Turning Knowledge into Action

Nisha Walibhai, RN, is a registered nurse with expertise in strategic quality improvement and patient experience who has worked in quality management for more than 15 years. She currently works at Critical Care Services Ontario as a senior manager, and leads the provincial system quality and patient experience improvement portfolio.

Tell me about your clinical and administrative background, and what attracted you to the Safety, Quality, Informatics and Leadership (SQIL) program?

I am a nurse by training and have been in project and operational management involving quality and safety for more than 15 years. My expertise lies in quality improvement. I’ve grown a lot throughout my career, but was at a stage where I wanted to take myself to the next level. First I was attracted to what the program name suggests—safety, quality, informatics and leadership. In my career, I had personally experienced how those four factors are the key drivers in making quality happen, but I had never seen a program that addressed them together from a clinical quality perspective.

The website also attracted me. Many programs call themselves “global education programs,” but the online class picture really spoke to the fact that it is indeed a global program. Also, there was a good mix of face-to-face and online work. I’m from the generation where a 100% online program won’t work well, because I need that personal face-to-face connection. I also looked at the faculty backgrounds and, again, it was a global mix.

One of the stories on the site was about a woman who had a doctoral degree and all this knowledge, but the SQIL program was able to make her knowledge actionable. It made me think, “That’s exactly what I’m looking for.” I’m very much a believer in finding out how to move your knowledge to action, and that’s what this program does. The assignments, classes and group work are designed to provide the tools you need to follow the process by yourself and create a habit of turning that knowledge into action.

How are you applying the insights and interventions from the program to your work today?

When I came to the first workshop in London, the focus was on the Learning Health System (LHS). I’m part of an organization that looks at improvement from a system level, not from an individual hospital level, so the concept of the efferent and afferent parts of the LHS connected with me. I’ve been able to bring that to some of the work that I’m doing. When I presented the workshop diagram to my colleagues, they said, “That makes so much sense.”

I have only dabbled in informatics for one or two years, so I don’t have the expertise. But the LHS is addressing the reality that I see not only in North America, but also overseas when I talk to my colleagues. Many times I would be sitting in the workshop or talking to my team members through Skype about assignments, and I felt like I was part of a little United Nations trying to change the world.

Do you think that this program will be beneficial to someone with a background similar to yours?

I think that SQIL is designed to cater to people at all levels. When I came to the program, I was quite comfortable in terms of quality improvement, but I still learned many new things. I was able to brush up on informatics and gain new insights into predictive medicine. Even if you’re an expert, or have been working in the informatics niche, that kind of concept might not be part of your daily routine.

My group was a mix of people who were very young, mid-career, and late-mid-career. Every time we met for assignments, we were teaching and learning from one another. If someone didn’t have a health care background but was contributing, everyone was learning from that person. I also think that the level of self-directed study, such as recorded online lectures and webinars, is well thought out. You can learn as little or as much as you want from that system. Another thing, which I think you would hear from other people as well, is that the Harvard name has a strong appeal.

On that note, let’s talk about your capstone project. What are you working on?

The focus of my capstone project is to implement a renewed quality framework by mixing the learning that I got from the SQIL program with my existing knowledge When I started out, I was looking at developing a framework that is focused on high reliability in terms of quality and safety. What I’ve learned from my career and what I learned from SQIL kind of jived together. I came up with a framework that looked at not only high reliability but also the cultural resilience and six elements of quality, as well as patient voice. So, just as Harvard brought together the four components of SQIL to form a program, I’m renewing the provincial quality framework based on the feedback that I’ve received from different stakeholder groups.

How will you bring together all the pieces of your project and implement it?

I’m currently in the process of implementing it. But it’s about a three-year project, so it’s going to take time. What we learned during the third workshop was to focus on the informal network as well as the formal network. One morning, for example, I was sitting in class thinking about the two projects that I’m doing. One of them is zooming along, and the other is slowly proceeding one step at a time. I was able to see what the difference is in terms of how one is like a contained project—something that I’ve done before and am familiar with, whereas this other project has a lot of moving parts to it. One woman in class was talking about implementing a change that is divergent. Because it differs from what you’ve done in the past, you need different kinds of processes to manage the change. So I’ll be able to take that back and think about how I can include that concept in my implementation.

In what ways has the program shaped or expanded your global perspective?

Becoming part of this program really tested my prejudices. I grew up in the developing world, but over time had become part of the North American way of thinking. When I came to the SQIL program, I was interacting with people from the African continent, especially the less developed part of Africa, and with people from the UAE where the country is rich, but the infrastructure is still developing. How they’re addressing these problems was really eye-opening for me.

During one of our projects, we were talking about developing an application. One of my team members said, “No, you can’t do that in the UAE,” and he gave us the cultural context. I lived my life like that 20 years ago, but when I became part of the developed world I forgot it. I think that’s where the true global perspective that this program has given me comes from. Right now, through my work, I’m developing and implementing a new quality framework, and I have applied a lot of the concepts and ideas from what I learned during SQIL. So in terms of career impact, I’m in the same job, but I'm much better prepared to face its challenges.

Learn more about Safety, Quality, Informatics and Leadership.

Written by Chike Lawrence-Mitchell