Culture of inquiry: Doing things a little differently
Have you ever asked yourself: how can I do things differently? Better yet, how do I make this a habit?
We talk more and more about continuous quality improvement (CQI). In fact, this fall, I shared how the Royal College’s Maintenance of Certification Program has put a new emphasis on CQI.
For some, this may feel like an extra strain — especially in the context of pandemic-related constraints and backlogs — however I suspect most of us are already asking these questions as we go about our days, particularly with all the changes we have had to make. When we pair this inquiry with deliberate actions, we have the potential to truly transform how we deliver care for every one of our patients in both small and meaningful ways.
I would suggest that a culture of improvement comes from a culture of continuous inquiry. In other words, a mindset that enables a learning health care system by rethinking “the way we’ve always done things” and looks for opportunities to grow, to ask questions, to evaluate and then move towards different outcomes. Learning health care systems help our patients and all those who work within them.
So, how do we get started?
The learning health care system
We have to think differently in order to get different (and better) outcomes.
A culture of inquiry is the foundation of a learning health care system. By this I am referring to the concept of a system or an environment that puts research, and the knowledge generated from that research, into practice through a cycle of continuous improvement.
To enable a learning health care system, we need
- a culture of inquiry;
- leaders who are committed to nurturing a culture of continuous learning, research and improvement;
- patients to be included as vital members of the learning and research team;
- systems to capture, analyze and share data so to improve care.
The learning health care system can be thought of as a learning cycle. The cycle is around generating knowledge so to improve outcomes and performance, then understanding performance to understand the data that comes from it and, finally, transforming that back into knowledge.
This cycle can be embedded in every aspect of health care — including professional development.
Continuing professional development
Ask yourself: what do you know about the care you’re providing now? How could you use data, both qualitative and quantitative, to look at how you could do things different? Perhaps a change to improve efficiency, make a procedure safer or render care more patient-centered.
If we focus on continuous inquiry and integrate research into our processes, health care scholarship and outcomes will improve. But it takes some discipline and an open mindset. We have to think a little bit different in order to really embrace this culture of inquiry. We must accept that there is no quick fix and no finish line. Instead, we must have an insatiable appetite for improvement.
To apply these principles to our continuing professional development, there are six basic steps:
- Understand the care you provide in your care environment (using simple tools, supports)
- Use data to identify gaps and learning opportunities
- Create a process improvement plan (i.e. set goals)
- Implement your plan by engaging in learning activities that support your objectives
- Measure and report on outcomes (assess the data, report outcomes, apply changes)
- Repeat the cycle (and keep repeating)
Whether a small test of change or a larger project, just remember this sequence: learn, research, implement and learn again. For example, we recently learned from Brian Wong, MD, FRCPC, and Lynfa Stroud, MD, FRCPC, that a small investment of time during COVID allowed their care team to improve the safe use of PPE. Well done team!
And always, always evaluate the impact of your actions on patients.
Act locally, impact globally
There is also a tremendous opportunity to amplify your local improvements. Small actions lead to big change.
Years ago, I had the opportunity to write a paper with two scientists: Dr. Peter Embi, an informatics professor, and Dr. William Smoyer, a pediatric nephrologist. At that time, we were looking at how we can develop and nurture local learning health care systems. What we landed upon was this: you have to do what you can within the system you exist (i.e. where you are providing care) but then think more globally about how those local changes can impact all of us.
An often-overlooked aspect of this cycle of continuous improvement is the potential to share our lessons learned. After all, the learning cycle is continuous and bi-directional. I would argue that we have a responsibility to disseminate our findings so that we can all benefit from the learning. The Royal College is committed to helping to share and disseminate ideas, solutions and collective improvements.
In closing, a culture of inquiry at every phase of our learning, training and care continuum can truly leverage the learning health care system. It allows us to be inquisitive and to improve outcomes by engaging in research and implementing improvements so to serve patients and ourselves. Healthier patients support healthier doctors and, ultimately, a healthier system.
Together, let’s keep asking: how can we do things a little differently?