In 1985, I was one of a small group of people who were invited to a conference in Udine, Italy, with sponsorship from the World Health Organization (WHO), to explore the growing interest in measuring and improving the quality of healthcare services. One result of that meeting was the formation of a new professional association---the International Society for Quality Assurance in Healthcare. I had the pleasure of serving as a board member of that fledgeling organization for nine years, including serving as its president from 1989 to 1991.
Now fast forward to September 2018. I travelled halfway around the world (literally) to attend the annual ISQua conference in Kuala Lumpur, Malaysia. There I was one of about 1400 attendees from 70 countries, all of whom were there to learn from one another and to share their experiences in monitoring, measuring and improving the quality and safety of health services in their own organizations. Many were from hospitals or clinics, but a number were from ministries of health or other governmental or private sector bodies that establish and enforce standards for quality care in their countries.
More than 100 posters were on display, all crafted to share the experiences of one or more attendees in identifying a quality concern in their organization, conducting a study to understand what needed to change to improve care, implementing the change, and re-evaluating to assure improvement. Most of the projects were small, involving one organization and a small number of patients. But in the aggregate, they painted a picture of commitment - from developing nations as well as from highly developed countries - to making sure that the care their healthcare organizations provide is continuously improved for the benefit of the citizens they serve.
The Malaysian Minister of Health, in a plenary session address, discussed how his country is using technology to enhance care. Although Malaysia only devotes about 4.5% of its GDP to healthcare (contrasted with about 18% of GDP in the US), the country has a very sophisticated information technology industry and many of those organizations are developing high tech solutions for healthcare problems. One example is the growing use of artificial intelligence (AI) for improving diagnostic accuracy. For example, AI interpretation of mammograms is some four times more accurate than radiologist readings. Accordingly, AI is being deployed throughout the country to enhance the accuracy of mammography. Telemedicine is also widely used to assure that excellent care is available to citizens even in remote areas of the country.
Another very moving plenary session was presented by a solicitor from the UK, Sandra Jayacodi. She was a partner in a law firm in London, married, with a daughter, when she first began to experience mental health issues in 2007. She had several psychotic episodes and was treated by a variety of psychiatrists, who added bipolar disorder to the list of conditions from which she suffered and treated her with multiple psychoactive drugs. Her illness was so disabling that she lost her job, her husband, her home and almost her daughter. But then she came under the care of a professional who helped her focus on caring for herself. This professional took her off many of the medications that had made her - in her own words - a zombie and helped her realize that SHE had to be the center of her own care and treatment. In her presentation, her point was well made---that mental health and physical health are inextricably intertwined and that we in the health professions need to really put the patient at the center of our care---helping them cope with their illnesses and providing them encouragement and support, rather than paternalistic care which often does more harm than good. Her ability to help heal herself was quite apparent, as was her courage in sharing her experience with the audience at the conference.
In discussions with some of the attendees, I learned that one area in which the US is quite different from the rest of the world is in coupling quality of care to both institutional payments and individual compensation. Frankly, I got a lot of strange looks and dubious reactions when discussing how that trend is growing in the US. But I also planted the seeds of an idea that I know many of the attendees will take home and consider in their own settings.
I came away from the four-day conference feeling that I had, once again, learned a great deal from people whose healthcare systems, as well as their cultures, were radically different from ours. But regardless of the system or the culture, healthcare professionals and healthcare organizations worldwide share a common interest in assuring that the care we provide is safe and that the quality of that care is continually improved.
To learn more about ISQua and some of the projects, posters and papers presented at the conference, go to their website (www.ISQua.org). And give some thought to attending the 2019 Conference next October in Cape Town, South Africa!
Dr William F. Jessee, MD, FACMPE, Senior Medical Advisor, Gallagher Integrated Healthcare Strategies, is a past President of ISQua (1989 - 1991)