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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:
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.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
High reliability is often treated as a collection of visible practices: safety huddles, rounding, event review, reporting systems. But Nicholas Testa argues that the practices matter only if they create an organization that can reliably surface risk, learn, and respond. The harder leadership problem is durability: can those behaviors continue when the CMO changes, the CEO turns over, or the original champion leaves? This conversation examines the organizational scaffolding that makes safety less dependent on personality. It also surfaces a critical tension: psychological safety cannot mean the absence of accountability. Leaders need people to report mistakes, near misses, and uncertainty without fear, while still creating clear expectations that problems will be examined and acted upon. The goal is not simply a safer culture, but a system capable of seeing and correcting its own weaknesses.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Dr. Testa
...on LinkedIn
...via Email: [email protected]
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Healthcare organizations cannot learn simply because they have dashboards, safety reports, improvement methods, or formal escalation processes. Learning depends on whether people can surface what leaders do not know, challenge assumptions, admit uncertainty, and act on problems without making truth-telling personally dangerous. This second year-in-review episode examines the human conditions that make a learning system work: leadership humility, trust, psychological safety, accountability, high expectations, and agency. The central tension is that these ideas are often treated as opposites. Leaders are expected to be confident, yet must remain open to being wrong; organizations need psychological safety, yet cannot abandon accountability; and improvement should support people without lowering the standard of care. The challenge is to build systems that are demanding about the work while remaining curious about why reality falls short.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Follow Dr. Meadows on LinkedIn
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Healthcare organizations can run hundreds of improvement projects without becoming fundamentally better at improvement. After 26 conversations in the first year of Leading Quality, a larger question emerged: what makes an organization capable of learning repeatedly, across problems, teams, and time? This episode examines the difference between having people who know improvement methods and having a system that can recognize problems, understand the work producing them, test its assumptions against reality, and carry what it learns forward. The challenge is not to move beyond projects because projects do not matter. It is to ensure that successful projects leave behind more than better results; they increase the organization’s capacity to solve the next problem.
Key Ideas Explored
Takeaways for Quality Leaders
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Healthcare organizations often tolerate ambiguity, workarounds, and recurring operational problems until they produce serious harm. Dr. Steve Spear explains how leaders can apply the same disciplined thinking used in clinical diagnosis to the systems in which care is delivered—making problems visible early, investigating them rigorously, and building problem-solving capability throughout the organization.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Steve Spear on LinkedIn or through the See To Solve website
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Patients spend most of their lives outside the hospital, yet healthcare teams often have limited visibility into what happens after discharge, between visits, or during long-term recovery. In this episode, Dr. Joshua Liu discusses how SeamlessMD was built to close that gap by helping patients navigate clinical journeys, giving care teams better insight into patient progress, and showing why successful health technology depends as much on workflow, incentives, and leadership alignment as it does on the product itself.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Joshua Liu - LinkedIn
SeamlessMD
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Healthcare has made real gains in quality and safety, but Ken Segel argues that too much improvement work still lives as projects, dashboards, or specialist-led initiatives rather than as part of how organizations are run every day. This episode examines what it takes to move from episodic improvement to habitual excellence: a clinical operating system where safety, flow, problem solving, leadership, and accountability are built into daily work.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Ken Segel on LinkedIn
Ken Segel at Value Capture
The Habitual Excellence Podcast
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Patient safety has often been built around what happens after harm occurs: incident reports, investigations, accountability, and corrective action. In this episode, Dr. Peter Lachman argues for a more proactive and moral view of safety: one where teams talk about risk every day, anticipate who may be harmed next, and make safety part of the “genome” of healthcare education, leadership, governance, and frontline work.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Dr. Peter Lachman on LinkedIn
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Healthcare organizations often know they have problems with flow, safety, delays, frustration, and waste, but they may not actually see the work clearly enough to solve them. In this conversation, Maria Mentzer explains how See to Solve helps organizations surface hidden problems, involve the people closest to the work, and build practical problem-solving capability through simple, repeatable behaviors rather than heavy improvement infrastructure or abstract training.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation
Maria Mentzer on LinkedIn
Resources & Frameworks Referenced
Disclosure: This episode is not sponsored. Jason has no financial or commercial relationship with See to Solve. The conversation reflects his editorial interest in the work and in Steven Spear’s contributions to improvement science.
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
Why This Episode Matters
Healthcare organizations often treat improvement as a set of projects, tools, or training programs. Amar Shah’s work at East London NHS Foundation Trust (ELFT) and NHS England points to something larger: the long-term work of building belief, capability, infrastructure, and leadership routines so improvement becomes part of how a health system thinks and operates. This conversation explores what it takes to move from local improvement activity to organization-wide and national-scale improvement strategy.
Key Ideas Explored
Takeaways for Quality Leaders
Continue the Conversation with Dr. Amar Shah
Resources & Frameworks Referenced
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
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
From the publisher's feed
Welcome to Leading Quality, the show that dives into the real-world stories and strategies of healthcare quality improvement leaders at all levels, from Frontline Champions to C-Suite…