeatable moves that allowed a small pilot to grow across the province. I wanted him on the show because his approach is both humble and high impact. We're going to trace the early days of PQI, the decisions that helped it scale and the leadership habits any organization can borrow, whether you're starting on one ward or trying to shift an entire health system. Kurt, welcome to the show, thank you, and before we get too deep into it, welcome to the show.
Speaker 2:Thank you and before we get too deep into it, do you mind if I call you Kurt for this conversation?
Speaker 1:Oh, please go ahead, very good.
Speaker 2:So you've done a lot in quality improvement in British Columbia. I'm curious to know how you got started, both in terms of your backstory as an anesthesiologist and what sparked your interest from clinical work into quality improvement.
Speaker 1:So I was a late entry into medicine. I've had a number of careers in the past, including marine biologist, computer scientist. I did doctor's research. My interest in quality improvement started back in about 1980, while I was still in industry, and that's about the time that Deming came to notice in North America. Through that period I was doing my work in IT and applied some of those principles. When I switched over into medicine in 1992, and it was my first day in medical school my attention was somewhat divergent. But once I went through medical school, went through residency and got a firm footing in medicine, then I naturally turned back towards quality improvement, and the timing seemed to be right. The appetite was there and so, as with all good leaders, I jumped in front of the crowd.
Speaker 2:That's great, and so paint the scene for me a little bit more in terms of where you started with quality improvement clinically. Where you started with quality improvement clinically, was there a first project or was there a particular mentor in the quality space in healthcare that got you involved in this?
Speaker 1:My entry into quality improvement back in 1980 and throughout that period was all self-taught. Most of us at that point were self-taught. When I tried to apply it in medicine, I went back and I got my training from IHI. I was part of wave 30 of their improvement advisor cohort and then I stayed on with them to help teach a couple of waves just to consolidate my knowledge. To help teach a couple of waves just to consolidate my knowledge. So my mentors at that point were most of the principals involved in quality improvement at IHI and I still keep up to date with them and very much appreciate their input and leadership leadership.
Speaker 1:Once we got back to working in Canada, doctors of BC here had an interest in having physicians engaged in improving the system.
Speaker 1:They didn't have a lot of knowledge around quality improvement or exactly what it was that would make this successful, exactly what it was that would make this successful, and so to a large extent, I was in the right place at the right time, 2014,.
Speaker 1:Dr Jan Korner presented some information about having a physician compact that I kind of took him to task for just because I felt there was a power imbalance there, and suggested that the common ground between the administration and the physicians was actually quality improvement. If you wanted to engage, you wanted to work together, work on that common ground, because we all wanted the system to function better, our workplace to be better, our patients to improve faster. Later in that spring John kind of tapped me on the corner and it was kind of a put up or shut up type of proposal and so I took over the Ecosystem Quality Improvement Program in Fraser, which was the first in BC, by about a year and a half in BC by about a year and a half, and so you used quality improvement as kind of this common ground to unite people who were in Doctors of BC as well as people in provincial politics, or was it mainly Doctors of BC?
Speaker 1:It was a combination the quality improvement program the funding for it came out of the 2014 physician master agreement, so that was an agreement between the Ministry of Health and the doctors and it provided funding for quality improvement.
Speaker 1:So we had the doctors at BC on board, we had the Ministry of Health on board and then at Fraser, I spent quite a bit of time working with the current CEO and VP of medicine to get them on board, because one of the things that would run us into trouble pretty quick is any sense that we were undermining what they were doing, or running rogue, or we're trying to get aligned, we're trying to get everyone running the same direction, but there's a lot of suspicion on both sides about what our intent is. So there's a lot of upfront work that I did in order to make sure that everyone was clear what we were doing, why we were doing it, a little bit about how we were doing it, because I wasn't really clear at the time exactly what this was going to look like. And then, using those relationships that I developed throughout 2014, we had permission from the health authority, the proposal went through Doctors of BC and we initiated the first cohort, probably appropriately April 1st 2015.
Speaker 2:As you're thinking back to that first cohort, we're about 11 years out from that now. Were there important lessons that you learned in doing that? Can you walk me through, maybe, what the lessons were and just how that cohort went?
Speaker 1:Well, the first lesson. It was a tremendous amount of work For that first cohort. I did the teaching, I booked the rooms, ordered lunch, did everything. It was a lot of work, but it was also very, very rewarding. The first cohort we had 12 people. They were from pretty much all aspects of medicine and one of the things I told them is that you know, 10 years from now or whenever you look back on today and say I was there when, and guess what?
