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Edinburgh 2013

ISQua 2013 - Edinburgh Recorded Sessions

This year's conference was our first live streamed conference.  Our Plenary sessions and a selection of our invited sessions were live streamed around the world to those of you who were unable to attend the conference.  If you missed the conference or streamed sessions or you just want to view your favorites again please see the recordings below.

'Hospital on Trial' 

Come and decide whether your healthcare colleagues are guilty or not guilty!

In a time of unprecedented pressure within the health system on safety and quality, this session brings to life a court room 'drama' hosted by lawyers and with real medical professionals giving evidence, based around an all too common medication error.  The session delivers a genuine court room experience to highlight how such errors can be perceived outside the hospital environment, with strong messaging around consequence, set within an entertaining scene.

The session was run by DAC Beachcroft LLP, a leading international law firm providing advice within the public and independent health and social care sector since the inception of the NHS, now pre-eminent in both strategic and operational advice in an evolving health system.  Witnesses giving evidence are leading professionals at Guy's and St Thomas' NHS Foundation Trust.

This session was one of the most well received ever hosted at an ISQua Conference.

Mechanisms of Improvement with Atul Gawande

Atul Gawande is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital in Boston, and is Director of Ariadne Labs, a joint center for health systems innovation. He is Professor in the Department of Health Policy and Management at the Harvard School of Public Health and Professor of Surgery at Harvard Medical School. And he is also co-founder and chairman of Lifebox, an international not-for-profit implementing systems and technologies to reduce surgical deaths globally.

He has been a staff writer for the New Yorker magazine since 1998. He has written three bestselling books: Complications, which was a finalist for the National Book Award in 2002 and Better, which was selected as one of the ten best books of 2007 by Amazon.com; and The Checklist Manifesto.

He has won two National Magazine Awards, Academy Health’s Impact Award for highest research impact on health care, a MacArthur Fellowship, and he has been named one of the world’s hundred most influential thinkers by Foreign Policy and TIME.

Scotland's Approach to Safety and Quality with Jason Leitch

Jason Leitch has worked for the Scottish Government since 2007 and is now the Clinical Director of the Quality Unit  in the Health and Social Care Directorate. He is a member of the Health and Social Care Management Board and one of the senior team responsible for implementation of the NHS Scotland Quality Strategy.

In May 2011 the NHS Scotland Quality Strategy was published and set three large-scale ambitions in safe, effective and person-centred healthcare. This ambition is demonstrated best in the Scottish Patient Safety Programme which has led the way globally in the field of large scale patient safety initiatives. More recently the same improvement methods have been extended into more complex areas such as the crucial early years of children's lives.

This plenary presentation demonstrates Scotland's globally recognised ambition to deliver high quality, people centred and assets based public services. It shows real examples with real data and discusses the lessons learned including the mistakes made along the way.

Clinical Management Systems with Dr NT Cheung (Hong Kong) and Big Data Approach with Dr Jack Li (Taiwan)

The ability of electronic medical record systems to improve the quality of care delivery has been demonstrated repeatedly for many years.  However there is also a widespread notion that electronic medical record systems (EMRs) are highly disruptive to workflow, and will reduce clinical efficiency.  

ISQua's Tuesday Plenary Speakers show how the consideration of the impact of an EMR on workflow is key and the numerous key projects developed to ensure this.

Dr NT Cheung (Hong Kong) presents on this in 'Quality and Efficiency - Improving both with the workflow enabled Hong Kong wide Clinical Management System'

Dr Jack Li (Taiwan) presents on 'Big Data Approach to Improve Quality and Patient Safety (QPS).

It is simply murder: How do we communicate and improve the value of the quality movement? with Robert Brook

About 130 years ago, the new president of the United States was shot. However the physicians who took care of him murdered him by exploring his wounds with dirty instruments and fingers even though 16 years earlier Lister had discussed his new methods of antisepsis in front of exactly these same American doctors.

This year the New York Times reported that 30 per cent of physicians are washing their hands, and hospitals are investing in video monitors, id chips and prizes to increase this number.

We know that when patients visit a physician they get half of what they need, and perhaps 30 per cent of what they get they do not need. Whether a new drug or procedure works is probably as much dependent on the quality of how it is used as on the basic advances made in the laboratory that produced it. This plenary talk will explore what we can or should do to increase the likelihood that our health systems will provide humane, effective, excellent care.

