The 2018 QuaIity and Safety Forum proved to be an excellent two days in Amsterdam with much interest in what is happening in Wales.
The event showcased the collaborative working between the Wales Deanery and 1000 Lives Improvement Service, which is of real benefit to NHS Wales. We hope to have an even bigger presence at IHI/BMJ International Forum of Quality and Safety in Healthcare in Glasgow 2019!
Ewart Johnstone and Dr Alistair Bennett, QIST Leads for Dental and GP respectively, give their thoughts on the event:
Attending the Quality and Safety in Healthcare Forum in Amsterdam this year was at a personal ideal time. Having just completed the Improvement Adviser Professional Development Programme in April, my year’s knowledge and increased understanding in Improvement methodology allowed a more insightful attendance to forum discussions, meetings and to review the standard of the poster submissions.
The theme for the meeting was Reclaiming the Quality in Healthcare and our hosts, the Netherlands, immediately explained how their country was developed with a shared communal spirit and will to overcome the combined forces of the North Sea and the Alpine melt water, and how using the same will and sense of community they are developing themes and systems for Quality and Safety in their Healthcare system.
The stresses in Healthcare systems are more prevalent with an increasing ageing population and limitations in the economic climate. The closing keynote speech from President Emeritus of the Institute for Healthcare Improvement, Don Berwick, on Friday was a harsh reminder to all that Quality, Cost and Value are key to future worldwide healthcare. The closing speech was a call to arms and I would advise anyone to listen to the message online.
In this speech it is noted that the IHI methodology is utilized in every continent in the world except Antarctica, although certain areas in Wales had a cold winter with deep snowdrifts we certainly have a developed understanding of IHI methodology for Quality and Safety in our healthcare systems and the Welsh possess a community spirit similar to that of the Netherlands.
On Thursday I attended a discussion on Antimicrobial resistance in Healthcare. This was a theme that I have been involved in with the Wales Deanery dental section. The discussion noted how Antimicrobial stewardship was integrated in New York state in the USA and there has been a reported reduction of 18% in prescribing antibiotics as a result of Quality Improvement programmes.
I have to admit certain smugness as I can recall that there has been a 22% reduction in antimicrobial prescribing in General Dental Practices in Wales as a result of utilizing QI methodology, with several PDSA cycles since 2012. One of the PDSA involved the development of the National Antimicrobial Prescribing Audit. The discussion stressed the continued importance of Antibiotic Stewardship and this would be an area that I would certainly want to develop methods to sustain the improvement in primary dental care.
Team Wales provided several speakers for the forum over the two days and the NHS Wales stand, well positioned at the entrance to the main auditorium, was a hive of activity, drawing worldwide attention and discussion that can only provide a positive regard for our commitment and partnership with our patients.
Dr Alistair Bennett
A GP, a dentist and an intensivist go into a conference. This may sound like the opening line of a very bad joke but was actually the reality for the Quality Improvement Skills Training (QIST) team recently for the BMJ/IHI International Meeting on Quality and Patient Safety in Healthcare. The QIST team deliver training in Quality Improvement methodology that is equally applicable if you are a tertiary care trainee in a teaching hospital or GP Registrar or Foundation Dentist in a small practice in rural Wales.
The QIST team was part of a Wales delegation travelling with our improvement colleagues from 1000 Lives. As a GP it was great to see the project run by 1000 Lives on the care of people with Learning Disabilities that had been carried out in my (and other) practices being presented alongside work from some of the most prestigious healthcare centres in the world. Sharing ideas and projects with other centres has given us a raft of ideas for further improvement in the care of vulnerable adults such as the 4 M’s approach toward holistic assessment and questions such as ‘what matters to you?’
Introducing QI to busy clinicians who already feel overwhelmed by workload can be a hard sell. The session on the ‘business case for QI’ demonstrated that QI projects can save time and money by making processes more streamlined and efficient. It is important that clinicians are engaged with the process and can see benefits for themselves and their patients. Improvement projects should be identified by clinical teams on the ground and are likely to be unsuccessful if imposed from above.