Speaker 1:They really were there when. For us, a lot of those people are still involved. They're still actively teaching or leading programs throughout the province. The lessons there was a lot of work, but it's worth it. You build your leadership from within and my success, you know, as I measure my success, it's the success of the people that I've empowered to do this work, that I've taught and have now become leaders, not only in quality improvement in BC but within the medical administration as well, because we have a lot of people who have made that transition. You know we used to joke about well, it wasn't so much a joke, but moving over to the dark side, now there's a lot more understanding of the different points of view, the different constraints that everyone runs under and how to work together, and so that's been a huge part of the process for us.
Speaker 2:You mentioned that you had 12 participants, all physicians, because this is a physician-driven and physician training program. I'm trying to imagine are these people you were just knocking on doors and saying, do you want to get trained in QI? Or are these people who were expected to do quality improvement already and this was an outlet?
Speaker 1:How did this cohort of the people who were originally there, how did they come into it? The first cohort was probably the most difficult to recruit into because nobody knew what it was about. We put the word out through any channel that I had available, so mostly through the administrative, departmental channels, we ended up with the 12 people. The first question that we had was it comes through Doctors of BC, but it comes through the Specialist Services Committee. You know that's where the funding comes from. So were we going to accept family doctors? Yes, and so the answer to that was yeah, why wouldn't we? And so we did include family doctors in that first cohort and then after that it really wasn't a problem.
Speaker 1:The program after the first year really sold itself. We developed a lot of word of mouth referrals. You know we were seen to be a very rigorous program, but also a program that gave you a way to deal with the frustrations of your day-to-day work, a way to get in there and legitimately deal with. You know what we're now calling the pebble in your shoe. Deal with you know what we're now calling the pebble in your shoe, but also to you know, as I try and sell it to the administrators to deal with some of those problems that we have in the system that are low ending fruit, that are the day to day inefficiencies in process or cost inefficiencies, or or patient care that you know on on the ground you see it every day, but from the 30,000 foot level you would never see it, and so, having that bottom up drive and the reputation that was rapidly being built, it really wasn't very difficult to recruit.
Speaker 2:And you mentioned this interplay between Doctors of BC and the Specialist Services Committee and I understand that's also how the funding comes to be. I'm curious if you can share for people who might not be familiar with BC or even are listening from outside of Canada kind of what those two groups are, how this interplay has worked so well and maybe even you know ballpark, what kind of funding this program is receiving today compared to when it started.
Speaker 1:The organization that we're working under is I think it's probably unique in Canada so we have Doctors of BC, which is our medical association, and then, kind of off to the side, we have an organization that's a partnership between the medical association and the provincial government, which are called the Joint Clinical Committees, so the JCCs. Under the JCCs it's split into family practice specialists, shared care, which is kind of a transition between the two and rural. So we have the four different groups represented there. Each of them has their own funding and each of them is governed through a joint set of committees that is half Doctors of the BC and half Ministry people, so that we keep that coordinated and so that keeps us all aware of what's going on and aligned and legitimizes the work that we're trying to do. Oh, and you mentioned budget. The budget that we have is somewhere between $10 million and $18 million over the years for every year. But remember, it's a provincial program, so $100,000 doesn't go very far. So we run $10 million to $18 million in the budget.
Speaker 2:Certainly no small feat in the context of finding that spare you know, the spare change to, you know within a provincial healthcare budget to be able to deliver something like this. And I can imagine there might have been some skepticism initially, as you said, as you kind of alluded to before, on what it is you were doing and what the ROI might be.
Speaker 1:We still have those issues because when we started the program we recognized that we didn't have the skill set within the doctor. So I had the technical skill set that I brought back from IHI and the ability to teach it, but within the province there really wasn't anyone that was trained in quality improvement, so to take on quality improvement projects was going to be a problem. So the beginning of the program we focused on training and focused on creating capacity and we've done, I think, an outstanding job of creating capacity and now we're trying to make the transition from creating capacity to actually using the capacity that we've created. Part of our problem again we're quite unique in this is that most QI programs are top-down, and you'll hear it said very often that if you want to start a QI program, the first thing you have to do is you have to get the CEO or the administrators in line and then take it down to the shop floor.
