MEERQAT: A journey to increase staff engagement in quality improvement

The quality improvement journey

Health and aged care are vitally important sectors that society simply can’t live without.

While every industry has its own value and place in this world, these two sectors deal closely with human life itself, and therefore need to be as safety focused as an industry can possibly be.

That’s why integrating quality and safety measures is core business for hospitals and aged care homes. That way, they can optimally fulfill their duty of not only preserving, but also improving people’s lives.

But unfortunately, this isn’t always the case.

The many issues that arise in health and aged care organisations aren’t the fault of a single person. The problems are systemic and collective— a snowball effect of processes that have grown problematic over time and have been overlooked as not important.

Front line employees see these problems, but they have neither means nor power to address them on their own, and there is no system in place that gives them confidence to raise these concerns.

This is why we started MEERQAT.

Shifting a paradigm in health and human services

What we provide is an online knowledge harvesting tool that enables organisations to have a more structured approach to tapping into the knowledge and firsthand experience of their staff, and using that knowledge productively to improve their processes and services.

The idea of harvesting information from staff isn’t new. Organisations do this through surveys and “suggestion boxes”, for instance. These approaches are OK, but they don’t drive engagement between management and staff. What sets us apart is that our method offers a genuine opportunity for management and staff to have a direct and constructive conversation about the realities of routine work.

The current paradigm in health and human service organisations is that senior managers are expected to drive improvement and develop solutions to issues. Other workers are expected to do their job, but they aren’t seen as having anything to contribute to identifying what needs fixing and how to fix it.

What we want to do is to shift the paradigm.

Our tools develop the collective competence of a group or team. With a better shared understanding of the organisation’s processes and systems, the team’s capacity to work together is elevated. And by shifting to a more collaborative approach and acknowledging issues from the ground up, persisting issues are more likely to be resolved.

MEERQAT provides a different set of eyes to guide management with their decision making.

“It’s not about proving that managers don’t know their job. It’s about giving managers better information to make the decisions that they need to make,” our director Donna Cohen says.

Sometimes an external perspective is needed 

Safety and quality frameworks and guidelines have been in place in the health and aged care sectors for more than 20 years. 

However, the level of preventable harm is still unacceptably high, with one in every nine patients in hospital experiencing an adverse event. Some are small inconveniences, while others are big enough to risk a patient’s life. 

Everyone can see that the issues persist, although there is a reluctance to try new approaches to solving them. But as Einstein said, the definition of insanity is doing the same thing over and over again and expecting a different result.

What’s happening today is that many organisations are following a compliance-based approach for quality. It has become just a box that needs to be ticked. But quality is not something that you do on its own. It’s neither a noun nor a verb; it’s an adjective and an adverb – a descriptor of the way you do things.

We could see that a new approach is needed to improve how the safety and quality standards are being implemented. So we started sharing our philosophy with our contacts in the health and aged care sectors. 

Frontline managers and staff looked at our solution and said, “Yes! This is what we want to do!” But it was difficult to get the attention or interest of senior decision-makers. Afterall, we were outsiders without the backing of a large institution.

We approached a number of organisations that politely showed interest, but they never engaged with us. So we asked a couple of frontline teams if they’d like to do a small, informal trial of our approach and they agreed. 

This showed us that our idea had potential and encouraged us to keep going. All the while, we were funding our own software development, because getting funding for a startup is very hard.

We then obtained a small grant to conduct a proper research trial and the study provided hard data that the approach really works.

Even from there, the rollercoaster ride continued. The data from the research trial was published as an article in one of the top international journals, BMJ Open Quality. But as luck would have it, it was published on April 1st, just as COVID-19 really took hold. Although it was one of the most read articles in the journal for two months in a row, with the pandemic still raging around the world, understandably, no one had the time to pay attention to a new approach to quality improvement.

We know MEERQAT is not an easy concept to get across to people. There’s no 30-second elevator pitch. It’s something people have to watch and see to understand the value in it.

Difficult as it is at times, we’re convinced that this journey is worth the ride.

MEERQAT is about making a difference 

After the success of our clinical trial, we realised there were many opportunities waiting for us. But we also realised we need to take things one step at a time. 

The first thing we want to do is to work with a small number of hospitals to demonstrate a hospital-wide benefit. We had a trial in the emergency department and an in-patient unit of a hospital that produced amazing results. If this were to be scaled up across the whole hospital, the benefits will be multiplied.

