For internationally renowned quality improvement (QI) expert Paul B. Batalden, MD the road towards enhancing 21st century medical training and ultimate patient outcomes is a clear – but complicated – one.
According to Dr. Batalden, the only way to truly improve healthcare quality and ultimate health outcomes is to completely revamp and redesign the healthcare system, itself.
Dr. Batalden, the closing plenary speaker for the upcoming 2016 International Conference on Residency Education, is professor emeritus of Pediatrics, Community and Family Medicine and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, and guest professor of Quality Improvement and Leadership at Jönköping University in Sweden.
He has previously founded, created, or assisted in the development of a number of QI initiatives worldwide, including the Institute for Healthcare Improvement (U.S.), the Improvement Science Fellowship Program of The Health Foundation (UK), and the Vinnvård Improvement Science Fellowships (Sweden).
As a sneak peek to his plenary lecture, Dr. Batalden recently took the time to talk to ICRE about strategies for improving 21st century health care outcomes, and why he believes “every system is perfectly designed to get the results it gets”.
Q: What are some of the biggest/most critical gaps that currently exist around quality of care/patient safety? Why do you think they still exist in the 21st century?
We, and our language about the work we do, have been captured by a “product-dominant” discourse. So we make what we call a healthcare service like one would make a product: “I make it, you buy it.” We’ve effectively accepted the premise that it is possible to “outsource” your health to professionals and now we struggle to pay for it. We labor under models of value-creation that work for manufacturing and products, rather than creating more flexible models that fit the need for particularization and flexibility. Good health professionals know better, and they resent being treated as manufacturing process machines.
Little pedagogical research and development is focused on the preparation of healthcare professionals capable of improving the value of the contribution that healthcare services might make to health.
Q: One of your most well-known and most talked about observations is that “every system is perfectly designed to get the results it gets” – can you talk a bit about what this means in relation to the push for quality improvement?
We are obsessed with “installing” remedies and evidence — as if there weren’t real smart people involved. So “improvement” often involves searching elsewhere for what must be installed locally. A systems understanding of work helps us see that the work we do involves other people, behaviors, and information technology, in relationship for a shared purpose. When we do “get” that, we realize that if we seek change, it is that system which must be understood and modified.
Q: Why is a focus on quality improvement and patient safety especially important now, in the context of 21st century medical education?
It seems unlikely to me that the world of healthcare service that graduates today will face or live in for most of their professional lives will work like the present one.
This means to me that faculty who seek to be useful for their graduates will help prepare them with different questions, different curiosity that will allow them to contribute to the development of these new systems. Consider: How might they participate in leading the changes that must and will occur? What competencies or capabilities will be necessary? What mental models will be useful?
Q: The term “quality improvement” can be interpreted, implemented and theorized in many ways – but what does it mean to you, in the context of your own practice, and in terms of residency education and training?
For me, improving the quality, safety and value of the healthcare services that, as a professional I help create, is part of what makes me a “professional.” My work on improving my work helps legitimate my societal claim as a professional.
Q: Your involvement in quality improvement initiatives and organizations has spanned the globe. Having been involved in quality improvement in places like the U.S., the UK and Sweden, do you think that truly practical solutions around quality improvement/patient safety should be determined on a global scale, or are quality/safety gaps generally country/regionally specific?
Some things can be universally addressed, such as the development of curiosity about the actual systems of healthcare service and the capability to change them, when desired.
Some things we can learn from one another through the global exchange of frames, mental models, and practical examples.
Broad sharing across national, language boundaries awaits the creation of such an exchange program. Maybe gatherings like [ICRE and the QI Conference] are a start.
Q:You’ve done quite a bit of work around something you call “sustainably improving healthcare” – can you talk a bit about this, and what it might take to achieve this goal?
I believe that until we link better outcomes, better system performance and better professional development, we will not have sustainable, generative improvement of healthcare services.
Q: In all your research and work around patient safety and quality improvement, what has surprised or inspired you the most?
Not sure it’s a surprise, but it may be to some. Health professionals’ deepest desires about the quality and safety of healthcare services for their patients may be the strongest ally we could imagine—but we struggle to acknowledge this and use it. Young professionals don’t want to work in settings that don’t do a good job for patients. From these, you would suspect that faculty, especially the really good ones, get it and are eager to demonstrate that in their own practice settings.
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To find out more about Dr. Batalden’s academic contributions and accolades, visit the plenary speakers’ page on the ICRE website.
Dr. Paul Batalden will deliver ICRE 2016’s closing plenary on Saturday, October 1, 2016 (16:00 – 17:30) in Niagara Falls, ON.
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