Hello Healthcare: Uniting healthcare professionals to sending out an open invitation to patients with Beth Lilja

It is well known, that when patients and families are being invited, by the physicians and nurses at the ward, to actively engage in patient safety and care decisions, they are more likely to do so. But quite often, and for many different reasons, patients are trucked by “white Coat silence”– leaving us reluctant to vocalize our concerns, knowledge and questions to the staff.

The consequences are real and fateful: Important and vital choices about care and treatment, are silently approved by the patient with a quiet “yes”. Beth Lilja from the Danish Society for Patient Safety will present a new solution to this problem: Bringing and boosting the invitation to dialogue from the enclosed wards at the hospitals to the streets and the public sphere.

Can we unite healthcare professionals to sending out an open public invitation to patients and families – thereby creating and sharing a new norm and understanding of what you can do and expect as a patient?

Uncharted Territory: Quality in Treating Complex Patients: Bridgepoint's Transformative Solutions with Marian Walsh

Bridgepoint has been leading a transformation in the way that complex patients are treated within the healthcare system in order to intervene earlier in their life course and prevent acute episodes. Hear from Bridgepoint’s President & CEO about the discovery that led to this strategic focus upon complexity and the construction of a $1.2B new facility to provide care for complex patients.

Marian Walsh is the President and CEO of Bridgepoint Health. Under Marian’s leadership, Bridgepoint has established a bold vision for the future “to be Canada’s leader in complex care and complex rehabilitation - the new frontier of healthcare.” She recognizes that the future of health care lies not just in saving lives, but in optimizing the lives of those who are living with complex chronic disease. Marian is a strong advocate for major system transformation because she believes that the current health care system, which is organized to deliver acute, episodic care, no longer meets the needs of the majority of its users, who have complex chronic conditions.

Social Circumstances and Health

Harry Burns graduated in medicine from Glasgow University in 1974. He trained in surgery in Glasgow and developed a research interest in the metabolic consequences of illness and injury. He became a Consultant Surgeon and Senior Lecturer in Surgery in the University Department of Surgery at the Royal Infirmary in Glasgow in 1984. Working with patients in the east end of Glasgow gave him an insight into the complex inter-relationships between socio-economic status and illness. He completed a Masters Degree in Public Health in 1990 and shortly afterwards was appointed Medical Director of The Royal Infirmary.

In 1994, he became Director of Public Health for Greater Glasgow Health Board, a position he occupied until 2005. During his time with Greater Glasgow Health Board he continued research into the problems of social determinants of health but also worked on measurement of outcomes in a variety of clinical conditions, including cancer. In 1998, he took a part-time appointment with the Health Department in the Scottish Government and worked for three years as lead clinician in Scotland for cancer care. In the course of this work he developed Managed Cancer Networks and helped re-organise cancer services in Scotland.

In 2005, he became Chief Medical Officer for Scotland where his responsibilities include aspects of public health policy and health protection.

This presentation also includes 'The molecular biology of a cuddle'!

Scotland's approach to e-health including telehealth and telecare
Speaker: George Crooks

This presentation will challenge the status quo and suggest we need to radically rethink how we reconfigure and deliver future health services. It will look at the role that technology has played to date and what role it may play in the future. The presentation will explore the different digital channels available to deliver health services and the platforms available to serve the needs of patients, their family as well as informal and formal carers. It will give insight to Scotland’s strategy for telehealth and telecare deliver and focus on the increasing importance of co-production in health and care settings. It will showcase the findings from a national community engagement exercise on the public’s attitude and expectation on the use of technology, supporting their care and give a glimpse of what the future landscape may look like in Scotland.

Improving Quality in Nations: The Role, Responsibilities and Contributions of Government
Speakers: Sheila Leatherman; ISQua, Enrique Ruelas; MX; Carol Ann Marshall; SA, Sodzi Sodzi-Tettey; GH

 The aims of this were:

  1. To describe the potential role of government in making changes to the macro environment to foster quality.
  2. To discuss the mechanisms that government can use to influence health care quality such as legislation, regulation, standards, external evaluation/accreditation, payment reform, performance data and public reporting, influencing workforce, national campaigns, etc.
  3. To present case studies from 3 countries – Mexico, South Africa, Afghanistan – which demonstrates systemic national approaches to health care quality?

