Developing Improvement Capability: Part 2 – Who needs to know what?

September 5, 2019 by David M. Williams

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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.

This is part two of a four-part series. You can read part one here, part three here, and part four here.

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
Executives	Create a system of improvement and integrate it with the business Build collaboration by promoting cooperative goals and fostering trust between all stakeholders in the system Invest time and other resources in improving products and processes and developing people to lead these efforts
Managers First-line supervision	Connect the roles of people to the role of the departments and purpose of the organization Lead cross-functional improvement teams Develop supervisors to lead process improvement in their areas Remove defects and waste from the processes of daily work Participate in improvement teams that contribute to the larger aims of the department of organization Help people execute on the requirements of the job with the aim of delighting the internal and external customer
Front-line employees	Engage in the improvement of daily work by suggesting and testing changes Participate in improvement teams that contribute to the larger aims of the department Execute on the requirements of the job, with the aim of delighting the internal and external customer
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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