#Quality2019 : my reflections

I was lucky enough to be one of the 3500 or so delegates at the BMJ/IHI International Forum on Quality and Safety in Healthcare (the ‘Forum’), held in Glasgow last week. The annual conference held in Europe can be argued to bring together the European healthcare ‘Improvement’ community and a few others from slightly further afield, typically from the USA and the IHI. There are arguably other conferences that might cater better for Lean practitioners, (such as Lean19, on in the USA concurrently), improvement scientists, regulators, and other role variations of ‘improvement in healthcare’. Nevertheless, in many ways this particular conference has to my mind become the market leader in bringing quality improvement (QI) to the healthcare masses, in particular, leaders and practitioners. Well done and thank you for all that this Forum contributes. I felt it was a great success and the Scottish venue was excellent, (certainly better than the Excel in London… speaking in the non-biased English way, that you can only have when you grew up only 8 miles south of Hadrian’s Wall! 😉 ).

This year, the theme of the conference was ‘People Make Change‘. I rather liked this, especially the use of the word ‘make’, rather than ‘deliver’ or other words that might have been subtly more coercive; and I liked that ‘make’ is a verb, implying action and thus for me the idea of continuous improvement. There were many super keynotes, in particular from Nicola Sturgeon, First Minister of Scotland (and former Scottish cabinet secretary for health and well-being [note that emphasis]), who demonstrated the kind of improvement knowledge that many of us wish more healthcare leaders might aspire to develop. Other highlights included Henry Timms speaking about New Power, and the conversational ‘I have changed my mind’ morning session from Don Berwick and Maureen Bisognano.

I rather liked this conversational and surprisingly informal morning session, which covered a number of topics including mental health, what matters to you, measurement and kindness. I certainly felt inspired enough to consider that maybe we can start to build some kindness PDSAs into our improvement work. I also really liked the messaging the topic area gave, i.e. it is ok to reflect on the evidence and what you have learnt and change your mind. That is, use your critical thinking skills, it helps! What I also liked, this time, was a bit of a step towards more strategic improvement work at the meso and macro level, not just micro projects. With more emphasis on the conditions and context that support or hinder improvement and how they may be tamed, strengthened, different for different health needs and assessed (this last area being of most interest to me due to the overlap with my thesis research).

I also heard of some super work continuing around the world: on waste reduction from Australia, Joy in Work in England, emergency care improvements, growth mindsets, patient co-production approaches from many places, the Scottish daily mile, the use of Quality Management systems in Scotland or patient safety in the Netherlands and Sweden. I wish there was more time to hear more, and read more, of the substantial number of posters presented at the forum. Mine is below. Next time, I hope there might be a contribution possibility on new improvement habits that might help to sustain change supporting improvement capability.

I have been to, and/or had work shared by my teams at this conference since at least 2008 now (we won best poster for our lean based Trauma improvement work in Bolton… it seems a lifetime ago!) In addition, I have been lucky to be able to attend in person for the last 4 years on the trot, first with my research and then with work. Some things about the Forum do frustrate me. Such as a rather lack of critical thinking of what is presented by delegates and lack of opportunity to challenge presenters, which is perhaps why I liked the ‘I’ve changed my mind’ session so much. Other frustrations include: the presentation of much of the improvement work as scientific, yet a rather laid back approach to rigour in results reporting, the lack of reported limitations; the sometimes questionable methodological fidelity; and the rather surprising lack of an evaluative approach to the improvement work presented. In addition, some speakers could now be described as ‘frequent flyers’ and it is, to my mind anyway, rather expensive and perhaps even exclusive, for delegates to hear from many of the same individuals in sessions each year. Is not an aim of the conference to spread and share improvement including improvement leadership?

Don’t misunderstand me though, to be clear, I’m not trying to ‘throw shade’ on the Forum. I’m just make more personal sense of it by reflecting on it, and in the spirit of improvement, and kindness, offer thoughts on areas that can still be strengthened, whilst still appreciating the uniqueness the Forum brings. There are lots I very much like about the Forum. In particular, the significant opportunity to reenergise, reinvigorate and reconnect with colleagues, the opportunity to hear stories about improvement in practice, and how practitioners have dealt with the many different facets of context that somehow seem to become obstacles whilst experimenting on the ongoing quest to improve care.

I also love the opportunity to meet new allies and friends and I am so grateful to be able to debate with people with differing views, (I probably like this debating the most). And it is this relational side of the conference, through networking and sharing food and time, that I feel I benefit most from the Forum. It is my view that it is the strength of our relationships, that in the end, make such an impact on our improvement outcomes. In terms of bringing more and more people into a world of improvement, encouraging involvement and action, through new relationships, the Forum is perhaps not bettered elsewhere. Thank you again.

What are my hopes for a future Forum? That the spirit of friendship, networking and relationship building goes from strength to strength and with that, the Forum continues to explore how to strengthen its inclusivity of different and emerging voices, and diverse perspectives of improvement into its programme. I hope this will help to amplify new approaches, think about better and new ways of building improvement practice and habits, and create more space for healthy debate and constructive challenges and many, many more ways to improve care. To not only make change together, but also strengthen our learning together.

Right, I’m off to practice my new habit of a daily mile. Roll on the next Forum.

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