Speaker 1:We did exactly the opposite. We felt that the positions were ready, but the administrators were not. We created the program in the opposite direction. We created it from the bottom up. It gave us the ability to do the training, it gave us the ability to make local change and I think we had some really good successes in that. But when the scope of change that you're able to make is limited to the scope of single physicians, you don't see those really big system level improvements that you really want level improvements that you really want. So now what we're trying to do is we're trying to make that transition so that we have a balance between the bottom up the low hanging fruit and the top down for the higher system impact. And I think if we can get that balance going, then we really have something to show please.
Speaker 2:Yeah, we really have something to show, please. Yeah, and it sounds like something that started really as an initial seed with this first cohort back in 2014. That has now grown into a province-wide movement and I certainly I meet people, a lot of people at the IHI, and certainly the Canadian cohort is heavily represented by British Columbians, and certainly the Canadian cohort is heavily represented by British Columbians. What kind of key governance decisions do you think were pivotal in getting from that local pilot to a province-wide program? And then I can also imagine that this had a kind of a grassroots energy, as you're talking about this coming from the bottom up, and I'm curious if it has been a struggle to maintain the grassroots energy as it's gotten bigger.
Speaker 1:Yeah, I think grassroots energy is still there. But the governance structure that we've set up, I think, is really important. So, to be honest, I really didn't expect the program to survive as well as it has. So some of the structure is guerrilla structure. If you create a monolithic governance structure, it's easy to attack and destroy. If you create a distributed governance structure, then if one arm of that runs into trouble or gets cut off for whatever reason, the program itself can still exist.
Speaker 1:So we created a governance structure that was focused in six different areas for the six different health authorities. Five of the health authorities are geographic and one of them is province-wide, looking after things like cancer agency and that type of thing. So each of those has their own steering committee. Now the governance structure within steering committees is important too, because the health authorities, as most of our health administrative systems are, is extremely hierarchical, and what we built is we built a very entrepreneurial system within this hierarchy. We built a system of four equal partners within the hierarchy and there's a bit of a culture clash when you do that and there's a bit of a culture clash when you do that. So our four partners was the administrators, the doctors, the patients and doctors at BC, mostly to make sure that the intent across the six different health authorities is maintained and that there's some consistency between them and that there's some consistency between them.
Speaker 1:So having that structure meant that we could have good representation of all the stakeholders without worrying about who had the balance of the voting power or who was the boss of who. We were all equal participants at that level and it also made sense from the point of view that if the health authority really didn't want to do something, it would be foolish for us to try and push it. Similarly, if the doctors really didn't want to do something, it would be foolish to push it. So that consensus decision-making structure that we put in place has really served us very well, and the culture clash has only really happened a couple of times and the recovery from it's been fairly easy.
Speaker 1:It's just people kind of get into their at-work modes and doctors give orders, not suggestions, and administrators they not suggestions and administrators. They run a hierarchy, and so when you get everyone together and everyone has to work as equals, it doesn't always flow naturally, but over the 10, 11 years we've done this it's really become ingrained and we've recently had a situation where everyone kind of got together and fought to maintain it, because we had an incident around budgeting that people weren't consulted and that has become such an ingrained part of our culture that people just weren't having it and we got back to consulting all parties. So it's not just a cultural I'm sorry it's not just a technical quality improvement program. It's a very big culture change that we've put in place as well.
Speaker 2:And it sounds like the structure right, the way that you've organized these steering committees, the way that this is an intentional collaboration between doctors of BC and the specialist steering committee, all of these kind of meta aspects, all these structural aspects are perhaps as important as the training itself, as the projects themselves.
Speaker 1:Yeah, very much so. It's the cultural aspect, but also the patients, right? So back 11 years ago, when we put this in place, the idea of bringing patients into structures like this was questioned. People didn't understand why you would do that. We're doctors, we know what the patients need, or we're administrators, we'll tell them what they need. We brought patients in as full partners. So one of my first patient partners joked that the first day she met me, I handed her a stack of textbooks and told her to get to work because she was a full partner. We've had conversations about why would you have patients involved in the budgeting of the program. Well, that's the same question. Why would you have doctors involved? Most of our patients know more about budgeting than our doctors do. So in all aspects of the program the patients are full partners and that's really important to the culture of what we've built and it's expanded right. Once you get these things in place and people see them work, they want to push them out to other areas.
Speaker 2:Yeah, and so I'm hearing this theme of reducing hierarchies and doing so very intentionally, and I am imagining, as this program is growing, you have more physicians getting trained. Each of those physicians works in their own context, whether it's their own family clinic, whether it's a hospital, whether it's some kind of group practice, and those structures themselves have hierarchies where physicians are often seen as being at the top of some of those structures or certainly in a bigger role of authority. Was there work that had to happen for this to work also at that local level, so that physicians were aware of perhaps being inclusive or intentionally reducing hierarchies within their own project teams?
