Blog: International Forum on Quality and Safety in Healthcare

Published: 08 May 2024

Personal thoughts from the International Forum on Quality and Safety in Healthcare

Clare Fountain, Associate Director at Healthcare Quality Improvement Partnership (HQIP)

 International Forum London 2024: 10-12 April 2024 (bmj.com)

This year the cultural flavour and voices of the diverse Southeast London community were brought into the International Forum, through entertaining music, confronting local health inequalities data and inspirational community wellness work shared. The transformative impact of community engagement on health was exemplified by the remarkable efforts of the West Ham United Foundation.

We also heard a provocation from early career leaders in health and care who shared their views on how senior leaders are managing the space between safety, financial pressures and workload. However, no presenter matched the sheer passion of London-based Daze Aghaji as she addressed the urgent global climate emergency, reminding us all of the imperative for immediate action.

A wealth of topics were covered at the forum this year, with top international quality improvement professionals coming together to consider Quality Improvement in a world full of evolving challenges.

So what stood out for me?

Health not just Healthcare: Partnering with communities

Making the world a healthier place by focusing on “health” not “healthcare” was a recurrent theme. This was not a one-size-fits all message of public health, but an urging to work in partnership with communities.

We were urged to move away from a ‘professional-centric’ view of those we serve, to one that recognises the power to their own health being with individuals. We don’t ‘empower’ others, as we never had that power.

At HQIP we undertake an extensive amount of engagement. We recognise that it is community and connection with support, energy, kindness and partnership working across health, care and other organisations, that has the power to significantly improve health.

Throughout the forum there was a clear presence of people with lived experience. Speakers talked about moving on from ‘patient engagement’ to  ‘partnering with people with lived experience through strategic co-production’ from boardroom to bedroom, with an equal partnership.

The inspirational @SCFNuka, who talked about their 25-year community driven transformation journey in Alaska – where they work with the community “in shared responsibility.” They focus on “health” as “multi-dimensional wellness”, (NOT “healthcare”) through a shared and lived philosophy, reinforced regularly.

“Inequities in our system are a cancer. A single persistent metastasis spreads and causes harm throughout the entire system, depriving all of us compassionate care”,

Kedar Mate, CEO IHI

As a number of speakers reminded us  “improvement work only moves at the speed of trust” and relationships are key to activating people’s own agency. West Ham Foundation told us as a governmental institution communities don’t always trust the NHS, but working as an organisation ‘born of the people’ creates the conditions for community-led actions.

Inch wide, mile deep: Focusing efforts for equity

Multiple speakers challenged us all to think differently about how we tackle health inequalities and told us that:

  • Kedar Mate told us that we need to “stop admiring the problem of health inequality, and we need a full threated decade of action”.
  • Pedro and Aoife told us that efforts to improve access, experience and outcomes been too broad, and this either maintains/increases inequalities. Instead we need to:
  • Leverage data to know where to focus, having an “Inch wide, mile deep” focus.
  • Take an asset-based approach, working with the strengths / characteristics of a community, not taking a problem or deficit view
  • Stop copy pasting and assuming all groups need the same provision/ solution, but giving each place freedom to adjust to local preferences
  • Understand that inequalities are structural violence, unfairness as a result of structures we established. Understanding that history and building trust with communities is a better way to work out together.
  • Working in partnership includes not expecting communities to deal with our jargon and work around our ways of working.

But despite the positive case studies I couldn’t help wondering how can we reduce inequalities at scale and pace?

  • Do we need to adjust our improvement ‘toolkit’? and how best bring together the skills of community engagement, and assets of improvement science?
  • How do we make sure we don’t just keep asking ‘what matters’ to communities over again and actually move into action?
  • How can we speed up the use of existing data to zero in on where the greatest disparities are? For example National Clinical Audit data is powerful, containing process and outcome measures, but demographic information in HES is poor.

From silos to synthesis of approaches and methods?

The allure of exploring fresh perspectives in healthcare improvement is undeniable, and embracing new perspectives is pivotal for advancing our methods. The wake-up call from presenters at Quality2024 to prioritize community partnerships and address inequalities is valuable.

Yet, as I stood among esteemed healthcare leaders, I reflected on whether we inadvertently nudge out time-tested methods that once formed the bedrock of our practice? Are we effectively utilizing all the existing quality management and improvement methodologies at our disposal?

Effective improvement hinges on our ability to seamlessly integrate and interchange methodologies, flexing to suit the unique contours of each challenge we encounter. Do organizations possess the acumen to discern the nature of the challenges we face and select the most fitting methodologies accordingly?

The Health Foundation’s “Improving across health and care systems: A Framework” was also presented at the Forum.

 

This framework encouragingly advocates for the convergence of diverse improvement activities to catalyse sustainable change at scale. Six modes of activity are outlined, balancing the creation of conducive conditions for improvement with the execution of transformative endeavours.

Could we do more as an Improvement Community to support the cross-pollination of expertise across the continuing silos?

Could we convene Q expertise to confront our complex challenges from multiple methodological perspectives simultaneously and collaboratively? E.g. Q think tanks

Déjà vu: Are we extracting transferable principles from Improvements for sustained improvement?

My final thought was one of curiosity. The International Forum has an important role in sharing high-quality content, helping us to evolve our practices, network and learn what works.  But as I scanned through the recurring themes and areas of focus in the posters, I couldn’t help but wonder — are we really working on some of the same issues?

Eight years ago, as part of the founding cohort of the Q community, we agreed that the sharing successful improvements and fostering faster, more scalable progress was an important aspiration.

Do we need to step up our game in documenting and sharing case studies of what works, extracting transferable principles for local adaptation? How do we bridge academia and implementation for impactful knowledge translation? How do we fund more academics to partner with improvers?

Looking back, Q has achieved a lot, boasting a large, active, and diverse membership with a collaborative spirit. I remain optimistic about its enduring value. Yet, there’s room for growth, and I believe we can do more to fulfil our potential, through learning together.

About HQIP

A long-term partner of NHS England, the Healthcare Quality Improvement Partnership (HQIP) is an independent charity with the primary aim of improving health outcomes for patients through evidence-informed change and service design. We achieve this by supporting robust quality improvement through national clinical audit, clinical outcome review programmes and registries as well as providing a wide range of reports, guidance, benchmarking and other related resources and services. While always evidence-based, our work (and its value in supporting targeted improvement) goes far beyond data collection. By identifying where resources are needed most, and where they would make the greatest difference, our approach offers maximum impact for those who plan, deliver and use health and care services.

For further information, go to www.hqip.org.uk/services .