Feb 6, 2017

Building bridges at ISQua 2016 in Tokyo

Rainbow Bridge, Tokyo
“The older I get, the more clearly I remember things that never happened.”
 Mark Twain

I try and distill my three main action items after conferences as soon as I get back home, so that I can commit them to memory, or at least to paper. This report on The International Society for Quality in Health Care (ISQua) 2016 conference, as you can see, took a little longer to write! I would like to think that it was because I was still basking in the warmth of Japanese hospitality, or was busy networking with all the fabulous people I met at ISQua for months afterwards.

Why memorialize just three things, given that I learnt tons of new information over a span of 5 days at ISQua Tokyo? The rule of three says that messages or action items in threes are more likely to be remembered. Examples that come to mind are the Three Musketeers, Goldilocks and the Three Bears, Three Little Pigs, and Three Billy Goats Gruff. Messages such as Stop, Drop and Roll (fire safety), and Faster, Higher, Stronger (the Olympic motto) follow the same principle.

So here are my three action items from the 2016 ISQua conference - better late than never…

(1) Check out Charles Vincent and RenĂ© Amalberti’s open access book. ‘Safer Healthcare - Strategies for the Real World’.
The book refocuses our attention on patient safety from the lens of the patient's environment - instead of focusing solely on healthcare professionals and hospitals. The authors urge us to think in terms of the management of risk over time over the course of the patient’s journey. This includes contexts other than the inpatient setting – outpatient care, nursing homes, the home environment, and the patient’s community. As a primary care pediatrician, I especially appreciated the book's attention to risks in outpatient settings, an area that has relatively recently been attended to in the world of patient safety. 

(2) Involve health professions students and trainees in reducing overuse of medical care.
Wendy Levinson, Chair of Choosing Wisely Canada, spoke about involving medical students in reducing overuse. Too much health care is harmful to patients and the healthcare system. More is not always better. So why is it so hard to change clinical practice? It starts with medical education. A fundamental problem with the culture of medical education is that trainee doctors are rarely challenged for over-ordering tests and are more likely to be criticized for not ordering them. About 20 countries so far are involved in the Choosing Wisely campaign. Dr. Levinson urged us to encourage students and trainees to question overuse and to have them consider if a test, treatment or procedure will change the patient’s clinical course and if there are less invasive options. Dr. Levinson’s session ended with this video parody of Pharell Williams' song, Happy.

(3) Discuss supplier-driven variation when I talk to clinicians about the problem of healthcare costs.
David Goodman’s plenary talk on variation covered supply-sensitive care. This is when the supply of a service or resource has a major influence on utilization. Dr. Goodman showed us how variation in care is frequently due to differences in local capacity. In areas where there are more hospital beds per capita, patients are more likely to be admitted to the hospital. In areas where more CT scanners are available, patients are likely to receive more CT scans. Even though patients may receive less numbers of procedures or tests in areas where there are fewer medical resources, there is no evidence to show that these patients live shorter or less healthy lives compared to patients in higher-spending higher-utilizing areas! This is further compounded by perverse payment incentives that ensure that capacity is maximized.

Improvement Science Panel
With 1200 attendees representing 60 countries, ISQua 2016 allowed me to make new friends and catch up with old ones. The panel on Improvement Science that I facilitated was international and diverse, with quality and safety researchers from six countries. I also led a seminar with experts from Australia, Ireland and Japan on designing education to change quality outcomes.

Between sessions I found some time to enjoy the amazing food and culture of Japan, and even bought a kimono! Arigato gozaimasu ISQua and Tokyo for an amazing and memorable learning and cultural experience.

- Ulfat Shaikh