Lessons Learned in changing healthcare... and how we learned them 2010: 41-53

Chapter 3: Teaching Others to Lead Change

Linda A. Headrick

I appreciated the assignment to reflect on what I've learned about leading change in healthcare and how I've learned those lessons, but my first task was to renegotiate the assignment. What I can best discuss is what I've learned while teaching about leading change in healthcare. I've spent the last 15-plus years working to find ways to change health professions education so that new health professionals finish their training ready, able and expecting to improve healthcare.

To decide what lessons to share, I created the following exercise: I sat down with a stack of three-by-five index cards and wrote on each card a major project, role or event in my career. On each card, I described the role, project or event and then made notes about the important lessons related to teaching about change in healthcare. I spread out all the cards and studied them to see what emerged. I chose four lessons to share here. Three of them involve learning to improve care:

1. Because the goal is that future health professionals will be able to improve healthcare, both didactic and experiential learning opportunities are needed.
2. Clinically based learning is more powerful than classroom-based learning; therefore, partnerships are needed between education and clinical leaders.
3. Those who seek to teach others to improve care likely will be most effective if they demonstrate continuous improvement in their own work.

The fourth focuses on nurturing future leaders:

4. Take time to listen; be fully present.

Lesson One: Because the Goal Is that Future Health Professionals Will Be Able to Improve Healthcare, Both Didactic and Experiential Learning Opportunities Are Needed

Didactic learning leads to "knows that"; experiential learning leads to "knows how." Gaining competence in the improvement of care requires both. I'm embarrassed to admit that it took me three tries to learn this point in a way that I wouldn't keep forgetting it.

First Try

My first opportunity to understand that learning about the improvement of care requires both didactic and experiential strategies came from Dr. Edward McEachern. Edward was one of my first quality improvement teachers. He's an expert in the clinical applications of improvement, and he agreed to help me learn. As part of that process, he offered to let me come with him to Helsinki and help him teach a course on improvement in healthcare. But there was a caveat. He said, "Linda, you've been doing a lot of reading, and you've been doing a lot of studying, but that's not enough. You can't come to Helsinki unless you do an improvement project. You have to do one yourself."

So I set out on my first improvement project: to start patient appointments on time in my own general internal medicine practice. In general, while in clinic I was able to keep up with the schedule. My patients grew to expect that, so when I was late, they were dissatisfied. They usually didn't complain to me, but they did complain to the staff. So I thought, OK, how can I improve that?

I created a flow diagram of the check-in process; it is reproduced in Figure 1. I had a theory about what sometimes caused me to run late in clinic. A patient would come in and get checked in. If the examination room was not ready, the patient had to wait in the waiting room because I was working with only one examination room. I thought a big part of the problem when I ran late was that it took the nurses a while to get the next patient into the room. I'd stand there waiting or go get the patient myself so that we could start the appointment. MORE.