By: Melissa Meinel, MSN, RN, NE-BC, CPHQ
Teaching QI to interprofessional teams can be complex and often viewed by the learner as a “waste of time”. It is important to “hook” learners, both formal and informal, by making the concepts applicable to something else they understand: sales!
In many ways, being a part of a QI project can be compared to being in sales—both require strong skills in communication and trust-building in teams and teamwork to accomplish the goal. This must happen with external stakeholders as well as within the QI team. Some key principles of sales are:
- Identify the customer.
- Define the customer’s problem.
- Develop a solution to the customer’s problem.
- Convince the customer to test the solution.
- Create a positive experience and close the deal.
See the similarities?
In starting a new initiative, the executive sponsor may offer some “leads” for starting points of where to find information or who to talk to in order to gain insights from those whose values and interests are aligned.
Identify the customer.
There can be—and often is—more than one stakeholder in QI, especially when considering interprofessional cross-sections required in today’s complex clinical care environment. The “customer” is as much the care providers and support systems as it is those receiving care. Identifying willing participants can be a challenge and may require some convincing. Use the leads! The first step is to begin a relationship if there is not one already; if there is, then strengthen it and expand it with the other team members. Ryan Serhant, real estate agent and author best known for Bravo’s Million Dollar Listing, New York, suggests to start with the two Cs of creating a relationship: compliment and find something in common. Learn about them as individuals, ask them questions, and understand their viewpoint regarding the project topic. Fostering diversity, identities, cultures, and differences builds trust and creates an open mindset.
Define the customer’s problem.
The stakeholders participating in the QI initiative are well-versed in their own processes—they are the experts. However, sometimes there is a missing piece to be found and shared in the way of inputs and impact with multiple stakeholders. Brian Shapiro, professional development coach, communications expert, and author suggests building a tolerance for ambiguity, which means staying humble and embracing the idea that one does not know it all. As the facilitator—or participant—of this process, it is important to remain neutral, humble, and respectful. This is the opportunity to continue trust-building and enhance collaboration to objectively define the problem(s). Ask probing questions and listen for central themes. Consider and note all provided possibilities to encourage active participation and ensure all stakeholders have input to uncover insights.
Develop a solution to the customer’s problem.
It is all about collaboration and when stakeholders identify with the problem and trust that help with a viable solution exists, they become vested. This is where things really get exciting as teams build upon ideas and negotiate alternatives in response to anticipated challenges. If this part of the process has a slow start or a tendency to for lop-sided perspectives, slow down and focus on participation. Help recognize quiet participants by using their name to ask for their thoughts providing time for response. Create the connection. Another way to connect is to gain buy-in by seeking periodic affirmation or agreement on progress. This reflective exercise can improve team effectiveness. This brings the team along together and helps create progress “stamps” so that any re-review has a starting and stopping parameter for discussion.
Convince the customer to test the solution.
Decisions are not always purely logical, even among reasonable, “level-headed” professionals. Some stakeholders will be all-in to test the change while others are persistent nay-sayers. These concerns could stem from a previous poor experience, a fear of failure, not being able to process change, or feeling overwhelmed due to other priorities or events. Practice team reasoning, problem-solving, and shared decision-making. Continue to build and reinforce the team trust by recognizing and acknowledging any concerns. Recognize the value-add of voicing their concern and offer a time-limited deal through a small test of change.
Create a positive experience and close the deal.
Continually utilizing the skills during the process is what closes the deal and creates return customers. A study of perioperative cross-disciplinary relationship building identified six strategies applicable to any team: 1) be present, available, and responsive; 2) understand various roles; 3) establish communication; 4) recognizing supporting roles; 5) work as a team; and 6) build on previous experience. The last one is what will help keep stakeholders involved after the project concludes. This can foster self-fulfillment, collegiality, and civility across the team. If they had a positive experience, they are more likely to work with members of the team in the future or to engage in additional QI initiatives.
While the QI and sales comparison is a fun look at the improvement team process, the theory, knowledge and tools must be skillfully applied in interprofessional collaborative practice to provide a structured and systematic way to develop and deploy QI initiatives. A good quality improvement (QI) team is strategically created and the building work begins long before the first kick-off meeting. As with any interprofessional collaboration, team leads must commit to lifelong learning to understand at least some basics about the products (or outputs), processes, and people (stakeholders) to prepare themselves for the tasks at hand. The IPEC core competencies outline many of the skills and approaches needed for true collaboration and representation to build a better team, process, products, and services. QI team leads should be prepared to set the example to uphold the shared values and ethics through respectful interactions and by honoring the roles and responsibilities of the individuals and collective team throughout the process.
The successful, high-performing QI teams also have high emotional intelligence to bring people together in a meaningful way. QI practitioners and sales representatives have this in common, and authenticity sets them apart from those only working toward the deadline or the sale. Pulling from Aristotle’s Rhetorical Proofs, Shapiro states communication is key to strong teams and is driven by trust, emotion, and reason. A good QI team begins long before the first kick-off meeting…and continues long after the project concludes.
References
- Interprofessional Education Collaborative (2023). IPEC Core Competencies for Interprofessional Collaborative Practice: Version 3. Interprofessional Education Collaborative.
- Sasnal M, Lorenz KA, McCaa M, Wu A, Morris AM, Schenker Y, Shreve ST, Giannitrapani KF. “It’s Not Us Versus Them”: Building Cross-Disciplinary Relationships in the Perioperative Period. J Pain Symptom Manage. 2023 Apr;65(4):263-272. doi: 10.1016/j.jpainsymman.2022.12.140. Epub 2023 Jan 13. PMID: 36646332.
- Serhant, R. (2018). Sell It Like Serhant: How to Sell More, Earn More, and Become the Ultimate Sales Machine. John Murray Learning.
- Shapiro, B. (2016). Exceptionally Human: Successful Communication in a Distracted World. Shapiro Communications.
About the Author: Melissa Meinel, MSN, RN, NE-BC, CPHQ is the Clinical Operations Director for Nursing Quality and Magnet Program at Duke University Hospital. Melissa collaborates on various quality-related activities, serving as a local subject matter expert and liaison with department leaders and interprofessional clinical champions. Prior to her current role, she held various roles in healthcare quality for more than a decade supporting quality and safety in nursing and interdisciplinary initiatives. Melissa earned her Masters of Science in Nursing Leadership and her Bachelors of Science in Nursing and is also a board-certified nurse executive and a certified professional in healthcare quality.
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