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When people come to Shift to learn improvement, they often anticipate learning technical skills like measurement, root cause analysis, or PDSA cycles for testing new ideas. These skills are all critical ingredients of improvement, but to reach lasting and meaningful changes in systems, the most essential ingredient of them all is love.


Love isn’t a skill to be taught, rather an innate notion in each of us. Social sectors – whether in medicine, education, environmental stewardship, or social work – often look to the adoption of best evidence from science to improve. The ability to adopt change and create these new ways of working, however, relies on love. This isn’t the romantic or commercialized love that we think about on Valentine’s Day. Love in an improvement community closely resembles bell hooks’ definition: “Love is a combination of care, commitment, knowledge, responsibility, respect, and trust.”

This kind of love re-connects people with their purpose and why they started in their field in the first place – to provide the best care to their patients, to create classrooms where students belong and learn, to serve families in need to best care for their children. 

This notion was instilled in me early in my career. I moved to Malawi in 2006 to run my first improvement network with The Institute for Healthcare Improvement. I had the incredible fortune to be mentored by Dr. Uma Kotagal (you can read more about how amazing she is here)Our aim was huge and inspiring – to reduce maternal and neonatal mortality by 50% among ten hospitals across three districts. This aim was hugely personal to me.  I signed on for this job to move my family – my husband, a toddler, and a baby– six months after an emergency caesarian section saved my life and my son’s life. It seemed imperative that we all work on improving outcomes for mothers around the world.

As I set up in my new job, Uma taught and coached me on the essentials of my role. As I anticipated, I sharpened and practiced my improvement skills and collaborated with experts to gather the best evidence to put into practice. What I didn’t anticipate in a professional capacity was how important it was to connect my professional role to love. This was the element that my mentor most emphasized throughout our years together. She reminded me every time we spoke – my role as their improvement coach was to regularly call and visit. My job was to know what worries the improvement teams and stay up at night worrying about what worries them. My job is to know about their successes – big and small – and celebrate them all.

I’ve carried these lessons with me. My job is to create the kind of community where people feel valued and know what they contribute is essential to our shared success. This love, trust and respect isn’t calculated or forced. It’s built over time, in the words of bell hooks, by showing up with care, commitment, knowledge, responsibility, respect, and trust.

While I’ve made a lot of run charts and coached teams on testing changes, I’ve also made countless batches of cookies for improvement team meetings, gave blood when hospitals were on short supply, or organized parties to celebrate big wins. These aren’t the skills that people share during conferences or publish in journals but are just as critical to creating the conditions for change.

The capacity to love is intuitive and innate among all of us, but often needs a reawakening after years of focusing on technical skills and exploring our ideas of what it means to “be professional.” In the words of one of the great thinkers of improvement, Avedis Donabedian:

“Systems awareness and systems design are important…… but are not enough. They are enabling mechanisms only. Ultimately, the secret of quality is love.”


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