A few weeks ago, I was lucky enough to have the wonderful opportunity to attend the Asia Pacific Forum on Quality Improvement in Health Care Conference. More than 900 delegates from 16 countries were present, with guest speakers from America, the United Kingdom, and Singapore.
It was truly a fantastic experience.
Quality improvement is about the improvement of patient care; the improvement of better diagnostics and procedures; the improvement of proper workplace processes and systems; the improvement of developing people and future leaders; and the improvement of cost savings.
Maureen Bisognano, the President and CEO of IHI, encouraged us to write down five take-home messages throughout the conference that we thought were most significant to us. Here is what I wrote for those five things:
- What matters to you?
A lot of the time, we practice ‘What’s the matter?’ medicine. The patient’s got hypertension, diabetes, or decreased mobility, and what matters to us is that we fix him or her up. What if we asked the patient, "What matters to you?" The busy mother of three who works shifts to put food on the table, the lady whose relatives died from side effects of medicines, the man who wants to be able to go the gym again. The patient’s priorities are often unknown to us, yet they are the missing pieces of the puzzle which we can use to impact the patient’s health.
- Don't be afraid of failure
The biggest catastrophe that can come from failure is failure to learn from it — failing to see what went wrong, where it went wrong, how to prevent it from happening next time, and NOT sharing that information. Much like the quote “One person’s rubbish is another person’s treasure,” the same can be said about failures. They illuminate the paths to avoid and the otherwise hidden traps, saving time, effort, and money the next time someone wants to do a similar project. There are places where failures are actually celebrated, recognized, and appreciated. Failures are important.
- Culture at Counties Manukau District Health Board
Culture is the background foundation, the background atmosphere, which we do not see, touch, or feel. Culture tremendously influences our work, our attitudes, and values. The culture at Middlemore is one of innovation, improvement, challenge, and change. We are all extremely lucky and privileged to be working in such an environment, where research opportunities are abundant and innovations are encouraged.
- Quality leads to cost savings
Often, we associate higher quality with higher costs — whether it’s for material goods or high quality services. Studies and real life situations have shown it is the contrary. By implementing good quality processes, diagnostics, treatment, and performance, costs can be lowered and patient outcomes can be dramatically improved. Sure, occasionally there may be an initial spike in costs, but over the long term, quality pays for itself, many times over. The return on investment for quality is huge. A great quote from Muir Gray: “Waste is not just what is already in the bucket; it’s what we can get more value from if you invest it somewhere else.”
- It's all about the patients
Like the clinical work in which we all participate and practice, the reasons behind quality improvement are all about the patients. The stakeholders are not the district health board’s financial officer, the government’s clear cut budget, or the pretty numbers which appear in the books. The stakeholders are the PATIENTS. That's the only reason we are here. If we overspend on inadequate, inappropriate under- or overtreatment for a patient, there are a multitude of consequences. The patient’s health deteriorates. The patient gets readmitted, uses the hospital’s resources, the hospital bed, the doctor’s time, and our time. This not only affects the patient, but also impacts all the other patients for whom the resources, the hospital beds, COULD have been used. It’s the other patients that end up paying, the other patients that end up suffering.
On that note, I would like to share a quote by Albert Einstein: "Insanity is doing the same thing over and over again and expecting a different result."
It is our DUTY to improve systems by saying what we see, and sharing what we learn.
- Tony Wang, Intern Pharmacist, Counties Manukau Health, Auckland