This week, we're revisiting one of the earliest episodes of Leading Quality—and a conversation about what it really takes to build lasting improvement capability in healthcare. We'll be back with an all-new episode in our next release.
How do you build a culture of quality improvement across an entire healthcare system? And what happens when you start with frontline clinicians rather than executive leadership?
In this episode, I speak with Dr. Curt Smecher, a retired anesthesiologist and one of the architects of British Columbia's Physician Quality Improvement (PQI) program. Affectionately known as "Papa QI," Curt helped grow a small, physician-led initiative into a province-wide program that has trained more than 1,600 clinicians in improvement science.
What began with just 12 physicians in 2015 offers a compelling alternative to conventional approaches to healthcare transformation. Rather than waiting for top-down direction, PQI built improvement capability from the ground up, creating opportunities for clinicians to tackle problems in their everyday work while gradually building trust and stronger relationships with health system leaders.
We explore how intentional governance, protected funding, and meaningful patient partnerships helped sustain and scale the program. Curt describes why patients were included as equal partners from the beginning, how PQI graduates became more engaged in their work, and why building improvement capability is only the first step toward meaningful system-wide change.
We also look ahead to PQI's next challenge: moving beyond individual projects toward whole system quality, where improvement, measurement, and planning come together to address the underlying problems facing healthcare systems.
In this conversation, we explore:
Why PQI took a bottom-up approach to improvement rather than starting with executive leadership
How shared governance and authentic patient partnerships helped change organizational culture
Why protected time and funding are essential to sustainable improvement
How involvement in QI can strengthen physician engagement, autonomy, and relationships
The challenge of moving from training improvement leaders to deploying their skills at scale
Why lasting system transformation depends on relationships, shared purpose, and trust
Curt's story is a reminder that building a learning organization requires more than teaching improvement methods. It means creating the conditions for people to work together, share power, solve meaningful problems, and develop trust over time.
Because, as Curt reminds us, change happens at the speed of trust.
This episode is an ICYMI (In Case You Missed It) re-release from the Leading Quality archive. We'll return with a brand-new conversation in our next regularly scheduled episode.
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
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New episodes published every other Thursday at 7AM Eastern Time.
Credits:
Host, Writer, and Executive Producer
Jason Meadows, MD
Produced by
Thrive Healthcare Improvement
Edited by
Milan Milosavljevic
