1 Create a continuous improvement culture


1 Create a continuous improvement culture

1 Create a continuous improvement culture

We have looked at the micro detail of a change project or problem solving process – and have identified strategies to engage your staff in this along the way.  Now we will look at the broader structures needed to foster a continuous collaborative improvement culture.

The why and how of continuous improvement

There are multiple opportunities to catch risks before they result in incidents or catastrophes. But only if the individuals at the point at which the issues occur are empowered to make decisions and use their initiative when they see issues.  Enable individuals to take more autonomous action at the point of care. Do that and you will have less customer complaints, fewer incidents, improved patient experience and outcomes.  Create a culture where the individual cannot help but take responsibility for what they see is not quite right (NQR). Create a “see and fix it” culture.

The hierarchical nature of most hospitals and health systems, can force staff to wait for permission to do the right thing.  I think even the committee structure, and having specialist departments focusing on quality and safety centralises responsibility for quality, safety, risks and fixing things – removing it from the individuals who see what is really happening on the ground. So this section is less about the committee structure and departments – and more about what you can do in your units to make improvement everyone’s responsibility.

Risk aversion leads to micromanagement, which leads to dependency.  Managers who feel compelled to get down into the minutia, which not only disempower their staff (clinicians),  they will also distract them and make them stressed. Staff will be worrying more about what their manager is thinking and doing – and not what their patients and colleagues are doing.  With this increased scrutiny, increasing reporting up, individual clinicians may well take even less personal responsibility for what they see in front of them – they won’t use their initiative, and to avoid blame and castigation, they could shift responsibility for issues to others, ignore it or work around it.

Enabling individuals to take more autonomous action at the point of care (or service) actually reduces the risks, increases quality and responsiveness to consumer demands – so less customer complaints, improved patient experience.

It all starts with culture

Culture is quite simply the way we think we are expected to behave to fit in and get along.  It is usually the unwritten rules that are exhibited in how people do their work and interact with each other on a day to day basis.

Get people thinking and behaving in ways that foster creativity, that encourage people to speak up and take initiative, to seek out new ways of doing old things, and be open to ideas and other’s opinions, and you have a culture that is safe and progressive.

I think the best indicator of whether you have an improvement culture or not is how individuals respond to things that are NQR – especially when they are on their own!  Do they ignore it, report it, do something about it?


Specify how you expect people to behave, interact ad do their work in order to encourage continuous improvement. Share these in the comments below.

Engage your team in this exercise so that the unwritten rule become an explicit code that everyone can work by.  You could also add in the behaviours that would undermine continuous improvement and insert these ‘below the line’, so it is clear to everyone what is and is not expected – and they can hold each other to account.



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