Why Leadership is Vital for Quality Improvement

| Marybeth Farquhar, PhD, MSN, RN

Change is a part of every quality improvement initiative, and leadership is essential to the endeavor.  Thought leader Don Berwick, M.D. stated that the failure to move the quality agenda forward was due to the failure of leadership and the inability of medical administrators and the professional workforce to innovate (Galvin, 2005).

As we know, leadership and management are not the same thing.  Managers deal with the organization’s existing and growing complexity while leaders and leadership attend to transforming organizations to specific goals. Leadership is “working with people and systems to produce needed change” (Wessner, 1998).

Individual leaders must possess strong personal leadership attributes, know how to use them, and they must be authentic—embodying leadership characteristics such as trustworthiness, humility, honesty, passion about the work, and results-focused.  Both “being” and “doing” are required for leader success particularly in healthcare when quality improvement often involves reframing core values or reshaping professional teams. These types of transformational changes not only require individual leadership but must also have a supportive environment which means leadership must occur at the system or organizational level.  Organizational leadership incorporates a complex, interrelated set of activities.

Leaders set the future direction of the organization, establish foundational knowledge and skills needed to improve systems, build the will for change and execute it continuously, generate innovative ideas, and measure performance (Reinertsen, 2014).  For quality improvement to occur, leaders will not only have to improve their individual skills, but will also have to improve their leadership at the system level to affect successful and sustained change. Both leadership types – individual and organizational – are essential to quality improvement initiatives.

“Individuals and organizations that are good react quickly to change. 
Individuals and organizations that are great create change.”  (South, 1999).

Health care delivery systems are extraordinarily complex and encompass deeply held values and beliefs.  These systems, that reside in an ever-changing environment influenced by professionals, community, regulation, policy and markets, behave unpredictably. And when a quality transformation emerges, it has likely come about by a convergence of influences that can be both planned and unplanned. Leaders need to develop and work a transformational plan to change those things that they have control over and to influence those things that they do not control. This is how we move the needle on quality.

Leadership is an important aspect of quality improvement because it creates a culture that supports improvement. Good leaders, up and down the hierarchy, create an organizational atmosphere in which improvement teams succeed. However, leaders cannot single-handedly improve health care quality.  Front line practitioners are required in the quality improvement equation to ensure success where it most counts—better outcomes for patients.

image of Marybeth Farquhar

Marybeth Farquhar, PhD, MSN, RN, Vice President, Quality, Research, and Measurement.

Marybeth Farquhar, vice president of quality, research, & measurement, is responsible for conceptualizing and implementing URAC’s strategy for measurement and research. Farquhar has more than 30 years of experience in the field of nursing and healthcare administration, research, and quality measurement. Prior to her tenure at URAC, Farquhar was vice president of performance measurement at the National Quality Forum and was responsible for strategic oversight of the consensus development process. Prior to NQF, she led key activities of the Agency for Healthcare Research and Quality performance measure initiatives and worked with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) team on several projects, including Hospital CAHPS.

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