Publication Date: March 20, 2017
Pierre M. Barker, MD, MBChB
Chief Global Partnerships and Programs Officer
Institute for Healthcare Improvement
Q: What was your path to becoming a doctor?
I grew up in Durban, South Africa, in a medical family; my father was a surgeon. So I had an idea from a very young age that I was going to be a doctor. Because of the way the South African education system works, I went to medical school (at the University of South Africa, in Cape Town) at 17, and I found myself a qualified doctor by the time I was 22 — incredibly exciting for me and maybe scary for my patients! I loved clinical medicine.
I was also motivated very early on to find ways to use my training to address injustices and inequities in my community. This was the Apartheid era, a time in South Africa when black people had to get a permit in order to be able to move into and work in one of the cities. Many people living in the city slums were undocumented; they didn’t have permits. And they had no medical services because they were too worried they would be picked up and arrested if they brought their children to the government-run health facilities. We knew this was a potential public health disaster: a whole population of unimmunized children.
So when I was in medical school, a friend and I developed a program to bring a mobile medical clinic out into these very poor neighborhoods and provide care. On Saturdays and Wednesday afternoons, with a doctor supervising us, we traveled to the shanty towns in a donated truck that university architecture students had re-configured for us as a mobile clinic.
It was a huge success. Parents felt safe bringing their children in, and we would provide basic primary care services – treating colds, earaches, and the like. During the visit, we would offer them immunization, with a supply of donated vaccines we had with us. So in a period of just a couple of years, we immunized 2,000 children. This experience opened my eyes to the huge impact a doctor could have in both public health and clinical medicine.
Q: What drew you to the US?
When I finished my medical training, I did a year of internship in South Africa. Then I had to leave the country — against my wishes — because I was called up to the army. I left South Africa the day before I was due to report [for military service]. I moved to London, where I did my pediatric training in general pediatrics and neonatology. I started following a research track, and I was particularly interested in lung development. My team was looking at how we make the transition at birth from being essentially a fish swimming in the womb to an air-breathing human. How do we make that switch? How do we start breathing air? We discovered what channels drain the lung at birth and how those channels are controlled by hormones during late pregnancy. This has a lot of relevance because premature babies are not able to breathe well.
That’s what brought me to the US. I entered a joint basic science and clinical pediatric program at the University of North Carolina, Chapel Hill (UNC), to continue pursuing this research, and did further clinical training in children’s lung diseases. Even in my global public health work today, I’m very interested in how we can increase chances of survival for premature newborns.
Q: How did you shift your focus to quality improvement and connect with IHI?
The change happened when I had been at UNC for about 12 years. I was deeply involved in my lab research, but at some point realized I missed clinical medicine, which had been my roots. Around this time, I happened to talk with a close friend heading off to Africa to launch some really interesting work in pediatrics at a population level. Hearing his story made me think, “I should be doing that.”
So those two things converged, convincing me to leave the laboratory and go back into full-time clinical practice and hospital administration. I became medical director at UNC’s Children’s Hospital clinics. Until this point, I had had no exposure to improvement science, but I soon joined a Collaborative led by NICHQ [National Institute for Children's Health Quality] on cystic fibrosis that became my introduction to IHI and improvement methodology.
I started learning more about the IHI world from another good friend, Peter Margolis, who’s now at Cincinnati Children’s. He told me I had to learn to use QI methods, as they were the key to improving processes of care at a large scale. During the Collaborative, I met [IHI Senior Fellow and Improvement Advisor] Lloyd Provost, who told me IHI was looking for someone to test the IHI methods in a low- and middle-income country; ideally, they wanted a physician to try this out in Africa.