Speaker 1:Yeah. So we've been very clear right from the start that you know quality improvement is a team sport, that you know you can't do it by yourself. You need to have those different perspectives. Every team has a leader and often that leader will be a physician not always but if a physician is not a leader, the physician will be involved in the leadership in some way. You know, when we started there were a few tenets that we adhered to. One is that physicians do want to make a difference, they do want to make the system work better. That the physicians will engage but only from a position of strength. If they don't know how this works or what's happening or whatever, they will find something else to do with their time where they feel it can contribute more. So they needed to have that position of strength that the quality improvement is a team sport and that everyone had to be involved, and not involved just in doing the work, but involved in all aspects of it.
Speaker 1:I have a couple of t-shirts I call my medical administration t-shirts. One of them says the floggings will continue until morale improves and another one says teamwork a whole bunch of people doing what I say. So we try and make sure that people understand that teamwork involves respecting others' knowledge, their perspectives and working together more in that flat structure. And I think that comes across not so much because of what we say but because of how we demonstrate it. And creating those steering committees of four equal partners, I think, is a really good demonstration of that. And then we apply it in different aspects of what we do as well, where the teaching is teaching by example, especially for a lot of the cultural stuff stuff, yeah, and you alluded to this a bit earlier.
Speaker 2:But this idea of building capability and then from there, leveraging the capability that you've built at scale. So training is certainly one thing. It's quite another to have protected time after the training is over or to leverage your skills in new ways, perhaps form new collaborations that exist outside of the program, but maybe with other graduates of the program. How are you thinking about this leveraging of this huge cohort of 1600 physicians who have been trained under PQI?
Speaker 1:A number of things that we've learned over the years. So one of those is that, you know, as we bring people through the system and the physicians and the administrators start to work together, they develop trust and understanding, and that extends far beyond just their learning project project. They make those relationships and that trust builds and it grows as they bring other people in, either on the administrator side or on the physician side. The other thing that we and that was expected, that wasn't a surprise. What was a surprise was that what we bring in with our funding is we bring in protected funds.
Speaker 1:So the health authorities they are so strapped for cash to get the clinical work done that any money that could possibly be diverted into clinical work tends to be diverted into clinical work, and so any money that would have come to them for quality improvement likely wouldn't have lasted very long just because of those operational pressures. So one of the things that we bring to the table is protected funding for them, because it's our money and if it's not used for quality improvement they don't get it, and that's always been understood. It's never been a problem. But having those protected funds and having this protected workforce is important because we pay. You know we don't pay as well as clinical work does, but we pay enough to take the bite out of it. And so we provide the workforce, we provide funding for the projects and it keeps us that's our carrot, I guess is it keeps us in the program and working with each other and it helps bridge over any rough periods in the relationships, which are very few and far between but it keeps us at the table.
Speaker 2:I read a research report that was looking at the impact of PQI and this is, I think, about three, four years ago that this was put out and one of the things that caught my eye was they commented specifically on how PQI has impacted the quadruple aim as defined by the IHI, and within that they comment on improved physician experience, which we know is one of these four aims. And in an era where moral injury and burnout seems to be one of the highest, the most talked about priorities and the most urgent priorities in our healthcare workforce, how do you think PQI has impacted physician well-being and perhaps rippling even further to others who have participated through these projects?
Speaker 1:One of the things that we did a number of years ago.
Speaker 1:Well, quite a few years ago, doctors at BC started to do an engagement survey of all physicians in the province.
Speaker 1:So for PQI, we took some of the questions that they'd been using and gave them to our cohorts and the difference between physicians as a whole and our physicians our physicians were about 40% more engaged, or 40% more engaged than the physicians as a whole. So it gave them, you know, feelings that they, they were making a difference, that they had, say in their own destiny, and they, they had some autonomy within the system. They knew who, who to talk to and and how to, how to approach these issues rather than just being a victim. And so that has had a huge effect and we see, we see it all the time. It also means that they're not afraid to to speak up, and then when they speak up, they speak up with some knowledge of their audience. And we all know that if you're doing a presentation, the first thing you need to consider is your audience and what's important to them. So now when they make any presentations, even if it's just an elevator pitch, they know who they're talking to and what's important to them and how to phrase it.
