What does it take to be a good quality professional? Leadership skills, says L. Dale Harvey, MS, RN, a patient safety fellow and director of performance improvement at VCU Health System in Richmond, VA. Even at the entry level, someone has to have demonstrated the ability to lead in at least an informal way.
They need “superb critical thinking skills.” Harvey says the ability to solve problems, riddles, puzzles — that’s the kind of thinking she looks for. Someone who likes detective work will like this kind of work.
One hard skill to find is someone who can see the forest and the trees at the same time. The ability to both drill down to detail and never lose sight of the systems-level goals at the heart of a good quality project is vital for someone who will one day run a quality department. “They need to understand the problem or process in the context of the entire system,” she says. “They have to understand how both patients and staff will be impacted by what is changed.”
At VCU hospitals, candidates for quality positions are given a self-assessment that helps the hiring manager determine how comfortable a potential employee is with the skills they will use — such as writing a formula in a spreadsheet document, or giving a presentation to a large group. This also helps the health system customize the orientation process to the new hire’s needs.
During the interviewing process, the hiring manager is watching how a candidate reacts to the questions, judging answers to questions on how they would handle a hypothetical problem or what they would do during specific situations. Hiring managers also ask for examples from the candidate’s experience when certain things happened and how they handled the situation.
People who express interest in quality jobs — whether internal or external — are pointed to self-learning opportunities through the Institute for Healthcare Improvement. “Then we tell them to take on a small improvement project in their current work area and see what they like about that,” Harvey says. “People who think they are interested in this often find it’s not for them.”
VCU is a high-reliability organization and embraces Lean Six Sigma, “which takes years to learn in a meaningful way,” Harvey says. “Project management skills, likewise, take years to master. Data analysis, how to design measures, facilitation — all these skills are required to be successful, and a good quality professional will have them all. That requires more than a couple years of sabbatical time in the quality department. If that’s all you are looking for, we can leverage you to work on some projects in your department, but it’s not what we want full time in our department.”
“I want to see that lightbulb go off when you talk about quality,” says Claire Davis, RN, CPHQ, director of quality at Middlesex Hospital in Middletown, CT. “I want to see a true passion to change things and see what can be better.”
Davis always asks prospective employees how they would go about a particular task — who would be at the table, what they would discuss. As with Harvey, there’s an element of riddle-solving she’s looking for. “I want to see an ability to lay out puzzle pieces, as well as the usual ability to think critically and some good common sense. If they have 10 problems, I want to know which they would tackle first and why. And they need to have a good grasp of statistics.”
Systems thinking — the ability to see things at the macro level rather than getting caught up in the micro — is a key to success in this industry, Davis says. Other people have those micro skills, and you need to be able to find and harness those abilities, “but you do not have to be that person,” she says. “There is an intuitive ability to know when you need to drill down to detail, but the overarching mission has to be present in your mind always. You can’t lose that. You can’t think just about lower length of stay, but also readmissions and quality and safety and how impacting length of stay may impact those other things. You have to understand this all at once.”
Being able to juggle is a good skill — at least figuratively, because there will be “hundreds of items, topics and initiatives on your plate at the same time, and you will never see the end of your to-do list at the end of the day,” she says. If someone is tied to a sense of accomplishment by completing a list, he or she may be discouraged in the quality department. There is no end to the journey. A project you thought you finished last year is not over, it just moved to a different place on the list, she says, and someone who doesn’t understand that it’s not like “a patient who gets sick and you discharge them when they are better” may not be a good fit.
Playing well with others is important, as is “getting along with difficult personalities,” Davis says. “You have to be able to form collegial relationships with people who will get mad at you. You have to have strength and courage and know when not to settle, when to stand up and say something is not right,” she says. A person who can’t stand her ground, state the evidence in the name of patient safety, and take the flack that comes back at her won’t last. “You have to be gutsy and courageous,” Davis says. “Sometimes it is just one person who stands up in the name of quality for large populations of people.”
“Gutsy” is a word also used by Mary Huddleston, RN, MHSE, CPHQ, FNAHQ, president of the National Association for Healthcare Quality and a quality professional working at a large health system hospital in St. Petersburg, FL. “We have to have a safe environment for reporting things that aren’t right, but there may be cases where reporting quality or safety problems will have a negative impact on the bottom line. There may be pressure to not report because of that.” Huddleston says she has heard of people being pressured or even fired in such cases. So courage to speak up is vital.
Along with all the technical skills, critical and analytical thinking skills, Huddleston has one more recommendation for people looking to hire someone great for their department. “Do not be afraid to hire someone smarter than you.”