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#fivelessons

“Improvement in healthcare is 20% technical and 80% human”. So says Marjorie Godfrey, Executive Director & Founder, The Institute for Excellence in Health and Social Systems (IEHSS), University of New Hampshire – a world expert in positive change within healthcare. In a nutshell,  it’s your people rather than your technical capabilities that will make the difference in a quality improvement project. But how do you manage the influencers who could make the difference between success and failure?

1. Step back (you can’t do it alone)

Improvement is not something to do for team members, it is to be done with them, and you have to get that across from the outset. How do you make that real? Let go of the reins. Involve staff in the process of setting the team or department’s strategy and goals. Giving team members control helps them take ownership of the strategy driving a quality improvement project and makes them feel part of the change. Inviting participation rather than holding control is much more likely to generate a surge of engagement that’s both change-making and sustainable.

There is increasing research showing that a key factor of sustainable change is whether people genuinely feel involved in – and part of – the change. Giving staff little opportunity to contribute, show initiative or to be engaged in improvement and change in any meaningful way encourages further dependency and makes a profound negative impact on culture.

So step away from deciding what needs to be changed, and instead start enabling others to come up with their own solutions.

2. Talk to and trust the team (lead as an enabler)

It’s not rocket science but it so often doesn’t happen. Ensuring that there are clear expectations for each team member’s functions, responsibilities and accountabilities will empower ownership and help to optimise the team’s efficiency. Everyone should know that they have a meaningful part to play in the quality improvement project.

In addition, giving regular feedback to staff so they know exactly where they stand and what they need to do, is essential. Recognising staff’s efforts and successes helps to make them feel appreciated, which in turn makes them more inclined to continue trying to improve. Be more carrot than stick.

On a similar note, it’s just as important to ensure there is a practical way for staff to provide feedback to you on what they think could be improved. Be accessible and approachable so that staff feel comfortable providing suggestions. The ImproveWell platform can of course help with this.

3. Inspire the inspirers (they’ll have more influence than you)

In their article, Tapping the Power of Informal Influencers, McKinsey & Company write “Employee resistance is the most common reason executives cite for the failure of big organizational-change efforts. Winning over sceptical employees and convincing them of the need to change just isn’t possible through mass e-mails, PowerPoint presentations, or impassioned CEO mandates. Rather, companies need to develop strong change leaders [that] employees know and respect—in other words, people with informal influence.”

Indeed according to Innovisor, just 3% of people in the organisation or system typically influence 85% of the other people – and as Helen Bevan rightly points out, this pattern is mimicked in social media. Research by Graham MacKenzie using NodeXL notes that in health and healthcare globally, tweets by 3.3% of tweeters accounted for 85% of retweets.

But how can we identify these agents for change, and what do they look like? Helen Bevan explains. Superconductors, or “the 3% of informal influencers:

  • have the relationships, networks, content and context;
  • drive the perceptions of other people;
  • are the go-to people for advice;
  • make sense of things and reduce ambiguity for others;
  • are trusted by peers more than formal leaders are trusted; and
  • are often unknown to formal leaders.”

To identify them, McKinsey suggests that conducting simple anonymous surveys to ask: “Who do you go to for information when you have trouble at work?” or “Whose advice do you trust and respect?” will “quickly identify a revealing set of influencers across a company.”

4. Chart your change (and be open and honest)

A Lucian Leape Institute report states that “from the quality and safety perspective, transparency is foundational for learning from mistakes and for creating a supportive environment for patients and health care workers.” When launching a new quality improvement project, leaders must be transparent every step of the way. From setting goals, to communicating expectations and feedback, to sharing ongoing progress updates – communication and transparency are key. There’s no hiding here. You have to be honest and mean it.

It’s also crucial to make data easily accessible to the team, and in real-time. By demonstrating impact early on, staff will be able to see what and how change is being made from the beginning. Have regular meetings or huddles to review the data together and use it to inform further improvement work. Visually tracking changes that have been suggested and are in progress is a great way to ensure staff know where their efforts are taking effect and what is coming in the future.

The goal of improvement is turning new behaviours into habit. In order to ensure changes will stick, improvement outcomes should be measured and communicated regularly. Skip this at your peril.

5. Kick away blame (fail, fail, fail – then fail some more)

Blame culture – and its toxicity – should be a thing of the past. Instead, start viewing failures as learning opportunities. Finding out what doesn’t work is just as important as learning what does, and it can also help lead to the best possible solution.

Cultivating a workplace that embraces failure is key to success. Employees who fear making mistakes may be less likely to take risks or express opinions, which leads to a lack of innovation, meaning good ideas going unheard. Embracing failure sends a message to staff that all ideas are welcome and mistakes will be learned from in just the same way that successes are. There’s often pushback and negative feedback in times of change. Rather than avoiding those negative voices, involve them in finding solutions and use these as learning opportunities.

In short, change your thinking, eschew old-fashioned top-down hierarchical thinking and facilitate and celebrate your greatest asset – your people.

Step back

Talk to and trust the team

Inspire the inspirers

Chart your change

Kick away blame


Engage to Improve with ImproveWell

ImproveWell is a digital solution that helps healthcare organisations in the NHS and beyond achieve their improvement and staff engagement goals. With it’s smartphone app and intelligent data dashboard, ImproveWell empowers teams to:

Give staff a voice, track workforce wellbeing and drive a culture of connectedness.

Gather instant feedback & learning 24/7. Plus create a funnel of staff-generated improvement ideas.

Empower local leadership, cross-collaborate, and drive data-driven decisions.


“ImproveWell allows me to hear from everyone in the department, regardless of their role, about what aspects of our work needs to be improved, what matters to them, and suggestions and solutions for how we can best improve those aspects”


Joy Harken, project development manager in the Department of Orthopaedic Surgery at the University of Minnesota, Minneapolis,

Connect with Marjorie Godfrey on LinkedIn

Photo by Franco Antonio Giovanella on Unsplash

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