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By Hugh MacLeod Thursday. Mar 12, 2020

Leveraging Environmental Intelligence, Inspiration, & Creativity Featured

Healthcare organizations are patterns of energy, webs of human conversations and decisions. Think about this reality; relationships and interactions are the ‘genetic code’ of healthcare quality, people are not just individuals but rather individuals standing in the middle of many relationship systems. When people change their part of the relationship pattern, the organizations quality pathway changes. A major obstacle on the pathway to quality improvement is the failure to leverage emotional intelligence elements of; self-awareness, self-integration and ability to self-regulate in the asking of questions that will lead to a deeper exploration of quality assumptions we make.


From my experiences at the operational level, policy-making level and national patient safety planning level, the organizational capacity for naming elephants in the room, i.e. talking about tough quality issues that no one talks about, is a common characteristic and behaviour in a healthcare organization with extraordinary adaptability.


Asking questions is a proficient self-management tool to keep us focused on the bigger quality picture. As a formal and informal leader, there’s a responsibility to your healthcare team and healthcare organization.


Offered are four sample sets of quality questions for your consideration.


Questions For All Health System Players


1. Do we treat vision and mission as noble ideas that we ignore in our everyday actions?

2. Do we congratulate ourselves based on short-term quality results achieved at the expense of long-term quality sustainability?

3. Do we ask ourselves this key question: What behaviour have I tolerated in myself or others that conflict with my commitment to quality of care?


Questions About Healthcare Organizational Governance

1. Do boards make it clear that the adoption of quality improvement practices is a core expectation?

2. How do boards articulate their quality goals and expectations, and how do they communicate their commitments to their organization?

3. To what extent are board resource allocations, priorities and decisions focused on improving quality?


Questions For Healthcare Executives and Managers

1. When quality incidents occur, are there formal processes for turning them into learning opportunities?

2. Does the culture signal that improvement is a core organizational value and an integral part of front- line work?

3. Are there processes in place to identify and address unjustifiable variations in practice, and are  clinical peers jointly accountable for overall quality performance within their control?


Questions About Professional Cultures and Values

1.What is the hierarchy of values among care professionals and does quality trump other professional values such as autonomy and group loyalty?

2. Are professionals concerned about a broader unit or organizational performance, and do they view variations in quality practice as inherent danger signs?

3. Do professionals perceive advanced transparent health information gathering and analysis as core elements of their identity?


A healthcare culture of quality improvement is an emergent property and as such the human beings who created it can change it. If a change in a change in your quality improvement culture is desirable, change the conversations. Healthcare people are capable of brilliance. To maximize quality effectiveness, take advantage of the skills, talents and potentialities of everyone.


Changing the quality of social patterns of interaction and the degree of participation, overcomes the intellectual, emotional and systemic barriers that exist to tapping emotional intelligence, inspiration and creativity - pathways to quality improvement!



Short, R. “Learning In Relationship.” Learning In Action Technologies Inc. 1998

MacLeod, H.B. “Humanizing Leadership.” FriesenPress, 2019.

MacLeod, H.B., Lewis, S. “Asking the Unaskable -Thinking the Unthinkable.” Longwoods Healthcare Quarterly, Vol.15 No.1, 2012.

Gilbert, G, Malik, B. “The Beautiful Lie.” Hospitals & Health Network Digital Magazine, 2010


ISQua Expert & Member, Hugh MacLeod retired as CEO of the Canadian Patient Institute in 2015. Currently, he is an Adjunct Professor of the School of Population & Public Health at the University of British Columbia.


Hugh has recently published his first book 'HUMANIZING LEADERSHIP: Reflection Fuels, People Matter, Relationships Make the Difference' which has been described as 'Candid, concise, and skillfully delivered leadership advice.'


Registration for ISQua's 37th International Conference in Florence, Italy (30 August - 2 September 2020) is now open, and discounted rates are available for Early Bird registrants, ISQua Members, applicants from low-income countries, and students. Please visit the conference webpage to find out more -


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We all have two vocations in health care – to do our job and to continually improve