It can take weeks or months to plan a quality improvement (QI) project. Doesn’t it make sense to spend time developing a plan to communicate with important stakeholders to help ensure its successful implementation and spread? If you wouldn’t undertake an improvement initiative without a measurement strategy, you shouldn’t proceed without a communications strategy.

W. Edwards Deming understood the importance of communication in furthering QI. Deming’s influential approach to QI (his System of Profound Knowledge) includes “psychology” as one of its components. According to the IHI Psychology of Change Framework white paper, “Psychology, in Deming’s definition, is the way people think and feel, what motivates them, what demotivates them, the problematic effects of incentives, and how they behave.”

In other words, Deming understood the importance of engaging the human side of change. One of the most potentially powerful ways of doing this is by sharing stories. Chosen strategically, stories can do more than entertain. Stories can engage both hearts and minds. Stories can inspire, instruct, and inform. They can remind improvement professionals about why they started in health care in the first place.

Showing (Not Just Telling) the Story

“That’s exactly how I remember Henry! You had just got married,” says 82-year-old Ernst Jørgensen. His dialect sounds like he is singing as much as talking. He is standing in Inger Thode’s living room. Inger and Ernst are looking at an old black and white wedding photo of Inger and her late husband, Henry.

“Yes, getting married was a big step,” Inger replies. The two seniors look at each other and laugh before they sit at the dinner table for a meal.

“Losing your spouse is difficult. I was falling into some kind of depression,” says Inger. Ernst pours himself a glass of cold beer. “Helping you was easy, because I knew you and could talk to you.”

Inger and Ernst have been part of a project in Denmark called Safe Senior Life. It’s a collaborative effort between the municipalities of Horsens, Thisted, and Faaborg-Midtfyn to find new ways to detect and prevent depression in older adults and improve their mental health and quality of life.

A key to Safe Senior Life’s success has been the co-creation of solutions between professionals in local communities and volunteers from civil society organizations. To spread the valuable experiences and lessons learned in the project, the Safe Senior Life team decided they needed to show people this neighborly way to co-create better mental health for seniors.

Instead of just telling people about their cross-sector change ideas, networking programs for single seniors, new ways of collaboration, and volunteers coming from many community organizations, they decided that creating a video and showing how it works would be more effective than simply telling.

There are many ways you can communicate about improvement work. Videos, blog posts, newsletter articles, and posters are just a few methods. However, just as a training alone isn’t an implementation strategy, you shouldn’t mistake these different tactics for a communications strategy.

Using Communications to Support Spread

Once an improvement takes hold in one place, how do you get it to work somewhere else? Many dedicated quality improvers have seen that simply replicating the original processes and protocols won’t guarantee proliferation. Experts on large-scale improvement will tell you that it’s necessary to plan for spread from the beginning. This includes developing ideas for how to communicate about change.

In Denmark, the video of Ernst and Inger has been used to spread the change ideas that are part of Safe Senior Life. By sharing the story of real people, it has illustrated the power of human connections. It has helped build will for co-creation between professionals and volunteers by showing this process in action. The film has inspired, motivated, and informed, thereby strengthening and sustaining momentum for achieving the project’s goals. This is what quality improvement communications — or #QiComms as it has become known internationally — is all about.

We all want to spread the best care to as many patients in as many communities as possible. We don’t want results to remain isolated secrets of local successes. In the same way we try to be systematic about everything else we do in our improvement work, we should use communications in a systematic manner.

What is #QiComms?

Despite its importance, communicating about improvement — especially to the teams most responsible for making care better and safer — is too often an afterthought or overlooked altogether. This is why #QiComms was created.

#QiComms is an international initiative which I had the privilege of launching with Andrew Cooper from NHS Wales at the International Forum on Quality & Safety in Healthcare in 2018. It was developed by improvement organizations in various European countries and across the Atlantic.

#QiComms focuses on teaching improvement teams how to develop communications strategies to accelerate quality improvement and spread. For example, if you decide that making a video is the best way to meet your goals, you don’t necessarily have to hire a professional videographer. Depending on what you have in mind, your own cell phone may be all you need to capture a story that engages people.

As IHI President Emeritus and Senior Fellow Don Berwick says, “To deliver QI in complex systems you need to win everyone over. You can have all the facts right, but if people don’t understand the story you won’t get the conversation going. Communications is an essential element of all improvement efforts.”

Frits Bredal is the Head of Communications at the Danish Society for Patient Safety. He and IHI Senior Managing Editor, Jo Ann Endo, will share a communications framework work at the IHI National Forum during session D08/E08: Using Communications Strategies to Accelerate Quality Improvement on Wednesday, December 11, 2019 from 9:30 AM to 10:45 AM and again at 11:15 AM to 12:30 PM.

You may also be interested in:

The #QiComms Charter and other communications resources.

Exploring the role of communications in quality improvement