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By ISQua Tuesday. Nov 27, 2018

Closing Remarks on ISQua's 35th International Conference, Kuala Lumpur, Malaysia

The following are the ISQua 2018 Conference Closing Remarks provided by President Wendy Nicklin. 



For those who attended and for those unable to attend, this speech provides an overview of some of the messages delivered during the 3 days of plenary sessions.


Monday morning began with the cultural performance – the amazing Malaysian dance performed for us with dancers in beautiful dress carefully chosen to represent different states, cultures and races.  They performed with precision movements and stimulating music.  It was spectacular and the tone of the conference was beautifully set.


This was followed by the first key note address titled Patient-Reported Outcome Measurement:  Past, Present and Future – A personal Account by our winner of the HAL lifetime achievement award, Madeleine King.  Madeline clarified the terminology, PROs vs PROMs, and helped us to understand the momentum for PROMs – noting that the patient’s voice is central to patient-centred care, the patient is the best informant of sensations, feelings and function; standardized self-report can be done validly and reliably; and PROMs complement clinical measures.  She outlined the historical context beginning with the 1980’s and spoke about the emergence of Quality of Life research and the challenges being addressed.


Please listen closely to the messages –  the messages of challenges faced and directions to be considered are relevant to every country, regardless of our stages of development.   Many countries wrestle with the same issues.


We were honoured by the arrival and presentation of His Royal Highness the Sultan Nazrin Shah. He spoke about the increasing attention being given to the emotional dimensions of health and healthcare, the growing emphasis on mental health, and advances in neuro-biology.  He spoke about ‘science fiction turning into science fact’. He spoke about technological advances, genetic mapping, robotics, connected devices and wearables, and nano-technology.  Technological advances along with the concurrent growing awareness of the importance of patient engagement and self-management was mentioned.  He concluded by saying “So while we must invest in Artificial Intelligence, in devices, and in the other cutting-edge technologies that are transforming the sector, at the same time, we must not neglect the human elements of healthcare, and must continually strive to build our capacities in this area as well.   There will always be a role for so-called ‘human medics’ to deliver this all-important human touch.”   At this point the conference was declared officially open. 


Monday concluded with a plenary panel session titled Alma-Ata at 40:  Quality & Primary Health Care – Challenges, Opportunities and Urgency.  Given the upcoming 40th anniversary of the Alma Ata, Shams of WHO summarized the evolution of Primary Health Care, noting that UHC is grounded in quality primary health care.  Odet Sarabia spoke to us about the Mexican health system and their pressures, including the challenge of the fragmented system.  Their goal is to achieve a unique health system with Univeral Health Coverage grounded in quality primary care.  Andrew Likaki of Malawi noted challenges that included lack of transparency and accountability for poor quality, with political will tailored to improving access rather than quality.  “Quality has been silent for the last 40 years”.  He pointed out that quality of care is different from quality of medical education and suggested that the actions required included adopting NQP&S, that local communities should provide a local definition of quality, and to “stop pilots and projects.  Evaluate what works and what doesn’t, and scale up.”


Cliff Hughes rounded out this panel session noting that we need a vision – that sometimes we look too closely.  He spoke about the lessons learned from Florence Nightingale and concluded that a new order means new values.


The Tuesday morning Plenary began with Sandra Jayacodi of the UK, speaking about Quality Improvement and My Recovery – A road Less Well Travelled?   This powerful presentation about living and growing with mental illness was presented in Chapters:  1 – Happiness, 2 – A Road less Traveled, 3 – The Gap, 4 – Why it matters, 5 – The Mask, 6 – Domino effect, 7 – Wash my brain, 8 – Hope, 9 – Patient – Public involvement, 10 – The Learning, 11 – The Opportunities, Final Chapter – Take home Message – Help Us.  She concluded says “It is nothing to be ashamed of, share what has been learned, involve us in quality improvement, get us involved, appreciation keeps us motivated”.