CareTrack Australia: the levels of appropriate care in Australia and the international implications
Speakers: Jeffrey Braithwaite & Bill Runciman; AU

The CareTrack Australia study was designed to determine the percentage of healthcare encounters at which a representative sample of adult Australians received “appropriate care” (care in line with evidence-or consensus-based guidelines) following the RAND-UCLA study in the USA ten years earlier. Participants in our sample received appropriate care in 57% of 35,573 eligible encounters compared with the US ten years earlier. Participants in our sample received appropriate care in 57% of 35,573 eligible encounters compared with the US at 55%. We found high compliance for some conditions such as the management of coronary artery disease (90%) and dyspepsia (78%), and poor compliance for the use of recommended risk assessment tools (1%) and inadequate responses to severe or deteriorating conditions (between 5-40%). At health care provider level, compliance ranged from 32-84%. We cannot rule out that it is a current property of modern health systems that only half the care delivered is appropriate. We will discuss the study, consider the international implications, and propose some initial steps for addressing this situation. 

Debate: "Within health care and social care, accreditation leads to safter patient care and improved outcomes"
Session Moderator: Edward Kelley; WHO, Speakers: Wendy Nicklin; CA, Mark Brandon; AU, Sodzi Sodzi-Tettey; GH, Sir John Oldham; UK

Objective: This session examined how health-care accreditation facilitates health-care and social-care professionals in providing safer care to patients. The purpose is to explore ideas, issues and some self-reflection on how health-care accreditation contributes to the patient safety and quality agenda and how it works in real life day-to-day patient care, and to do so in a format that will encourage active exchange from some of the world’s leaders in this topic.

Concept: Accreditation, which has been widely used for health-care quality improvements, is well established as one of the strategies for good safety practices and ensuring quality of health care. Hospitals around the world use the accreditation efforts. While there can be a variation in levels of quality, it is expected that all health-care facilities meet the minimum acceptable standard that is sufficiently good and safe for patients. However, accreditation efforts are not the only tool available to policy-makers to ensure quality of health care. Moreover, in recent years, accreditation programmes have been under the spotlight based on the cost of training and verification efforts and some research highlighting lack of relationship between accreditation status and better clinical outcomes. How can policymakers and practitioners get accreditation requirements “right”? How do countries ensure that the rules are clear, practical, actionable and compliance observable at all levels of care? Indeed, should accreditation be the focus of the global patient safety community to drive patient safety improvement? This session will attempt to address these issues in a debate format that will explore “touchy” questions while elucidating some ways forward for accreditation programmes globally. 

WHO: Leaders Guide to Patient Safety and Quality of Care
Speakers: Bruce Barraclough; AU, Agnes Leotsakos; WHO

The importance of leadership in safety and quality improvement has received increasing recognition. Healthcare leaders are in a unique position to influence and inspire individual and organisational commitment to create a positive organisational culture and implement organisation-wide safe practices. Leadership commitment is also fundamental to achieving the sustained delivery of safe and quality health services. Despite increased awareness, existing evidence suggests that resources directed towards developing and strengthening capacity of health-care leaders, which will help facilitate the adoption and implementation of patient safety concepts and practices on an organisational level. In this session, WHO will share progress towards the development of its new Leaders Guide to Patient Safety and Quality of Care which targets hospitals CEO’s, directors, managers and senior administrators and policy-makers from ministries of health and health-care institutions, associations and educators teaching this subject.

Quality and Safety in Public Health
Speakers: Carol Tannahill, Phil Hanlon; SC

Carol outlined the history of Scotland’s health in a European Context over recent decades. The key point will be the relatively poor position of Scotland. This invited the question ‘why’ and Carol described a public health analytical framework for this problem and began to suggest some of the complex reasons which might explain Scotland’s position. Phil then explored the applicability of concepts like ‘quality’ and ‘safety’ to this complex set of population health problems. Carol will then outline the possible and actual public health responses in Scotland to is poor health – again she will emphasise the complex and multi layered nature of the public health response. Phil then lead an interactive discussion about ‘prognosis’- what can we expect as we move forward. A key question is the degree to which ideas being explored at the conference may or may not contribute to these public health challenges.

Publishing your paper: a special session
Speakers: Eric Schneider, Arnold Epstein; US

Drs. Schneider and Epstein “open the black box” for a look inside the editorial process of two peer reviewed journals – a specialty journal focused on healthcare quality and one of the world’s top general medical journals. They will describe successful approaches to writing and publishing a research paper and lead an interactive discussion. They will discuss the types of papers that each Journal seeks to publish and strategies for successfully navigating the peer review process. They will offer tips for peer reviewers to make reviewing easier and more effective.