Domhnall MacAuley: International Quality Forum, day 3

Domhnall MacauleyWhen it all goes wrong, that’s when you are really tested. Quantas pilot Captain David Evans described what happened when an engine disintegrated in mid air on Flight QF32 and three large metal shards pierced various parts of the huge A380 aircraft causing major systems failure. Only one of four engines could operate at normal capacity, fuel spilled from the tanks, and the aircraft was severely disabled. Parts of the engine fell on Indonesia, misreported on Twitter as a crash, which immediately made international news headlines, yet the plane was still in the air. The crew stabilised the plane, but still had to land an overweight aircraft at excess speed, with overheating brakes, leaking fuel and, from their calculations, just 139 metres to spare on the runway in Singapore. And, even when they landed, with one engine failing to shut down, there was still a very high risk of fire. The operation was a success—everyone survived.

And, the lessons for healthcare… team resource management, the synergy of experts, the value of collective thinking, a shallow hierarchial gradient. And, remember, we are all human and humans make mistakes. In aviation, they recognise the human factors and have created a reporting culture. A self reporting culture—things going wrong, personal errors, and near misses. Medicine could learn a lot. David told is that, as a senior supervising pilot, he once had to stand down a crew because the juniors were not speaking up. Hierarchies can be dangerous.

But, I also saw some great team work in action during the day. Marije Hansen-Stoffer, Rob Baatenburg de Jong, and Rinske Tabat from the Erasmus ENT unit in the Netherlands, showed how a team could create a successful quality programme in the face of a decreasing budget and increasing demand. They found that in seven out of ten patient interactions there was some form of waste and they generated 50k savings. Some words of wisdom: “Think big, act small,” “the first project has to be a success,” “Employees—do your job and improve your job.” Rinske had made a film of her own personal journey—an inspirational film that you can see here.

Rob Dillman showed us the hospital of the future in the Netherlands— which particularly addresses the problems of patients with multimorbidity. It wasn’t about building a medical cathedral, it was about ensuring patients don’t suffer from medicine thinking in silos. He promised to do a shared presentation with his GP colleagues next year to show how it works in practice. Bonnie Brossart told us how “total quality” worked in the entire province of Saskatchewan using Hoshin Kanri (when she asked the audience, only a handful knew what it was), and Rabab Diab described accreditation for an entire country—Jordan.

In his keynote address, Peter Van de Vleit reflected on the success of the medical team at the Paralympic Games in London 2012, but it was Helen Bevan in her introduction who made us think about how management principles applied to sport could be applied to the health services. In healthcare, we tend to look for problems, search for errors, punish mistakes. Sport is about positive reinforcement, seeking opportunity, rewarding excellence. In healthcare, we think as different professional groups. In sport, individuals work for the team. In healthcare, we encourage staff to improve standards, but in sport everyone expects to do their best.

Like every conference there were frustrations, but these are positive—so many sessions I would love to have gone to but couldn’t. Sessions where the speakers were sensational, but time was too short. And, it was all over too soon.

It happens again next year in Paris. For those who are serious about patient care, it’s transformational. Think ahead. Be there.

Domhnall MacAuley is primary care editor, BMJ.