‘What can we learn from aviation?’ was a stimulating session on concepts often overlooked in healthcare. Human factors science shows that under stress people behave in predictable ways and encounter phenomena such as cognitive overload. Culturally, medicine lags behind in accepting and therefore ameliorating these realities. These can be partially overcome by the use of checklists, improving the contribution of others in the team and adopting a systems based no-blame approach to medical errors. This has been shown to improve standards and safety in healthcare, industry and aviation. Unfortunately, recent events in the UK have demonstrated that this is a long way off as the regulators, and to some extent the profession, cling to the myth that regardless of the working environment, only bad doctors make mistakes and they should be punished when errors occur.
The focus of presentations and posters at the meeting is still very much dominated by secondary care. I hope that the introduction of a mandatory QI project for GP training by the RCGP, alongside training from the QIST section of the Deanery, will promote the QI agenda in primary care throughout Wales. This will give GP trainees the opportunity to learn improvement and leadership skills and present their work alongside secondary care colleagues.
Keynote Speakers at the Forum
Donald M Berwick: MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare and Medicaid Services; USA
A peadiatrician by background, Dr. Berwick has served on the faculty of the Harvard Medical School and Harvard School of Public Health, and on the staff of Boston’s Children’s Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women’s Hospital. He has also served as Vice Chair of the US Preventive Services Task Force, the first “Independent Member” of the American Hospital Association Board of Trustees, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality.
Donald has served two terms on the Institute of Medicine’s (IOM’s) Governing Council, was a member of the IOM’s Global Health Board, and served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Recognized as a leading authority on health care quality and improvement, Dr. Berwick has received numerous awards for his contributions. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by the Queen of England in recognition of his work with the British National Health Service. Dr. Berwick is the author or co-author of over 160 scientific articles and five books. He also serves as Lecturer in the Department of Health Care Policy at Harvard Medical School, and he’s an elected member of the American Philosophical Society.
Caitlyn Jenner: Former Olympic Athlete and Transgender Activist
In 1976, Caitlyn Jenner broke the world decathlon record by scoring 8,634 points at the Olympic Games in Montreal, and earned the title of “World’s Greatest Athlete.” Forty years later, she captured the world’s attention again when she revealed that she is a transgender woman during an ABC News special with Diane Sawyer. Since revealing her true self, Cait executive produced “I Am Cait,” the landmark series on E! documenting her post-transition life, partnered with M·A·C Cosmetics to donate over $1.3 million to transgender Initiatives and became the face of the H&M “For Every Victory” sportswear campaign. In April of 2017, Caitlyn shared her story in her New York Times bestselling memoir, The Secrets of My Life, co-authored by Pulitzer Prize-winning journalist Buzz Bissinger. Caitlyn was named Barbara Walters’ Most Fascinating Person of the Year in 2015, runner up for the 2015 Person of the Year, Out Magazine’s 2015 Newsmaker of the Year and one of Glamour Magazine’s Women of the Year. She was honored with the Arthur Ashe Award for Courage at the 2015 ESPY Awards for her transition from Olympic athlete to transgender activist.
Dan Heath: Author, Entrepreneur and Senior Fellow at Duke University’s CASE Center; USA
Dan Heath co-wrote four of the most-loved business books of the past decade: Made to Stick, Switch, and Decisive, and their latest book, The Power of Moments, which explores why certain brief experiences can jolt, elevate and change us—and how we can learn to create these extraordinary moments in our life and work. All four were New York Times best-sellers. Together the Heath brothers’ books have sold over two million copies worldwide and been translated into 33 languages.
Dan is a senior fellow at Duke University’s CASE center, which supports entrepreneurs who fight for social good. He is also an entrepreneur himself, having founded Thinkwell, an innovative education company that will celebrate its 20th anniversary in 2017. A former case writer for Harvard Business School, Dan was named in 2013 to the Thinkers 50, a ranking of the world’s 50 most influential management thinkers, and also to Fast Company magazine’s list of the Most Creative People in Business. He has delivered keynotes or workshops for teachers, police chiefs, U.S. senators, interior designers, Navy admirals, health care leaders, marketers, ministers, and countless executive teams, across 26 countries on 6 continents.
