Publication Date: November 20, 2015

Azhar Ali, BSc(Hons), MBChB, MRCGP(UK), MBA
Executive Director, Middle East and Asia-Pacific
Institute for Healthcare Improvement

Q:  How did you become interested in medicine?

I remember, in the American equivalent of about the 10th grade, telling my guidance counselor, who was also my chemistry teacher, that I wanted to study medicine. At the same time, I was drawn to medicine for personal reasons: I’m a Muslim, and I identify strongly with my religion. Very early in my life, I heard a quote from the Holy Qur’an that really stuck in my mind. It essentially says, “Whoever saves one life it is as if he has saved the entire life of mankind.” This has been a powerful motivation in my career and life.

Q: How did you become interested in quality improvement (QI) and leadership?

After I got my medical degree at the University of Glasgow in 1997, I wasn’t sure what specialty to pursue after my internship year, so I decided to take a year off. I left Glasgow, Scotland — my childhood home and where my family still lives — and went to London, England, for a series of clinical positions. Simultaneously, I started exploring further training in management so I could approach my work from a systems-level perspective, with the aim of magnifying the effect of saving lives.

I knew I wanted to continue my clinical work while also pursuing these broader aspects of health care, so I went back to Scotland for a residency program in general practice/family medicine. When I finished my clinical training, I went on to get my MBA part time, while still doing clinical work at a practice in Lanarkshire, just outside Glasgow. In time, I took on a partnership — essentially becoming part owner of the practice. Within about five years, my role evolved to a level of half-time clinical practice and half-time medical management within the Lanarkshire area.

Q: How did your path lead to managing primary care for 50 clinics in Abu Dhabi?

An opportunity came up out of the blue. I had given a talk at a conference in 2008 in Abu Dhabi, United Arab Emirates, where I made connections with other participants, including the CEO of the Abu Dhabi government’s primary health care system. Several months after the conference, the CEO contacted me to ask if I’d be interested in the role of Medical Care Director for Abu Dhabi’s primary care system, which had about 50 clinics. After exploring the opportunity and going through a lengthy recruitment process, I accepted the position. It was exciting from a career standpoint, and the idea of spending time with my young family in a Muslim country was appealing.

We moved to Abu Dhabi in 2009. Not long after, the health system’s quality manager left, and I took on that role as well because of my experience in the United Kingdom. It was a great opportunity because the organization was fairly new and still developing. There was a lot of enthusiasm around improvement potential and a recognition of the need: We weren’t measuring clinical outcomes — for example, how we were doing in diabetes management.

There was a lot to do across the organization, and our work paid off.  We implemented a system-wide electronic health record, expanded our services, and became financially self-sufficient. In 2012, our clinic system became the first network outside the United States to achieve Joint Commission International Accreditation (JCIA).

 Azhar Ali at Sheikh Zayed Grand Mosque in Abu Dhabi

Q:  What brought you from Abu Dhabi to IHI in Cambridge, Massachusetts?

I had known of IHI for a long time. I was still in Scotland when the Scottish Patient Safety Programme, a partnership between the Scottish government and IHI, was gaining momentum and making great progress. I also had several Scottish colleagues who were former Health Foundation-IHI Fellows, including Jason Leitch [Clinical Director, Quality Unit, Scottish Government Health Department and 2005–2006 Fellow].

Then in 2013, I got an email from Pedro Delgado [IHI Executive Director], introducing me to Kedar Mate [IHI Senior Vice President], who wanted to talk about potential work we could do together in Abu Dhabi. Ultimately, we did initiate some work with IHI which included IHI assessing our health system and helping us identify opportunities for improvement. That was my first experience working directly with IHI.

Later, when IHI was looking for someone to manage the growing work in the Middle East and Asia-Pacific regions, Pierre Barker [IHI Senior Vice President] approached me about the position. The more I thought about the opportunity, the more positive I felt. It seemed to offer a great combination of work, with a focus on health care and QI and the chance to explore new countries and cultures. I realized it was an ideal step for me, so my family and I decided to come to the US.

Q: What are you working on as IHI’s Executive Director for the Middle East and Asia-Pacific?

IHI is relatively new at working in these regions, but Kedar and his team have made great connections in the Middle East and Asia-Pacific. I see my job as building on that success through sharp focus on helping our current partner organizations to deliver results toward their improvement goals. We’ve got lots of exciting work underway.

In Qatar, we’re working closely with Hamad Medical Corporation, an IHI Strategic Partner, on multiple projects in safety and quality. In Singapore, IHI is supporting organizations that are part of SHINe, the Singapore Healthcare Improvement Network, as they implement and navigate improvement work initially focused on safety. In India, we’ve got large projects in maternal and infant health (ACCESS Health International and CARE India) that offer IHI the chance to have a significant impact on families and communities.

In addition to working on these and other projects, I also hope to contribute to IHI’s long-term vision for growth in the Middle East and Asia-Pacific. As an organization, we’re still learning.

Q: What are some challenges you see ahead?

I think our greatest challenge is learning how to expand globally, given IHI’s size and limited resources. It’s always a case of understanding our opportunities and finding the right strategy to grow effectively — through partnerships, networks, and other approaches. How do we move into China, for example?

The whole concept of working in new countries and regions that are vastly different from each other and from the places in which we’ve worked previously presents an exciting challenge. Another hurdle is simply geography, or the sheer distance between programs we’re joining and new partners we’re engaging.

For example, even defining my own area of work is a difficult. To say “the Middle East and Asia-Pacific region” isn’t accurate. It’s not one discrete region, but a massive area with multiple regions. And even within individual regions, you have so much diversity: both low-resource, low-income countries and high-income countries, which are some of the wealthiest in the world. There’s so much variability, around which we have to adapt and accommodate. It’s quite a challenge.

Q: How can IHI overcome the challenges of global expansion?

Our approach, I believe, has to be breaking things down, so that teams can focus on individual challenges more or less one at a time, and then crafting unique strategies for each area. We also have to be smart about learning from other groups and initiatives across IHI and applying knowledge from past successes to related challenges.

IHI’s Africa team, for example, has important lessons others can leverage. That team has mastered the skill of developing local expertise — designing ways to effectively train local providers and communities so they can develop sustainable improvement capability. That’s fundamental to IHI’s strategy.

Time, distance, and travel demands will always be challenging, and IHI may always be a small organization. But we have respect internationally and great potential, based on decades of experience and boundless energy and ambition. I’m very hopeful.

Q: How are you adjusting to life in the US and your work at IHI?

It’s been a great move. To be honest, I had never thought about moving to the US; I had only visited twice, in brief trips to Chicago, Illinois, with The Joint Commission. Before I accepted the IHI position, there were several factors to consider, starting with all the travel involved. I knew it would be a challenge for my family, but I actually enjoy it. Touring new parts of the world to support health has been a theme in my life. In my work and personally, I’ve visited more than 20 countries (and counting!) across the world. In 2005, after a massive earthquake in Kashmir, Pakistan, in which 75,000 people died, I went there to do relief work, managing a field hospital — a series of tents built on rubble. It was a harrowing and humbling, yet satisfying experience.

There’s a saying, “Get a job you love, and you won’t work another day in your life.” I feel that already at IHI. We have the same mission, to improve health and health care worldwide. My work at IHI honors my personal values and the message from the Holy Qur’an that led me to medicine in the first place — saving one life is as if you’ve saved the life of all mankind. Having the teams behind me at IHI and the tools and strategies of QI in hand make it really easy for me to know this is where I want to be.