We’re also continuing to develop tools in MEERQAT that allow hospitals to monitor their pandemic preparedness. And we’re updating our tools for the new aged care quality and safety standards, which will probably be even more necessary after the impact of the COVID-19 pandemic on residential aged care facilities.

On an even broader scale, we can picture our tool being used by other sectors and industries too, because the same principles for quality and business process improvement can apply to them.

Yes, it’s not easy, considering the challenges we are continuing to face, but the reason why we keep going is because we genuinely believe our approach works and it can make a huge difference in improving the lives of others.

We want to make that difference.

By taking things one step at a time, we believe that we’ll reach a point where our clients will become advocates for the MEERQAT approach. Then, we can expand into other areas and in turn, help more people.

Putting teamwork and communication into practice 

Whenever we present MEERQAT to potential users, we receive an overwhelmingly positive response.

Our challenge has been in converting that interest into a commitment to trying something new. 

This tool is very “hands on” and is not something you buy off the shelf, plug in and it does its thing. We have found it works best when we spend a bit of time with clients at the start, helping them to get set up and get comfortable with the tool. This is why the pandemic has made it a lot more difficult for us. Fortunately, we have seen that onboarding new clients still works fine with an online meeting.

Perhaps every business goes through this sort of period where it starts to feel like success may never be achieved. But, happily we have a support network that keeps us focused and motivated.

The MEERQAT founders are two families who get along very well. Throughout the years, we’ve developed a greater understanding and appreciation of each other’s perspectives and thought processes. We recognise there are times when one of us can’t commit too much to what needs to be done, so the rest of us just pick up the bits that the other person can’t do.

And that’s teamwork. It’s all about open communication and not having rigid expectations of each other. We adjust wherever needed and help each other get back on track.

Another thing working in our favour has been our terrific web development partner, Common Code, who has been very supportive since we started our journey. 

Best of all, we have the support of frontline workers who show their enthusiasm and share our conviction that health and aged care organisations need our services. And, we have the support of our clients, who are happy and passionate about MEERQAT and see our potential and value.

Through all these challenges and support, we’ve grown as a business and we’re not as much of a “newbie” as we were a few years ago.

We now have brand recognition in both the evaluation and quality improvement domains. We have several peer reviewed publications. We have more resources that we can offer and we continue developing new features for our tools. 

Most importantly, we’re more client-focused in our approaches now, so we’re also better at talking to potential users. We listen first to what they have to say before we present our solutions and services and we now have enough experience to recognise how we can adapt to their needs.

Communicating with clients and prospects has vastly improved following these changes. The more we move forward in the business, the more we’re learning as a team. And the more we apply these learnings, the better we become in helping human service-focused sectors.

Independent proof of a new way forward 

It’s never enough for others to hear from a business itself that their product or service works. All businesses should be confident in saying that they’re selling something spectacular. That’s why people need evidence, so they know they can trust a brand and what it offers. It’s one thing for us to believe in our product; it’s another for the rest of the world to do the same.

So the turning point for us was when we were able to get a grant for a 10-month study, which allowed the effectiveness of MEERQAT to be tested. The trial had to be approved by a Human Research Ethics Committee and the data collection, analysis and interpretation had to meet independent rigorous peer-reviewed standards.

When the trial resulted in a massive 34% reduction in adverse effects for the two participating units, as well as very positive levels of frontline staff engagement, we couldn’t help but be proud of the result and excited for the potential of our tools as we continue to tweak and improve their features.

Here, at last, was a definitive demonstration that everything we worked for and believed in, actually works.

How MEERQAT benefits others 

It’s one thing to feel gratified for having an idea validated by other people. While that’s certainly something we’ve felt from the high of the positive results from our trial, the reward of what we do runs deeper than that.

The reward isn’t about creating a sustainable or successful business.

The reward for us, as MEERQAT founders, is to have played a significant role in the shift to a better paradigm that ultimately improves other people’s lives.

It’s about us acknowledging a problem, seeing a solution from a different perspective, disseminating the idea, and seeing how it’s making a practical difference.

There’s no greater satisfaction for us than knowing that through our help, people feel more valued in the work that they do.

That’s what’s driving MEERQAT. Watch our short webinar on how MEERQAT turns staff engagement in quality improvement into a practical reality. 

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