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Making improvement interventions happen—the work before the work: four leaders speak
  1. Paul Batalden
  1. Correspondence to Dr. Paul Batalden, The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA; paul.batalden{at}

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Masterful work requires preparation. This anticipatory thinking, rehearsal, attention, reflection, real-world grounding can be done in many different ways, but it must be done well. Paul Batalden asked four expert leaders how they prepare for making improvement interventions happen. What they reveal provides inspiration, guidance and practical knowledge.

Nana Twum-Danso is professionally qualified as a public health and preventive medicine physician. She led a nationwide quality improvement project in Ghana, her home country, for 4 years before joining the Gates Foundation in 2012.

“ don't want to come across as being unrealistic, but you want to encourage them to be ambitious, to become a member of something which will give them pride.”

Maxine Power is professionally qualified as a speech therapist from the UK. Over the last 3 years, she has led the safety work stream of the National Health Service (NHS) national Quality, Innovation, Productivity and Prevention to improve quality and contain cost.

“I try to help each person to see the situation from the perspective of others… put a disrupter into the collective mindset to get different thinking.”

Christine Goeschel is professionally qualified as a nurse and implementation scientist. At Johns Hopkins School of Medicine, she has coordinated multiple large-scale group collaborative projects to improve health systems.

“I try to get deeply connected to the system settings where patients and health care meet, to better understand the realities or the ground truths of quality and safety efforts that live within them.”

Andrea Kabcenell is professionally qualified as a nurse. For the past 18 years, she has worked at the Institute of Healthcare Improvement, USA, where she has directed 13 breakthrough series collaboratives and several large demonstration projects aimed at improving patient experience and clinical outcomes.

“...adopting humility goes a long way and people seem to understand that it would be okay …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.