Dan has a Master of Business Administration degree from the Harvard Business School, and a Bachelor of Arts degree from the Plan II Honors Program at the University of Texas at Austin. He lives in Durham, North Carolina.
Maureen Bisognano: President Emerita and Senior Fellow, Institute for Healthcare Improvement (IHI); USA
Maureen Bisognano previously served as President and CEO of the Institute for Healthcare Improvement from 2010 to 2015, and as Executive Vice President and COO from 1995 to 2010. She is a prominent authority on improving health care systems, advises leaders around the world, and is a frequent speaker at major health care conferences. Ms. Bisognano is an elected member of the National Academy of Medicine, an Instructor of Medicine at Harvard Medical School, and a Research Associate in the Brigham and Women’s Hospital Division of Social Medicine and Health Inequalities. She currently serves on the boards of The Commonwealth Fund, Cincinnati Children’s Hospital Medical Center, ThedaCare Center for Healthcare Value, and on the Advisory Board of County Health Rankings and Roadmaps. Prior to joining IHI, she was CEO of the Massachusetts Respiratory Hospital and Senior Vice President of The Juran Institute.
Following last year’s success the Wales Deanery will once again, in joint collaboration with 1000 Lives Improvement Service, be attending the International Forum on Quality and Safety in Healthcare. The following members of staff will be representing the Deanery:
Dr Alistair Bennett, QI Lead for GP Training; Dr Gethin Pugh, Associate Clinical QIST Tutor; Lisa Bassett, QIST Manager; Dr Anton Saayman, Sub Dean (PGES and QIST); Dr Miriam John, LINCymru Clinical Lead; Ewart Johnstone, QI Lead for Dental Training; Dr Thomas Yapp, Foundation Training Programme Director and Tanya Hellard, QIST Officer.
Together, we will be exhibiting as NHS Wales. Our shared goal will be to showcase how NHS Wales and partner organisations are working closely to improve outcomes for people accessing our services; through dedicated local and national quality improvement programmes aimed at building capacity and capability across our professional workforce and improving patient safety and experiences for our patients. The QIST team are currently busy with the planning process and are very much looking forward to promoting our work at this high attendance event.
The Forum is one of the world’s largest conferences for healthcare professionals committed to improving patient care and safety, and has been held annually since 1996. This year the forum will be held at the Amsterdam RAI Exhibition and Convention Centre from 2nd to 4th May and will be attended by around 3,000 health professionals.
The theme of the conference is ‘Reclaiming the Quality in Healthcare’ and will feature over 50 sessions and more than 150 speakers. Key themes include ‘enhancing the patient journey’, ‘medication safety’ and ‘involving patients at every level of your organisation’. There will be opportunities for delegates to take part in interactive workshops, visit offsite centres such as the Radboud University Medical Centre and Albert Schweitzer Hospital, and view the vast array of quality improvement projects on show. Miriam John and Gethin Pugh have had posters accepted and will be presenting at the conference, as will five of the Welsh Clinical Leadership Training Fellows: Dr Richard Gilpin, Dr Sara Long, Dr Thomas Kitchen, Dr Dafydd Loughran and Dr Richard Ellis.
Lisa Bassett, QIST Manager for the Deanery, said, “Last year’s Forum was very successful and a great event for NHS Wales. As the conference keeps getting bigger and bigger, we hope that this year, once again, will be an excellent opportunity to showcase how over the last 18 months the Wales Deanery and 1000 Lives Improvement Service have worked in partnership to develop a unique strategy for Quality Improvement Training for all doctors and dentists training in Wales.”
Follow our blog over the next two weeks as we feature some of the guest speakers and their presentations in the run up to the event.