That was all I needed. Within about 24 hours, I had secured the job. I applied for a sabbatical leave from the University of North Carolina and returned to South Africa for a year with my family. It was an amazing experience. I started applying improvement science to the HIV epidemic in South Africa, and very quickly I could see how powerful this methodology could be in an area with such staggering challenges. I got totally hooked. And things have taken off from there. In addition to its foundational programs in North America, IHI now has vibrant programs in Africa, Latin America, the Middle East/Asia Pacific, and Europe, each led by remarkable IHI regional leaders and teams I feel honored to guide.
Q: As IHI’s Chief Global Partnership and Programs Officer, what would you say are your three top goals for the coming year?
Two main things, internally. First, to continue IHI’s journey to becoming a truly global organization, in the way we think and act. So, going forward we’ll increasingly think of IHI’s global work as an integrated portfolio that includes North America and all the regions we work in. Second, I’m excited about our work to improve the efficiency and effectiveness of IHI’s operations: to streamline systems and processes so we can effectively integrate our geographic regions. This will help us to unify IHI teams around the world in executing on IHI’s strategy.
Externally, I’d like to see us continue with the phenomenal progress in our high-impact work with partners – we are working with our strategic partners in almost a dozen countries, as well as partnerships developed in large-scale work. I’d like to see us expand our very strategic work with governments around the world, and with the WHO [World Health Organization]. And we’re actively seeking new partnerships, in our commitment to expanding IHI’s reach and impact. I think we’re getting ready to do some extraordinary work over the next three years on all the continents.
Q: What keeps you up at night — major challenges you see ahead for IHI and for health and health care improvers?
The main thing that keeps me up is making sure we really are having an impact: connecting the work we do to the results we want to get. It’s always in the back of my mind. And it’s an ongoing process. We’ve gotten a lot more systematic about the way we design, evaluate, and track programs. We train everybody on a team to look critically at their work and make course corrections, as needed. It’s crucial to make sure results are front and center, because when we can really show we are having an impact it validates everything we do.
Q: What projects are you most excited about?
I would highlight two or three. One is the work in Brazil on decreasing caesarian sections. It’s a country with one of the highest C-section rates in the world, so there’s tremendous opportunity to make a difference. This is a mixed private- and public-sector project, going really well so far and gaining widespread recognition. This work in now on the launching pad for national scale-up.
I’d also highlight the work we’re doing in Ethiopia, spearheaded by Sodzi Sodzi-Tettey and Hema Magge. It’s our biggest, most ambitious program in Africa, in the second-largest country on the continent. Working from an IHI office in Addis Ababa, this team is really trying to change the results of maternal and newborn outcomes in Ethiopia. They’re also training a whole generation of Ethiopian ministry staff to carry on this work and scale it up. The IHI team is working very closely with the Ethiopian government, and IHI has already had a strong influence on government thinking, planning, and policy because we worked with them on developing a national quality strategy before this project was launched.
The other big project I’m really excited about is our work with the World Health Organization. We’re helping to launch a program we developed with the WHO’s maternal and child health team during a period of months in 2014 when I was seconded by IHI to the WHO in Geneva. The program will help countries implement new WHO standards of care for mothers and newborns. What’s particularly exciting for me is that this is the first time the WHO has been involved in guiding countries on implementation. Historically, the organization’s expertise has been in directing the technical content of health initiatives. Now, using improvement science methods, they are guiding countries on the next step, which is how to implement maternal and newborn Quality of Care standards.
This new program is bringing together the top maternal and child health teams from nine low- and middle-income countries — seven African countries, India, and Bangladesh. They’ll work together in a multi-year learning community focused on implementation, which began with a highly successful, three-day face-to-face meeting in Malawi in February that launched the plan.
Q: Are there themes you’d point to throughout your career?
The main thing is that I feel incredibly privileged to have had this extraordinary, varied career. I’ve had the opportunity to cover the full range of endeavors available to a physician. I’ve worked with molecules, I’ve worked on the physiology of how the body operates, and I’ve taken clinical care of individual children. And now, with IHI, I can work on large systems of care and health that can affect the lives of thousands, if not millions, of people. So I just feel very lucky.