May 06, 2024

Quality, Improv and Collaboration During COVID-19

By Sarah Horst, ICSI Team Director

For the last six months I have been conducting a workshop entitled Lead Courageous Quality Improvement with Improv and Collaboration for audiences around the country. My job at ICSI is to do “capacity building” for healthcare leaders who know what they want to do technically, but are often stuck in the activities of how to get it done. The challenge with the how is often related to psychology – how people think and feel about the change.

Within the healthcare industry there seems to be a lack of formal training to address the mindset needed for change. To address that need our team at ICSI developed the Quality Improv(e) Framework.

The Quality Improv(e) (pronounced improv) Framework marries the science of improvement, which relies on testing hypotheses and learning through small iterative tests of change, with the art of improvisation, a mindset of agility, adaptability and collaboration at its core. The Guiding Principles within the Framework are:

• Trust - Trust yourself and your partners.
• Awareness - Tune in to what’s happening around you.
• Acceptance - Say “yes” to your circumstances.
• Movement - Say “and” to continue moving forward.
• Empowerment - Be free to explore bold ideas and take safe risks.
• Commitment - Stay fully engaged to the end.

In my workshops, I coach leaders to access their confidence and bravery as they tackle the challenge of leading complex systems change. I have taught thousands of people that the most powerful tool in quality improvement is the thoughtful conversation and that “courageous QI” involves cultivating an improvisational approach to navigate the attitudes and behaviors that help and hinder collaborative change. I believe this work can transform teams.

And then came the coronavirus.

In the weeks following school closures and stay-at-home orders being issued, my various inboxes were inundated with solutions for “these difficult times.” This included homeschooling suggestions, work from home suggestions, and my utility companies and the businesses I patronize all telling me that “we are in this together.” Professionally, I was encouraged to quickly convert the Quality Improv(e) content to video and be part of the hopeful solutions that were so desperately needed. If ever there was a time for an improvisational mindset, surely it was now.

But I froze.

Waves of doubt washed over me. “Courageous Quality Improvement”?! Courage was treating patients with no PPE. Courage was supporting your family when you’ve lost your job. A voice told me I was just an entertainer who does fun, feel-good training. And people associate improv with comedy - surely it would be tone-deaf to offer up improv as a solution right now. For a moment (or a couple weeks, to be exact), I leaned into the warm embrace and security that imposter syndrome and perfection paralysis offer. I would do nothing. After all, these are uncertain times and solutions are not obvious.

And in this state, I found myself and the entire world doing what was necessary as the coronavirus annihilated the status quo - we improvised. Acting without a script, our world is adapting, changing, testing and learning on a daily, hourly and minute-by-minute basis because we must. Doctor’s Office visits are converted to virtual visits. Lab tests are being done in parking lots. Facemasks are being made out of t-shirts. School is being taught online. New models of care and new protocols are adopted as new information demands. We may feel like we are “winging it” or just surviving, but the guiding principles of quality improv(e) are actively at play.

Using the Guiding Principles of Quality Improv(e) for Coronavirus here’s what we’re saying now:

• Trust: I am enough. I have something meaningful to contribute. I will fire the judge and stop editing myself and my ideas. We are the right people to get the job done.
• Awareness: We will stay informed, understand our options and be keenly aware of how people around us are doing.
• Acceptance: Yes we are in a crisis and everything has changed…
• Movement: And we will move forward making the best choices we can. When something doesn’t work, we say, “if not this, then what?”
• Empowerment: Everyone feels safe to contribute their best skills and talents.
• Commitment: We don’t know where this is going, nor how long it will last, but we are all in and will see this through.

Part of what fueled my imposter syndrome is that, for years, I’ve been told improv training fell into the realm of “soft skills” or superfluous optional training, lesser to the sexier technical skills which are easier to define and teach. My training was “fun” or “feel good,” or there wasn’t time or budget for something like this, or “our providers are very smart and serious” and they won’t like this. And yet, improv offers exactly what we need in a crisis: tools for adaptability, flexibility, nimbleness and collaboration. For years, I’ve told students, “You improvise every day. You may as well do it with some intention.”

It was reflecting on principle #1 of Quality Improv(e) that told me to trust myself, helped me step away from the grip of imposter syndrome and step into the light of being part of the solution. Knowing that “I am enough” is actually enough - and that’s the first step to successful improvisation.

Join us on Friday, May 22nd for a FREE webinar to learn how the Quality Improv(e) framework can help add more flexibility, agility and authenticity to your leadership toolkit. Click here learn more about this interactive live event and to register.