Working Groups

Over the past three years, ISQua’s Innovation and Systems Change Working Group has been assessing how health systems cope with current and impending ageing populations. The group's work compliments studies undertaken by the World Health Organisation (WHO), European Union and World Economic Forum (WEF).

Our aim is to facilitate a global collaborative approach to address this challenge. The group published a white paper last year on this subject. Now undertaking an in-depth analysis of literature and opinion on this topic, the group is working on its next open access resource, providing a pragmatic update on current and future strategies.

White Paper

During 2015, the Innovation & Systems Change Working Group began focusing on the global issue of ageing populations, the increasing pressure worldwide on health care systems and the transformation of care needed. Health care systems must continuously innovate and adapt if they are to meet the challenge of delivering safer, better care to more complex patients within limited health care budgets. In October 2015, a one day seminar was held in Doha, Qatar where representatives from sixteen countries shared their vision, diagnosis and further challenges to address their ageing populations. An editorial based on the discussions held in Doha was published in the International Journal for Quality in Health Care in March 2016. On Monday 17th October 2016 Professor Cliff Hughes officially launched the first white paper - Health Systems and Their Sustainability.



On 24th July 2017 Prof René Amalberti, MD, PhD, Senior advisor to the French Patient Safety Accreditation Agency (HAS - Haute Autorité de Santé) and Chair of ISQua's Innovative System Change Working Group gave a webinar on massive population ageing and the major effect this has on health care.

London Conference

During the 2017 ISQua Conference, in London, delegates were invited to participate in an interactive session facilitated by Prof René Amalberti, Ms Wendy Nicklin and Prof Jeffrey Braithwaite. The workshop was divided into two exercises, the verbatim of which we have published below. 

The Innovations and System Change Working Group are currently working on their second paper which will focus on the need for revisiting the basic principles of quality and safety in health care in the face of ageing populations.


London Conference - PreConference - Exercise 1

Focusing on the impacts of massive ageing on the very nature of the health care system, and how we define and provide care to all citizens, whether they are already aged, or they are younger but will need a better care system as they age, cite potential transformations of quality of care and safety standards and methods developed over decades that could cascade from the effects of massive aging in the next twenty years.


We agree to shift care to the community because acute care is quite costly and we want to be sure that the patients take care of themselves outside of the hospital.

The second thing we are looking at is the way we fund healthcare, because right now it is mainly a fee-for-service, and to address a good funding model we have to make sure that it is based on a value-based payment; we saw very interesting models in the US like bundled care and also capitation. These models are probably good to fund patients for what they value most.

Another thing interesting at our table was the input from the private system, since it is quite different from what the government is looking at. They prefer care to be in the hospital for maintaining profits.

Bangladesh and South Asia
North America, Canada and US
Europe, Norway, Denmark, Netherlands
Japan, India, China, Hong Kong, South-Korea
Australia and New Zealand
South Europe, Spain, Greece

London Conference - PreConference - Exercise 2

Of the challenges listed below, choose the two top challenges that make sense as priorities for your region within the next decade. For these two challenges, develop:

  • What changes could be considered
  • How your region consider steps to definitively advance progress.
  • What initiatives are necessary to truly advance the agenda?
  • Who are the key drivers and partnerships that will accelerate change/transformation?
  • How do we accelerate change?
  • CHALLENGE 1 Adapting basic Q&S definition and concepts
  • CHALLENGE 2 Adapting Q&S principles for a ‘just-in-time’ logic in acute hospitals
  • CHALLENGE 3 Adapting Q&S principles to home care/aiding persons
  • CHALLENGE 4 Adapting Q&S principles to patients living alone
  • CHALLENGE 5 Adapting Q&S principles to the growing number of cognitive impairment
  • CHALLENGE 6 Adapting Q&S principles to the digital revolution
  • CHALLENGE 7 New governance: impact on leadership, measurement and accreditation
Bangladesh and South Asia

We have two priority choices, challenge 7 is our number one choice, and challenge 3 is our second choice. Why we chose the governance? Because the ageing population is not a local problem; it is a global problem and to address the issue, we need to address both global governance, and local governance. So, we think that it is not only the local government to reduce for example the use of tobacco, but there is also a link with the WTO, World Bank, IMF, these kinds of things. So then what is the impact on the local government or national government? If we consider the local government, this issue of ageing should be prioritised, defined and motivated by local and national governance, and in our vision, at least, we think that ageing is not a prioritised issue because the governments have other competing interests and have limited human and financial resources. We are not very interested in governance however we need to learn to replace this term with stewardship that includes leadership and regulations. Policy should come before regulation, and both regulations and policies should influence public and private sectors. All public and private sectors should come together because private sectors are in all health sectors since globalisation in the 1980s. We see that in both public-private, it is only in finance but not in regulations, so it is not working. So we propose that both the public and private should come together to make policies and to prioritise the issue of global ageing populations. The leadership became popular in Bangladesh in 1978 but it has big competition with the effect of globalisation, because primary care health care has 4 main principles; social equity, community participation, multi-sectoral approach and appropriate technology. This does not work very well because of competition in the private market – a consequence of privatisation and marketisation of health care and a rise in the age of the population. We think that the leadership should include all the components of the country, including the ministries, public sector, private sector, the market and also civil society. These components could come together and do something better, using a very life-based approach for this ageing community. Their voice should be heard, because at one time they did something very productive for society, but now they are aged and have a right to get a return from society.

If I go to the second challenge, marketisation is only interested in investments and returns and not in prevention. We propose that prevention should be addressed in terms of sustainable development and that because of industrialisation and urbanisation, development is not sustainable. This is because there are no biking parks, green spaces and playgrounds in our surroundings or in our urban areas. We think these should be integrated into our policies for prevention of diseases. People who are 20 or 30 years old will be 60 or so in 30 years’ time and will have a good environment for exercise and good knowledge and information about better health. So a sustainable policy should involve all sectors of the society and include community participation. In short, I would say that civil society should come forward and play a role; there is a big part to play for society.

Challenge 3 should be integrated in this policy. It is not possible to give efficient treatment in a hospital that is not working – somebody can go to the hospital and then invest his own money and may leave to sell his own property. What is the consequence of this? Because of this we propose that home-based care and community-based health workers, skilled health workers, should be improved and in place. This would reduce the harm in the society.

North America
Brazil/South Korea