about me

Cathy Howe headshot smiling April 2015

I’m a healthcare improvement specialist with almost 15 years NHS experience, built on a varied background in the private, public and voluntary sectors. I’m currently an independent consultant and researcher at the NIHR CLAHRC Northwest London. I work mainly at the interface of healthcare and academia.  I work across the UK, including as Director of the UK Knowledge Mobilisation Forum, and I live on the beautiful North Wales coast.

The QI revolution – because we’re worth it

I started my quality improvement journey early.  Even in my formative years I was assessing the world against my dimensions of quality and demanding change.

My pursuit of equity began in pre-school when interactions with my older brother were punctuated by wails of “it’s not fair”.  Efficiency was important to me (“this is BOR-ing”) as was effectiveness (“mine’s better than yours”).  Person-centredness was all about me (“I want, I want, I want”), and timeliness I considered an art-form: I never got up one minute earlier than absolutely necessary. Safety on the other hand seems to have been my ‘Cinderella dimension’, with the various scars and dental reconstructions demonstrating my inability to stay upright on my bike/horse/skis etc.

Decades later the Institute of Medicine published these dimensions of quality in their report “Crossing the Quality Chasm” (2001).  I’m not completely convinced I was ahead of my time.

My first job after school was an admin role in a photographic lab.  I was so obsessed with quality (demonstrated by telling the bosses how they should and could be doing it all better) that they made me run the quality assurance department.  I suspect they thought it might shut me up for a while.

Since then, I’ve continued to be drawn to the concept and practice of quality, and to be truly, madly, deeply offended by the lack of it, though I have become more accepting of what’s achievable.  In my first management role out of college we restructured an entire organisation.  It taught me to be brave.  Obliviousness is easier than bravery, but disappointingly difficult to recapture once it’s gone.

I joined the ranks of NHS management in 2000.  I was so gobsmakingly appalled by the awful quality I found there I genuinely didn’t think I would make it through the first week.  I’d grown up with a GP.  I’d worked as a practice receptionist.  I thought I knew what healthcare was about. How could it be this bad?  There were 30% staff vacancy rates, unacceptable patient waits and unnecessary healthcare associated infections.  In week one!  I didn’t have a clue where to start.

14 years on and I still have to pinch myself sometimes to believe I’m still here, and that I’m still working on quality improvement in healthcare.  One little bit at a time.

But sometimes, just sometimes, I think I’m ready for the Quality Improvement revolution.  I’m ready for the point where I stop being a pioneer.  I feel like I’ve been doing this forever – is it really still new?

I want to do for Quality Improvement (QI) in healthcare what L’Oreal did for hair dye in 1973. But more than that, I want to do for QI in healthcare what L’Oreal did for women through their 1973 Preference campaign.

1973 was the first time L’Oreal used the tag line ‘Because I’m worth it’.  That line touched something important in the psyche of that generation of women, resulted in a massive market share increase for the company, and as we know, the phrase is still integral to the language thirty years on.  When you’re chatting about why you’re doing something anyone now, male or female, can respond with ‘I’m worth it’ and everyone accepts that that is important.

L’Oreal took the idea of great hair colour and changed it to something that affected the individual through their own sense of self.  Dying your hair with L’Oreal increased your self-esteem.

Imagine if we could do that for QI in healthcare.  Imagine if every individual who works in healthcare wanted to get involved in improving their services because they were ‘worth it’; because they recognised intuitively that improving services improved their self-esteem.  Incidentally, I think it does.

Jonkoping County Council in Sweden has made it integral for its staff.  Everyone has two roles.  First is to ‘do the job’, but the other is to ‘improve the job’.  Does it work?  In conjunction with their other approaches to QI such as tracking and rewarding improvements, having Directors lead quality management sessions, having a dedicated QI teaching facility and resource etc they are indeed recognised for their ability to improve healthcare.  The IHI forum in Florida in December 2011 revealed them as an international ‘Quality Improvement Centre’.

But are they truly, madly, deeply “revolutionary”?  It’s much harder to be sure.

So what might be required to make the QI revolution happen in healthcare?

The L’Oreal revolution didn’t happen in isolation of course.  Clairol had revolutionised hair colour before them.  They did this by making it more accessible.  First they developed the product so colour could be done at home.  Second, they changed their advertising pitch from high glamour to girl next door.

Maybe healthcare is not ready for L’Oreal yet.  Maybe we need the Clairol revolution first.  Have we truly developed the Healthcare QI ‘product’ that every individual or team can use?  Are we currently pitching QI to ‘the girl/boy next door’ i.e. everyone?

If the answer to both of these is no (and I think it is) then we have some work to do.  If it’s to become a mainstream revolution then QI in healthcare must be in a form that can be taken off the shelf and (to bring the analogy into the 21st century) it must be ‘plug and play’.  We can’t keep pitching a ‘product’, usually made up of a whole series of tools and techniques from a varied evidence-base, that take hours/days/weeks to learn, the benefits of which aren’t usually immediately obvious, but still want every member of the healthcare team to participate.

As staff, relatives and patients: We’re worth more than that.

Please note: The views on this website are my own.