Improvement Readiness

Ready to Launch

Here at the Center and at healthcare facilities around the globe, quality and safety is a top priority. We must continually look for ways to improve the way we do our work to ensure the highest standards of care with the best possible outcomes for patients and their families.

The work is stressful, though, and can take a toll both mentally and physically. And when you are tired and fatigued, worn out from late shifts and challenging cases, are you in the right state to take on a new quality improvement project?

Probably not. In fact, the quality improvement project’s impact could likely be diminished as we rely on overtaxed healthcare workers to do the job right.

In Dr. Carrie Adair et al.’s publication, The Improvement Readiness scale of the SCORE survey: a metric to assess capacity for quality improvement in healthcare, a team of researchers examine how we can measure how ready a team is for new project and preventative about the issue of readiness; if we can identify the units and teams that need more support before we ask too much of them, we can intervene and provide resources to ensure their success.

We asked Dr. Adair a few questions about the publication and the idea of Improvement Readiness:


How does Improvement Readiness (IR) relate to healthcare worker burnout?

Being high in Improvement Readiness (IR) means your team has the ability to take on quality improvement projects, engage in continuous self-reflection, and participate in ongoing learning – all of which require psychological bandwidth or capacity. But when we are burned out, our capacity to do more, especially to take on new projects or think deeply about quality improvement, is severely compromised. The data from our study reflect this. We found that burnout accounts for about 40% of the variance in IR – suggesting that groups high in burnout will have much lower improvement readiness. It also suggests that by reducing burnout we are also improving the likelihood that workers will be better prepared to tackle pressing quality issues.

You show in this paper how the SCORE (Safety, Communication, Operational Reliability and Engagement) survey can be used to measure IR. If a unit scores poorly in IR, what can a unit leader do to improve scores?

IR can be considered an index of group-level capacity for quality improvement. There are several avenues for leaders to improve their IR scores, each which depend on the culture and factors at play in a given unit. Given the high rate of burnout in healthcare, leaders should first look to the burnout scores in that unit. If burnout is high, start by identifying the sources of burnout in the work setting, taking appropriate action, and begin evidence-based interventions to improve well-being. For instance, the Three Good Things tool can reduce burnout and improve wellbeing, and it’s simple – for instance, consider asking everyone to answer  “What’s one good thing (professionally or personally) that has happened so far this week?” to your next meeting.

If burnout doesn’t seem to be a big issue, leaders can support and protect the ongoing learning of their workers by giving them opportunities to attend and present at conferences, talks, and trainings.

Leaders can also structure moments of learning throughout the day and week during rounds, department meetings, or individual conversations. Key questions to get those conversations rolling include,  “What did we do well in this situation?” and “How can we make changes to prevent similar defects in the future?”

We found that the item that correlated most strongly to the overall factor of IR was “The learning environment  in this work setting allows us to gain important insights into what we do well”. This was intriguing because improvement efforts tend to focus exclusively on what is not going well. Instead, these data indicate that pausing and reflecting on what is going well is a key aspect of IR, and leaders who place greater focus on the positives are more likely to have work settings with higher IR as well as lower burnout.

Conversely, if a unit scores very high, how much can be asked of them before their scores suffer?  

Even units high in IR have an upper limit to how much more they can add to their plates. It’s therefore prudent to track the quantity of “asks” of various groups, even for those high in IR who are ready to “roll up their sleeves”. Tracking the number and scope of quality improvement (QI) projects, alongside other factors like changes in leadership, low staffing,  and changes to technology, will help leaders get a sense for when groups are approaching that upper limit.

We must remember the day-to-day running of the unit is the first priority, and that any factors that hamper how it is running will decrease the capacity of the group. There may be times when a QI project must be placed on hold while more pressing issues are addressed. Hopefully leaders are aware of when they need to take the foot off the gas pedal for QI, and that there is enough psychological safety that workers feel they can speak up when demands are outpacing their resources. We certainly wouldn’t want thriving work settings to become burned out work settings because they are being asked to take on too much.