M. Rashad Massoud, MD
Senior Vice President
Institute for Healthcare Improvement
"There is so much that is independent of my actions as a physician...and that got me interested in health systems." (1:24)
I’m Rashad Massoud. I work at IHI. I am a physician by background and I work on improving health care. If I look back, I probably would have never imagined myself doing what I am doing now. Growing up as a child I always saw myself as a physician. I was particularly interested in being a family physician. As a practicing physician later on, I realized how tied up my hands were. I realized that there is so much that is independent of my actions as a physician that affected what I was trying to do, and that got me interested in health systems. In my MPH program I met Don Berwick and I was his student, I took his class, and from then onwards it just changed everything that I did. At the time I was working as a medical officer with the United Nations Relief and Works Agency. I was responsible for two health centers which catered to two communities, different communities. And I started to use improvement methods in my work. Very soon the effects were visible and I was being asked about them, and one thing led to the other. Within a year of doing that, I was asked if I would set up a national program for the emerging health authority in Palestine, which I did.
"When asked if I would do this on a national scale the first response that I had was, 'You know I haven’t done that.' And the person with whom I was speaking said, 'I was never a minister of health before.'" (1:39)
I’m Palestinian. I was born in Nablus and I grew up in Palestine. A body called the Palestine Council for Health was created to inherit the health authority from the Israelis and I joined the Palestine Council for Health and my agreement there was to set up the quality improvement national program. When I was asked if I would do this on a national scale the first response that I had was, “You know I haven’t done that.” And the person with whom I was speaking said, “Well, I was never a minister of health before. I’m about to learn how to become one; you can join me if you want.”
It was extremely challenging, and it was extremely rewarding at the same time because the amount of improvement that happened was phenomenal. For example, improving the use of prophylactic antibiotics in surgery. I remember we quantified the economic effect of that and we found a 92 percent savings and that is just drugs and supplies. There were waiting times reduced from like four hours to 10, 15 minutes in several places. There were improvements in diabetic care and hypertension care and working with jaundiced neonates, infection control. There were improvements in many areas. I had to leave due to an unfortunate set of circumstances, but luckily my colleagues who are there have continued to make improvements. I’m still in touch with them. They are doing great work. It’s just rewarding to see that it continues and that it’s going so well.
"Today I can say with a lot of confidence that actually improvement methods work far better in developing country contexts." (1:18)
Twelve years ago when I started doing this work I heard every comment that one could possibly hear from, you know, we don’t have quantity, or talking about quality that this is great for the US, great for Japan, this could not possibly be used in countries where we don’t even have the basic minimum. We don’t have standards in place; things are so chaotic, you know, every single comment of that nature. Today I can say with a lot of confidence that actually improvement methods work far better in developing country contexts because, one, we are talking about applying evidence-based practices in places where evidence is not necessarily being used. Second, we are streamlining and improving care processes, sometimes we are even designing the care processes and that goes a long way just by studying what we are doing and introducing changes to them we can make a lot of progress. The third is, in places where things are not quite well organized, what happens is that a lot of times there is waste, and the amount of waste is incredible. We’ve had cost savings that we never thought we would have in resource constrained settings.
"I think there is something about the work that we do that is extremely stimulating." (1:21)
I remember when I first graduated, I was doing my internship as a physician, a lot of people said to me, “Oh, you’re so enthusiastic because you’re new.” Later on, I remember many years later, “Oh, you’re so enthusiastic because you’re young.” I don’t know about that! Later on in improvement I was hearing the same thing. I don’t think that’s stopped. I think there is something about the work that we do that is extremely stimulating. To have so much effect and to see that effect initially on a patient-by-patient basis, but now we are seeing it on run charts and we see what is happening. Every time I remember that in Tver Oblast alone we reduced early neonatal mortality from 10.3 per thousand to 4.2 per thousand in a matter of a few years, that’s amazing! I could have practiced a couple of lifetimes and not gotten anything like this. To know that one can have so much effect in so little time. Along the way so much has also happened in terms of people and relationships with them and improvements in various places. It just keeps me going and going.
11/29/2005
