Maulik Joshi, DrPH – President and CEO, Meritus Health

President, Proposed Meritus School of Osteopathic Medicine

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Healthcare Leaders as “Fixers”

Over the last few decades, the role of healthcare professionals working in the quality space has evolved, and so have all healthcare leaders. Early on, one could suggest that quality professionals started with a “describer” approach. As the sentinel reports To Err is Human, Crossing the Quality Chasm and Unequal Treatment were published more than two decades ago, many healthcare professionals in the quality realm were describing the state of healthcare quality, rather than acting upon their findings. At the time, that was what was necessary by these professionals; the industry needed individuals to make clear the realities and opportunities for improvement. Back then, there was doubt that quality was “that bad.” Thus, quality professionals took on the role of “describers” by detailing the systemic issues plaguing healthcare in multiple ways, multiple times. It was an important role.

Going from the traditional quality assessment or assurance function to a quality improvement skillset, the “describer” approach changed from a key ability to one of many required competencies. In fact, the NAHQ Quality Competency Framework articulates a wonderfully comprehensive set of domains of competencies and skillsets desired for the quality professional. I believe an underpinning of the quality competency framework is that of a “fixer” mentality.

Wikipedia (Retrieved Aug. 5, 2023) defines a fixer as “someone who carries out assignments for or is skillful at solving problems for others; and, in British usage, the term means the sort of person who solves problems and gets things done.”

As the healthcare field and the healthcare quality profession continue to evolve, I would contend that the best quality professionals and healthcare leaders are now “fixers”.

Specifically, what does it mean to be a “fixer” in healthcare?

First, “fixers” are individuals who can role model behavior. “Fixers” can not only work with a team to identify solutions, but they will be one of the individuals who will test out the practice. They will be the person who is an early volunteer and is willing to fail in order to learn quickly and adapt for the next intervention and for the next person. Need someone to test out a new workflow in the ambulatory physician office? Or someone to embed pilot education materials in their communication with the patient? Or someone to help develop an order sheet in the electronic health record? The “fixer” will do it.

“Fixers” are versatile. “Fixers” bring different skill sets to the table in order to “solve problems for others.” The skills may vary from professional to professional, but the “fixer” possesses many skills. They may be great at influencing and inspiring their teammates, they may be great analytically – looking at data and finding meaning, or they may be great at networking and harvesting best practices from others. They will have the skills necessary to think through and implement solutions effectively. In sports, the “fixer” can be considered the utility player – someone who can play multiple positions well, and that diverse set of abilities makes them a key member of the team.

“Fixers” are fixated on results. They work to get the job done. Fixing something without a desired outcome is not really fixing. “Fixers” always keep the end goal in mind and thus are continuously tracking performance and using that to adjust interventions. Not losing sight of the desired outcomes and obsessed with progress is a hallmark characteristic of a “fixer”. It is worth noting that not all quality efforts lead to success, nor should they if there is a deep culture of continuous improvement. However, a fast failure is a positive outcome in itself as long as the learning is leveraged for the next improvement activity. Thus, although “fixers” won’t always get to the goal, they will make meaningful change.

Although it may not seem intuitive, “fixers” are also natural leaders and coaches. Since “fixers” can get things done they can serve as great teachers in coaching others to develop their skills. The quality professional in the quality department of a healthcare organization (though this is not meant to be limited to quality professionals) are great “fixers” when they are working with frontline clinicians in their improvement projects. All quality improvement projects need dedicated time, leadership, and work completed on-task. The quality professionals involved in facilitating improvement projects with busy clinicians are true “fixers”, and while they keep the QI project, they are teaching the others so that they can pay it forward. This mindset of fixing is not limited to quality professionals, though they can and should pave the way.

I would assume there are many people who read this that respond with the thought that healthcare needs more than fixing. I concur; healthcare needs some processes to be redesigned, and some redeveloped from scratch. “Fixing” may not be good enough. However, I would contend that many industries need fixing, and we should not trump fixing with innovating. We need to fix to get to very good while striving for perfection. But, we can’t do it without those with multiple skills sets, who fail forward, and those who have a drive to push the work to another level.

We need healthcare professionals (“fixers”) who model desired behaviors, are versatile in their skills, focused on achieving results and serve as great coaches. Let’s all strive to be “fixers”.

Maulik Joshi, DrPH

President and CEO, Meritus Health
President, Proposed Meritus School of Osteopathic Medicine