Improving quality has been unifying theme across health programs and countries for more than 20 years and a building block of our company, Shift. We are often asked how organizations can achieve a culture of improvement. The short answer? It happens with intention, through action, and over time.

Nearly 20 years ago, I had the privilege of participating in the research and development of a powerful framework and paper - Sustaining Quality of Healthcare: Institutionalization of Quality Assurance. It pulls together global lessons of quality improvement and assurance over 20 years across different countries and contexts to understand how organizations were able to sustain change over time. That research helped to develop a model for understanding the essential elements for the institutionalization of improvement that I return to when supporting efforts to create a culture of improvement within organizations.

The process of change and the institutionalization of improvement transcend sectors. While the framework is focused on healthcare, Shift and our team have had success in applying its principles to a variety of different projects. Our work in CaReQIC built on the existing investment in training and capacity development to empower frontline health care workers to partner with people living with HIV to implement best practices and improve quality of care. In education, Shift designed a team-based course – Improvement Methods for Equity (IM4E) – for school districts and education intermediary organizations who provide direct support to schools. Our goal was for participants to learn valuable improvement skills that they can apply in their organizations and networks to further educational equity. We also wanted teams to explore examples of how these skills and capacities can be implemented in networks and develop the diverse leaders needed for improvement to continue long after course completion – the institutionalization of improvement.

To learn more about the origin and development of the project, check out our blog post 'Learning from Twenty Years of Building Improvement Cultures.'

Though the essence of this framework has stood the test of time, my recent reflection on the work highlighted areas where improvement experts have learned and grown since it was originally published. We have learned that truly seeing the system can only be achieved with intentional examination of structural elements that result in disparity and how systems may impact people differently. We also saw the power of doing work with people in the system rather than for them. We’ve dug deep at the intersection of these two spaces – refining improvement methods to work with people to produce more equitable outcomes. 

To address these lessons learned, the team at Shift recently updated the framework in “Building a Culture of Learning and Improvement for Equity.” We also developed a course to teach the updated framework at the recent Carnegie Summit in San Diego. I’m certain that this work is far from finished; with every new partner and project we encounter comes learning and growth.

If you are interested in learning more about how to include equity in your improvement practices, check out our workshop offerings.