Change is always bad, until it gets good: Lessons from the Quality Academy at Mayo Clinic

I am spending a year as the Trauma, Critical Care, General Surgery Research Fellow at Mayo. I have time to focus full-time on projects that will hopefully make a difference, expand knowledge, and really help our patients. I have aspirations of completing a couple of Quality Improvement projects, which is a very particular type of research with roots in sophisticated industries that have developed complex strategies for minimizing risk and errors. I have attempted a project before and essentially got nowhere, as I didn’t even know where to begin. So I signed up for the Quality Academy, which in true Mayo fashion, was an efficient, information packed, slick course that gave us all the tools we needed to get going on our projects. We covered a broad range of topics, and I was inspired by many of the thought processes and exercises presented there, but non stood out to me as more profound that the so-called “Change Despair Curve.” It looks something like this:

Image result for change despair curve



Now this was not the exact curve in our presentation, but it’s essentially the same. The curriculum stated that any change, whether personal or institutional, small or large, is accompanied by this same terrible transition by all involved parties. Even if the change is obviously positive and gets unanimous support at the beginning, there is a valley where everyone is bummed.

The reason I thought this was so profound is that I have seen it play out in my toddler’s reaction to 100% of suggestions I have made to her in the past 6 months or so. That’s not an exaggeration. I say, “Banana?” and she gives me a tortured expression and says, ‘NO DON”T WANNA NaNeeeI!!!” before her face softens and she holds out her hand for the gift. Every transition, change in our momentum, new idea, or suggestion of any change in the current activity and state of affairs is met with initial resistance. So of course I smugly thought, “Ah motherhood, giving me yet another edge in the professional world,” and gave myself a mental high-five.

This curve  represents the challenges we will all face as we try to do good in the world by changing the status quo. All stakeholders will eventually get sore with us and with our ideas. We will get depressed about our projects and moving and traveling and starting new ventures. We will have to convince ourselves and colleagues that the change is worth it, over and over again. With perseverance, what is there on the other side of the difficulty is higher quality projects and a life of more purpose and impact.

I encourage every professional interested in global health to get acquainted with the principles of Quality Improvement, as we should be held accountable for proving the quality of any new endeavor or change we implement. We need to show that the change and resources required are justified, and having the right tools to do this analysis is part of the job description of a humanitarian physician. If your institution does not have resources available to get you started, email me at and I will send you everything I can to help.

What life-lessons have you learned from something like “Quality Improvement?” How important do you think quality research projects are to the field of global medicine? Please leave comments below!