Our ability to improve care quality depends on our ability to influence. Convincing someone to fund a project or getting a provider to change how they practice or a policy maker to change policy involves not only valid metrics and robust analysis, but the ability to paint a full picture (the context) of the need, the significance, and the impact of your project and results on the future. In general, there are six primary factors involved in influence within healthcare quality improvement, each of which is important to inspire and motivate those who can make the needed changes to practice and policy. 1. Clinical Knowledge: This first one should be obvious; if trying to effect change for a particular condition or adverse patient event, your level of clinical knowledge about those patients and that condition go a long way towards your ability to influence anyone to change how treatment or care is provided. 2. Practical Experience: The natural compliment to clinical knowledge is experience on the front lines of care, seeing patients, providing services, running a facility, and the like. Your level of practical experience in the field help you identify where the roadblocks are and allow you to envision how things could be better if certain aspects of care delivery were adjusted. The more practical experience you have, the more you can speak to the need for change and potential impact it could have in real-world practice. 3. Understanding of Data and Measurement: In order to prove a change has happened, you need to determine what to measure and how to measure it in a way that is valid and reliable (see more on these terms here). This involves identifying or collecting data with minimal or no bias, determining what constitutes a “meaningful” change, and analyzing the results in a way that addresses uncertainty and allows for accurate interpretation. The more representative your data, the more sound your methods, and the more robust your analysis, the more the intended audience will have confidence in the project’s ability to detect and quantify improvement. 4. Demonstration of Value: It is no secret that “value” is a major player in the quality world these days. However, demonstrating the value of a project may take many forms. Whether it is through a formal calculation of the likely Return on Investment, or whether it is a more general discussion of the improvement of patient experiences and quality of life, or of the reduced waste and inefficiency the project will produce, the value of the project helps to convince the audience that the project is necessary and significant. 5. Credibility: Certainly clinical knowledge and practical experience go a long way towards establishing credibility. However, there are things that can augment credibility in the eyes of either a potential funder, a clinician, or a policy maker. Previous examples of successful interventions or explorations into the drivers of care quality within a particular population demonstrate a deep understanding of the particular situation or project being addressed. One of the most effective (and universally accepted) ways for establishing credibility is through publishing peer-reviewed articles. Having a significant library of authored publications on a given subject signal to the intended audience that you are serious about this issue and have been studying it for some time. 6. Storytelling: Technical knowledge, lived experiences, and sound analytic methods are all necessary aspects of a good project and therefore the ability to influence those who can change how care is delivered and paid for. However, influence increases when we can paint a vivid picture for the audience of why the project is necessary, what the current landscape of care looks like, and what a vision for the future of care for this topic could look like. The more artfully and skillfully one can weave together the different components of a project’s background, methodology, and results, the more impact it will have on those reviewing it. To motivate and inspire readers or listeners to change requires that it stirs something inside of them and encourages them to believe in your vision for what could be and that it is necessary. Take a look at that list and ask yourself about your last proposal for funding or your last summary report for a quality improvement intervention. Did it contain each of those aspects to some extent? If not, where were you lacking? If so, did they appear to the full extent of effectiveness? Or could they have been enhanced in some way? Hopefully each of these attributes are things that can be developed and refined over time through careful practice and effort. Some of them (specifically numbers 3 through 6) can be directly addressed through increased understanding of some of the underlying concepts and through regular activities that help to hone them. We’ll explore some of these in more depth in future articles.
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