Health Care Improvement Lessons from the Vegetarian Haggis

A recent visit to Scotland, prompted me to complete a wee dissertation on gastronomic options in the country for non-meat-eaters. As you might imagine, my pro-haggis friends and colleagues were dismayed and a little amused when my research unearthed the vegetarian haggis.

In a country where traditional haggis (sheep's heart, liver and lungs encased in sheep's stomach) is the reigning national dish, this
nifty and surprisingly healthy creation composed of beans, lentils, vegetables, oats, seeds, herbs and spices, is relatively less well known outside Scotland. It may therefore shock you to realize that vegetarian haggis makes up a quarter of the sales of the national haggis brand, Macsween, in Scotland.

Turns out vegetarian haggis plus me was a match made in heaven. The star of the show of my full Scottish vegetarian breakfast shown in the picture above, was none other than my new-found friend.

Eating aside, I was in Scotland for the 30th Conference of the International Society for Quality in Health Care (ISQua). The theme of this conference was quality and safety in population health and health care. With 1250 attendees representing 73 countries, ISQua was four intense days filled with learning and sharing. I was there to teach a session on lessons from the literature and research at UC Davis on changing clinician behavior and clinical practice.

A day before the conference, I had been warmly welcomed at Healthcare Improvement Scotland, where I spent a wonderful day learning about the Scottish Patient Safety Programme, and making a bunch of new friends who do innovative and life-saving work across the pond.

And speaking of new friends - there are perhaps a few health care lessons that my other new friend, the humble and under-rated vegetarian haggis, could teach us.

1. Innovation can be found in surprising places: ISQua offers site visits to local health care programs. One site visit was literally steps away, in the loading dock of the Edinburgh Conference Center. The NHS Scotland's Mobile Skills Unit is a van that travels across Scotland delivering accessible simulation-based clinical skills training. Since its launch 5 years ago, this not-so-little van grew quite popular. In 2012 the Mobile Skills Unit trained over 500 health care professionals in their home towns, in the process saving them travel time and money. The vegetarian haggis was first created in 1984 as a "tribute to Scottish poetry" for vegetarian guests at Burn's Suppers. It took off, much like the Mobile Skills Unit, by focusing on the needs of a previously under-served population.

2. Simple is okay: Many health care advances that make news these days tend to be high-tech. As Atul Gawande, pointed out during his plenary session at ISQua, a low-tech pen-and-paper checklist, a lot like the checklists used in aviation, helped reduce death and complications in surgical patients in a global population. Vegetarian haggis lacks the complexity and enigma of its traditional version. This simple creation is most definitely not your grandmother's or Robert Burns' ode-inspiring haggis - but with half the fat of its meat-based cousin, it is still a keeper.

3. Kano's Model of customer satisfaction works: Meeting customers' basic expectations, adding extras to make customers happier, and then delighting the customer with an unexpected level of service has huge opportunities for health care. Identifying the voice of the customer is not just a buzz word in health care any more, it is sorely overdue. Health care has realized that meeting basic expectations is key, but investing in what Noriaki Kano terms "delighters" - qualities that the customer does not expect, but receives as a bonus - is crucial to demonstrating value. Much like my delight at discovering my new find at the grocery store. As several sessions at the ISQua conference pointed out, quality is cost-effective. And as Macsween's website points out, vegetarian haggis now makes up 25 percent of their sales. Invest in delighters and the money will follow.

4. Standardize, but allow for adaption to local contexts: Standardization does not equate loss of professional autonomy. In some cases, as demonstrated by research in health care safety, it can save lives. But standardization needs to allow for flexibility to fit local contexts. I shared with ISQua attendees our findings that a point-of-care electronic clinical decision support tool to alert clinicians to obesity in pediatric patients would need to be adapted to local organizational culture to be optimally effective. Macsween started off with a solid product. But then allowed for creativity and adaptability to local needs, evidenced by recipes on their website for vegetarian haggis pakora, haggis panini, haggis nachos, haggis lasagna, haggis in pita with tzatsiki, haggis pizza, haggis Chinese pancakes, BBQ haggis, and haggis tacos.

Which, to quote Macsween, is "sheer beany brilliance".

- Ulfat Shaikh