The Malaysia healthcare transformation experience was outlined for us by the Director General of Health.  He noted that although Universal Health Coverage is available in Malaysia, they must focus on quality.  While population health outcomes are improving, there are increases in some of the non-communicable diseases.  It was noted that artificial intelligence is 6 times more accurate than radiologists.  He spoke about the role of cluster hospitals, high impact at a reasonable cost, bringing diagnostics and health care to the home.  Within their transformation plans, the Healthcare2U Framework was presented – do it at home rather than come to the hospital.  


Dr Pawan Agrawal of India provided a powerful message through the study of the Dubbawalas.  He noted the principles of ‘work is worship; the customer is God; no alternative to hardwork; and the importance of human values’.  The focus on strong working discipline and the importance of ownership are lessons relevant to all of us.  Passion, commitment, consistency, 100% execution, accuracy, dedication, time management and complete customer satisfaction are qualities and goals they live. The outcomes of 6 sigma, the loyalty of the staff and quality of service provided speak for themselves!


Wednesday opened with the Integrated Care Panel.   Rushika of the U.S. explained the primary care model within which he works and outlined 4 areas to address within a model -  payment, process, platform and people.   Payment must align.  The process must fundamentally be changed – to focus on teams, health coaches, shared care plans, noting that what leads to good outcomes is not medical.  Regarding the platform – data is on integrated records, a collaborative care platform, and is owned by the patient.  Within the 4th area, the people, he provided patient feedback such as “you cared about me, taught me to care about myself, and I didn’t want to let anyone down.” We must change the culture.  Amanda Larkin of the Sydney South Western Local Health District spoke about bringing acute & primary care together and shared her experience in which integrated care focused on a population. Identifying high-risk cohorts and putting in place a coordinated care arrangement was a strategy.  Jacob Thomas of Malaysia noted the move towards public-private partnerships and a service philosophy of ’delight our customers’.  Uma stated that most of what we do as health professionals does not contribute to the health of populations.  We must overcome the obstacles to health – most of which are within economic factors, social factors, and living and working conditions.  The example of literacy and the importance of reading by Grade 3 strongly demonstrated her point.  Using data to identify community health needs and areas on which to focus was powerful with an impressive example of eliminating extreme prematurity in one community.


We concluded the conference with our President-Elect, Dr. Jeffrey Braithwaite discussing his edited book titled Case Studies in Low-Middle and High – Income Countries:  Health Systems Improvement Across the Globe – Success Stories from 60 countries.    Progress is being made!   He was assisted by personal reflections from chapter authors who joined him on the stage from the countries of Argentina, Malaysia, Namibia, Australia and Japan.  There are many success stories!  Jeffrey noted 4 reform principles that permeated the case studies within this book:  1)  Acorn to oak tree  2) Date to information to intelligence  3)  Many hands  4) The patient as the pre-eminent player.  We must learn from each other, share successes and work together to more effectively mobilize quality improvement around the globe – a fitting conclusion to our conference.


I urge you to think of the key messages you are taking home, to ensure they live on and impact on your work back at home.  Please optimize this amazing exposure you have had to the shared expertise at this conference.


On your behalf, my sincerest thank you to:

-the authors of posters -  The posters were amazing and of superb quality.  Thank you to those who shared your achievements with us.  You are truly to be congratulated.

-to all the speakers -  The quality of the presentations grows every year – thanks to all of you.

-to the Abstract Committee and the Program Planning Committee -  Both worked extremely hard for months – under the guidance of Eadin Murphy.  An amazing program resulted.

-to our Malaysia hosts – MSQH.  Madam Siti, Saraiya, Kadar and your teams – you outdid yourselves.  We will be forever grateful and appreciative.

-to Peter Lachman and the ISQua team, you are second to none. ISQua’s impact continues to grow in a measurable way.  Thank you so much.


Finally, to all of you sitting here, and to those who departed earlier, thank you for being part of our family.  Thank you for being part of the success of this conference.  Bringing together the collective experience of everyone here truly shows that our healthcare quality & Safety future is very bright.  We have truly spent 3 days ‘weaving the fabric of quality and safety with our heads, hearts and hands’.


Safe travels home.  See you next year in Cape Town, Oct 20 – 23, 2019.


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