An Eternal Optimist: Dr. Amar Shah’s Journey in Leading Quality Improvement
 
From Spaghetti to Hippos and collective hope for the future, this was a fabulous conversation with the brilliant Dr. Amar Shah. Here are some edited highlights of the episode. Available to listen to now on our Podcast.

Subscribers, comments and rating all really help our Podcast visibility so it’s a great well to support our network, on your favourite Podcast platform. 

What sparked your interest in quality improvement?
 
Dr. Amar Shah: Well, in some ways it’s a bit of a sad story, because when I trained as a doctor and through my postgraduate training, I don’t think I ever had any exposure to complex systems theory, quality improvement, or even patient safety.
 
It was only through seeing an opportunity to take some time out of clinical work. I applied for a year out-of-program placement where I worked with the Department of Health and the Chief Medical Officer. As part of that role, I was also with the National Patient Safety Agency. That was my first insight into the world of safety science, and I was only a couple of years away from being a consultant.
 
That really opened my eyes to the opportunity to influence not just the person in front of me on a one-to-one basis as I was as a clinician but also the system in which I operated. From that point onwards, I haven’t ever been a full-time clinician. I’ve always practiced as a doctor, but I’ve also been trying to apply what I’ve learned about quality improvement to the system in which I’ve worked.
 
Is there something about the conditions and the climate for people wanting to make changes, that influences whether changes will be successful?
 
Dr Amar Shah: I think the literature these days is pretty strong on the role of context. Taking the time to understand the environment in which change is going to happen, making sure it’s as conducive as possible, is time well spent.
 
There are good tools out there now that we can use, such as MUSIQ (Model for Understanding Success in Quality). It was first developed from structured interviews and observations at Cincinnati Children’s Hospital in the US, a world leader in improvement. You can use it now as it’s freely available, evaluate your own system, and see what might need to be strengthened before starting quality improvement work.
 
From an organizational perspective, if you’re trying to introduce this way of thinking about problem-solving and empowering people to identify and solve issues in their daily work, you need to create the right culture and climate for that to happen. We spent two years preparing the ground in East London Foundation Trust before we pressed the GO button on our quality improvement work. We ensured we had good staff lines coming from universities, particularly for nursing and AHPs, and strong clinical leadership across all teams.
 
Naomi: The MUSIQ tool talks about having that diversity of thought and being able to work on different system levels. It also emphasizes knowing your experts because improvement is a team sport. Those conditions we set around us and within us as a team can be game changers.
 
Dr Amar Shah: When you do improvement work, your view of where the expertise comes from will change. We’re used to deferring to seniority and certain professions in healthcare. When you’re trying to understand quality and safety issues, expertise often comes from unexpected places.
 
I’ve had the privilege of supporting many teams to apply improvement to solve something they were struggling with. Teams sometimes found the most useful insights came from people with lived experience of the service. I remember working with an older adults ward tackling physical violence issues. It wasn’t until they involved the domestic staff that they understood the importance of noise. The cleaning staff helped the team think about doors slamming, ambient noise, and people’s voices. By being more conscious about noise, the team was able to reduce people’s agitation and violence levels.
 
Diversity of involvement is important, but recognizing that people bring different expertise is crucial to understanding the system. Leadership changes from having all the answers to bringing the team together around a shared purpose, encouraging everyone to contribute to understanding and testing ideas. This is quite liberating for a senior person.
 
We face daunting challenges in healthcare today. How does quality improvement help?
 
Dr Amar Shah: There’s not always a lot of positivity in the media about the NHS. Huge waiting lists, financial challenges, and safety issues are common themes. When grappling with something big, quality improvement can be a helpful structure because you break it down, take it in chunks, and don’t have to feel like you know the answer. You have some theories and ideas to test.
 
You have a national role with NHS Impact. Can you tell us about its goals and how AHPs can be involved?
 
Dr Amar Shah: NHS Impact is a framework that sets out the five components organizations should focus on to adopt and embed a culture of continuous improvement. It’s coproduced and based on evidence. The aim is to accelerate the use and belief in improvement to tackle big national challenges.
 
My personal experience is that AHPs are brilliant natural improvers. Whether it’s the people who enter the profession or how they’re developed, I have no doubt allied health professionals will be at the heart of this effort. AHPs’ approach to their roles is not dissimilar to the scientific method, involving setting goals, testing things out, and measuring progress. There’s a real opportunity for people to build their skillset and expertise in leading and influencing change and improvement.
 
What gives you optimism amid the challenges the NHS faces?
 
Dr Amar Shah: I’m an eternal optimist. Improvers believe things can be better, and with the right ideas and methods, that can come to fruition. One privilege of my national role is visiting and talking to people across the country. This has brought me hope and optimism, learning about quality improvement work that I never knew existed. You don’t have to go far to find robust improvement work making a difference to people’s lives.
 
This journey can be lonely, so I suggest three things: learn the tools of quality improvement, find colleagues and friends for support and guidance, and stay connected to why this matters to you. Quality improvement can feel corporate or academic, but it’s really about improving people’s care and outcomes. Staying connected to our purpose keeps us courageous and motivated.