As organizations pursue quality as a business strategy, they quickly realize a need to develop improvement capability across the workforce. This requires understanding what people need to know, who needs to know what, and what is the best way to learn.
Who needs to know what?
Everyone in an organization requires knowledge and skills of the science of improvement as well as tools and methods that support the work at different levels. Crafting a theory and a strategy for creating system-wide capability is essential for developing people and for transforming culture and practice.
Robert Lloyd, PhD at the Institute for Healthcare Improvement coined this as a “dosing strategy” in a chapter in his new book. Using a medication administration metaphor, dosing is titrating or delivering just the right amount of learning or skills to enable people to have the best effect. Dr. Lloyd is quick to note that who needs what and how much varies by organization and where they are on their journey but is grounded in improvement science and core tools and methods. You can see examples of this thinking here and here.
Understanding the network of people needing capability begins with mapping core roles and determining what the expectations are for skills and abilities. Here is an example from The Improvement Guide (2nd Ed.).
|Expectations for Executives, Managers, First-Line Supervision and Employees|
|Table 14.1 from Langley et al. (2009) The Improvement Guide (2nd Ed). P. 332-333|
This example identifies broad roles by tiers, and the expectations describe the outcomes or behaviors. Other examples get more into specific tasks and actions. It’s important to focus on the results to be achieved and not solely on a menu of tools and activities.
Another example can be found in Figure 2. Architecture of a High-Performance Management System (pg 10) in the Institute for Healthcare Improvements Sustaining Improvement White Paper. The authors similarly look at people across tiers and consider what each tier requires for improvement as well as for managing or sustaining improvement.
There are a lot of improvement tools and methods we can all learn. Identifying who needs to be proficient in what to meet the aims of their role will help you assess your organization’s current state of capability. Then you can design a plan to build an appropriate, role and results-based approach, to developing people across the system.
In part three, I’ll look at the best way to learn to improve.
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