Change Happens at the Speed of Trust: Lessons from a Decade of Physician-Led Improvement

Leading Quality

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As Stephen Covey once wrote, "Change happens at the speed of trust." This simple yet profound insight applied by this week's guest, Dr. Curt Smetcher captures the essence of how British Columbia's Physician Quality Improvement program transformed healthcare from the ground up. Affectionately known as "Papa QI," Smetcher shares the remarkable journey of creating a physician-led improvement movement that has trained over 1,600 clinicians across the province.
What makes this story exceptional isn't just the scale, but the approach. Rather than following the conventional wisdom of starting with executive buy-in, PQI began with frontline physicians and built upward. This counterintuitive strategy created a powerful foundation of clinical expertise while gradually earning administrative support through demonstrated results. The program's governance structure – with physicians, administrators, patients, and Doctors of BC as equal partners – represents a radical departure from healthcare's typical hierarchies.
Perhaps most revolutionary was the early decision to include patients as full participants in all aspects of the program. When questioned about involving patients in budgeting discussions, Smetcher's response was telling: "Most of our patients know more about budgeting than our doctors do." This authentic partnership approach has been central to PQI's success and sustainability over its decade-long existence.
The program's impact extends beyond clinical improvements. Physicians trained through PQI demonstrate 40% higher engagement levels compared to their peers, suggesting that meaningful involvement in improvement work serves as a powerful antidote to burnout. Protected funding ensures resources remain dedicated to improvement rather than being diverted to immediate clinical pressures – a recognition that investing in system improvement requires dedicated space and time.
Looking ahead, Smetcher describes PQI's evolution from building capacity to effectively utilizing that capacity, with the ultimate vision of "whole system quality" that addresses upstream factors rather than playing healthcare whack-a-mole. For anyone seeking to create lasting healthcare transformation, this conversation offers invaluable insights into building improvement capability that outlasts any single leader or initiative.

Chapters

1. Building Physician Capacity for Improvement (00:00:00)

2. Origins of "Papa QI" (00:02:00)

3. Starting PQI from the Bottom Up (00:08:10)

4. Creating Equal Partnerships in Hierarchical Systems (00:17:30)

5. Physician Engagement and Joy in Work (00:29:25)

6. Future Directions: From Capacity to Impact (00:33:10)

7. Change Happens at the Speed of Trust (00:38:25)

8. Upstream Systems Change and Integration (00:43:40)