Speaker 2:Yeah, I'm hearing as you're saying this. I'm hearing some of these themes that I've also encountered, for example, through the IHI's joy and work framework, where you're giving people more choice and autonomy over the work that they do, you're giving them the ability to to actually influence how the work goes, and that that can be, you know, a big boost to how you know, how they feel, their kind of, their outlook for, for how this work is going to go for them one of the um.
Speaker 1:One of the things that that comes up fairly often is is the join, work and joy. Joy in work was always um, it was always one of the goals, I think, of the triple aim, but it was a derivative and then it worked its way into from triple aim to the quadruple aim and, uh, there was some resistance to it because there was a feeling that it was self-serving and that if you you push too hard on it, especially in political circles, it just comes across self-serving. But it's always been there as as a derivative. So when we talk about the moral injury, we talk about, you know, the autonomy, the, the ability to affect your environment as being a big part of joint work. But that's a, that's all part of the tripling.
Speaker 1:So so, yes, that fourth point, there they, the joy in work is important and, uh, recruitment, retention, productivity within the workplace, all of all of that is part of joy and work, but it's largely derivative from the others. I think there are some things that are specifically addressing joy and work, but the bulk of the effect we see is in making the workplace better, in providing better service and all of the reasons that we got into medicine, you know. Being able to enhance and focus on that is, I think, the biggest part of joint work.
Speaker 2:Looking kind of forward into the future of the PQI. I've heard that PQI alumni always ask what's next. I'm curious what you think is next for PQI. I've heard that PQI alumni always ask what's next. I'm curious what you think is next for PQI.
Speaker 1:Two things the first thing is we need to make this transition between creating capacity and using capacity, and we're in the throes of that right now. So part of that is restructuring so that we are structured around a project cycle as opposed to a classroom cycle. That's actually a fairly major transition in structure. So going to a project cycle means that September through June doesn't cut it anymore, that the end result is a finished project, not a graduation, that the choice of projects that we do needs to be more based on the value of the project now rather than the enthusiasm of the student. So we're making that transition.
Speaker 1:The other thing that's coming up is whole system quality, and it's starting to gain traction internationally. But within the province we're trying to socialize the idea very strongly so that quality improvement is just one aspect of it. So if you go back to Duran's trilogy, you have quality planning, which everyone thinks they do but they don't do. We have quality improvement and Duran called it quality control. I prefer to call it quality monitor, and we need to get those three put in place. So the way that I see that happening, first of all, we've got a pretty good handle on quality improvement and a lot of the measurement we do in our projects could easily filter into more of a dashboard type of quality monitoring system and then, if you add to that some purposeful building of that quality monitoring system, that's a fairly easy transition.
Speaker 1:The quality planning that can happen in stages, the the elephant in the room for a lot of this is always um, just the system, uh, system flow. And how do we? How do we? How do we make the system work better, patient, patient flow in particular. What we often end up doing yeah, I characterize as a game of whack-a-mole.
Speaker 1:Um, we, today the hot button is, uh, time specialist consult in the emerge, so you whack that mole and out pops something else. There's no beds to move them into, so you uh whack that one probably whack that one every day right now and then something else pops up and it's access to radiology or whatever it is. There's always something there that's a bottleneck. So, looking at system planning in terms of where are the real bottlenecks to the overall flow within the system, where are you going to get the biggest bang for the buck? I guess in solving problems and not just shift the cues around, shift the bottlenecks from one thing to another, and so that's something that we're actively talking about it's going to be a much larger task to actually get it working within the province. That's more of a 10-year plan for us, I think.
Speaker 2:Yeah, it sounds like the ideas are all there and it will take a little while to percolate and to solidify a lot of the partnerships there.
Speaker 1:Yeah, the partnerships is a big thing because when you work at that level in the system, you've got to have those partnerships. If I'm just worried about the, you know the flow through radiology in one hospital. You know that's within the scope of one or two physicians to work on. But if I'm looking at the flow of the entire healthcare system in the province, I've got to have buy-in on all levels in order to be able to address that. A lot of relationship building.
Speaker 2:If another province called tomorrow with zero extra dollars, what's the first move that you'd tell them to make and what pitfalls would you warn them about?
Speaker 1:Well, the first thing that I would say is that this is not rubber stamps. What works in one place does not necessarily work in the other. This has been extremely entrepreneurial, so you have to recognize the opportunity and have an organization in place that can pivot quickly enough to take advantage of it. So when we see an opportunity to help solve a problem, we need to be able to bring resources to bear very quickly in order to do that and help develop the sense of what our worth is.
