Hospital Impact—The skills that make or break a chief quality officer

Dave M. Williams

Is there anything chief quality officers aren’t asked to do?

With payers and the public demanding more from healthcare, the number of chief quality officers (CQOs) is on the rise. It’s a step in the right direction for health systems to elevate quality to the C-suite. But simply selecting a CQO does not automatically result in high-quality care, especially when there’s confusion about what the job entails.

In preparation for IHI’s new Chief Quality Officer Professional Development Program, I recently worked with a research team to find out: What are CQOs doing? And, more importantly, what should they be doing to achieve results? 

In reviews of job descriptions and interviews with dozens of CQOs in leading health systems, we found that the role varies widely depending on the organization. In some cases, the CQO’s responsibilities are tied to an outdated mindset of quality assurance and regulatory compliance. By contrast, we saw that effective CQOs are skilled leaders of people who achieve results through continuous, systemwide improvement. 

RELATED: Data shows link between hospital quality and readmission rates

What does that mean in practice? Here are the five levers that make an effective CQO:

  • Create the infrastructure to support quality. To succeed, a CQO must set up a strong quality department, develop strong physician leadership, align staff incentives to quality and link quality with financial goals—including those related to cost reduction, population health and value-based payments. One important structure is a standardized process improvement methodology (e.g. IHI-Quality Improvement, Lean or Six Sigma). Choosing one methodology helps everyone in the system speak the same language when it comes to quality. To create these structures, the CQO must build support among the board and C-suite. “Be a voice that can lead to a future state,” one leader said. “Ensure a connection to purpose.” 
  • Understand and design services to meet the customer’s need. One of the central tenets of improvement science is to meet the needs of the customer. CQOs must lead organizations to understand their patients’ needs and translate that understanding into annual and five-year quality plans. This process should involve clear decision-making on which projects will have the greatest impact and input from patients. As one leader put it, the CQO must have the soft skills to be a “chief listening officer.”
  • Create breakthroughs in quality improvement. No matter how robust the planning and design process is, there will always be aspects of services that fail to meet customer needs. Quality improvement is not only necessary to fix broken processes, but also to refine and innovate. The role of the quality leader is to develop improvement capability at all levels of the organization and establish processes to prioritize frontline projects based on organizational goals. Projects should be effectively managed and include: a standard charter, integration into daily work; a learning system for reporting, evaluation and feedback; and a process to bring improvements to scale.
  • Sustain performance through predictable and reliable processes. Once stable processes have been developed, quality leaders must closely manage performance. To sustain improvement, CQOs must help to develop standard work, review how well teams are following standard work, implement dashboards and create a clear line of communication for frontline staff to escalate problems to leadership. 
  • Foster a culture that turns every person in the system into an improver. IHI’s framework for high-impact leadership describes a set of behaviors that result from a clear understanding of continual improvement and the leader’s role in promoting it across a system. These behaviors include an unrelenting focus on person-centeredness, the use of transparency as a lever and coaching to develop knowledge. CQOs can start right away on this last behavior by encouraging others to test their ideas. “Fail, learn and try again” can be a powerful message coming from a senior executive.  

Creating a culture that supports scientific improvement and positions people to act is one of the toughest challenges of a quality leader. The reality is that no CQO can do this alone. Inherent in each of these activities is the ability to able to partner with and influence people above, below and across the organization. As one quality leader said in our interviews, “many people approaching change tend to rally similar-minded people and don’t think strategically about who to approach—those actually responsible for technology, processes, people (decision makers).”

Often, this is the capability that defines the effectiveness of a CQO.

Dave M. Williams, Ph.D., executive director at IHI, leads Improvement Science & Methods and Leadership and is faculty for IHI’s upcoming Chief Quality Officer Professional Development Program.