Speaker 1:If it takes us three, four years to pivot, we're kind of like the healthcare system as a whole, where you're trying to steer a tanker right, it doesn't pivot very quickly. Where, for us, if we have the ability to take up and work on a hot project right now and make it work and demonstrate our value, that's how you get to build up, you bootstrap. The other thing is there's the saying that change happens at the speed of trust, and there's a lot of truth to that. The thing is, how do you build that trust? And you build that trust by working together and, over time, understanding better how each other works, what their priorities are, how to work together better, and that's how you build that trust. So it's the same theme of being entrepreneurial, you know, looking for the opportunities and being able to address the opportunities very quickly.
Speaker 2:I have to say I love me a good QI quote, and I haven't heard that one yet. Change happens at the speed of trust. I feel like that so perfectly encapsulates a feeling that I have felt. I think that a lot of people who are in this QI world in healthcare and probably QI world more broadly, have experienced you in this community, have become affectionately known as Papa QI. I am so curious as to how that nickname came to be. And now, after more than a decade of doing PQI, what continues to get you excited about this work?
Speaker 1:about this work. Nick came up as an allusion to Papa Haydn, a musician, and Papa Haydn was a musician in his own right, but he was also the mentor to a whole generation of outstanding musicians and I got the nickname because that's the role that I play. I said earlier that I measure my success not in what I do, but in what I enable others to do. That's the heightened comparison. And why Papa QI? Not just because I have a big point beard.
Speaker 2:Fair enough, as we kind of close out our conversation today, if we had a conversation again in 2030, so five years from now what do you hope PQI is? What do you hope PQI is doing?
Speaker 1:I never really expected it to last this long. It's outlasted. What I thought the you know what I call the corporate immune system would allow, and now you know we've made enough cultural change that I think there's a reasonable chance of it actually lasting that as long as you're saying. What I've seen is we've infiltrated a lot of the system with QI thinking, and that is huge. So we're seeing people who are starting to think in terms of solving problems with scientific method, which is what QI is, of formulating a statement of problem, a name statement, in a way that can be solved and can be measured, and working from data, and we're seeing that throughout the system. Now, as our very many graduates work their way into higher positions in the system, what I hope to see is a stronger integration between people we train and the organization as a whole. It's a sharing of power that is very uncomfortable, I think, for the hierarchies, and what I hope to see is I hope to see that a little more accepted and also the planning for the system to be a little more shared. So right now, what I'm pushing for is every year we have mandate letters that come from the premier to the ministries.
Speaker 1:The ministries you know, such as health, create mandate letters for the health authorities and then the administrators within the health authorities have to operationalize it, those mandate letters. There's never anything there that we would disagree with. There's kind of broad sweeping motherhood statements. Where I think we could be of a lot of value initially is in operationalizing those mandate letters, because the people who are told this is what you're going to do this year, they don't have that knowledge of how things work on the floor. And so to get the doctors involved in that, to get the other stakeholders involved in that in more of a QI process, to operationalize those mandates, I think has a lot of potential to enhance those relationships, to make the yearly work more feasible and to start to build towards more of a quality planning type of structure.
Speaker 2:Yeah, it sounds like going further upstream to affect things at a broader systems level.
Speaker 1:Always yes.
Speaker 2:Yeah, yeah, I love that. I mean, I think that's a great place to end our conversation today, Dr Kurt Smetcher. Kurt, I really appreciate you taking the time. I don't know if you're much of a social media guy. I usually allow people to say where they can find you or find more about you. Is that just tapping you on the shoulder at IHI? Or where could people find out more about you and about PQI?
Speaker 1:Yeah, I'm not much of a social media guy, but I am very happy to talk to people very generally. So send me an email, give me a call, tap me on the shoulder at IHI. I will be at IHI in Anaheim for the first time this year, a little closer to home for us. So please, you know, come have coffee, we can talk.
Speaker 2:Very good, well again. Thank you so much, kurt. I really do appreciate the conversation and you telling us more about your own journey and about PQI. So thanks for joining me on Leading Quality today. Like subscribe and share it with someone who might find it useful. You can find all our episodes at leadingqualitybuzzsproutcom or in your favorite podcast app. The show was written and hosted by me, jason Meadows, edited by Milan Miloš Savljević and produced by Thrive Healthcare Improvement. See you next time.
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