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Hello, I’m Domhnall MacAuley and welcome to MedicsVoices.com, where we talk to the key opinion leaders in health and medicine around the world. Today I’m talking to Pedro Delgado. You’ve had a remarkable journey starting in Venezuela, educated in the US, working with IHI (Institute of Health Improvement) in Boston, but now based in Europe. Tell us about your academic journey and what you do now.
Pedro Delgado: I grew up in Venezuela, went to college in the US, did a master’s in the UK, and have been here primarily for the last 20 years. I studied psychology as my primary degree and then I did a Master’s in Health Care Leadership and Management and have been a passionate student of quality improvement, patient safety, population health improvement and equity over the last 20 to 25 years.
And that’s the space I’m in. My work is primarily in Europe these days but I’ve done work all over the world, which has been really enriching and I feel very privileged to have done that.
DMacA: You have a very senior leadership role in IHI. Tell us about IHI and what your aims and objectives are.
PD: Just over 30 years ago we brought the quality improvement methods that were being used in industry into health care. And, in doing that, we’ve learned a lot over the last 30 plus years. And, as a ‘not for profit’ institute, we have a mission to improve health and health care worldwide and a vision such that that every patient, every citizen, gets the best health and care possible. That’s easily said, and very hard to do. We’re backed by four values which help us stay grounded and ensures that our relationships with our partners around the world stay grounded.
The first one is courage. Sometimes in health care, it takes more than just being nice to get through some of the challenges and gaps that we’re trying to close, together with partners. The second one is equity. It’s a historical fact that we continue to leave populations behind and we’re keen to right that wrong. So equity is engraved into our values and it’s something that we try to act as well as think and write. Trust is our third value because improvement moves at the speed of trust. And the fourth one is love because there is a foundational element to what we do which is inherently humane. And unless you’re grounded in that, in order to push science and betterment and so on, you’re on a road to nothing.
Courage, equity, trust and love are the core values that guide IHI and as a ‘not for profit’, we work globally with partners to try to improve health and healthcare worldwide so that everyone has the best health and care possible.
DMacA: One of the things that fascinates me about IHI is its global impact. We’re all focused very much on our own health care systems but there must be huge differences between different countries.
PD: It’s one of the beauties and the privileges, I have to say, of both having grown up in one country, and having lived in two or three for a sustained period of time, and also being able to do work across frontiers and across regions, that enriches and enlightens the possibilities. And I’ll give you an example: Today, I was talking to some friends in Sweden who were describing some of the challenges since they have signed up for NATO, and now that some of the financial situations aren’t as generous as they have been over the years, and how tough things felt. And this person had just visited Mexico, to meet some of our IHI colleagues, and I took the opportunity to reflect with him on the fact that everything in life is relative. When you think you have a crisis and you look a little farther afield, then you understand what poverty is, what a real crisis is, and what it is to have limited resources. And so, primarily, the global opportunities that we have afford us perspective.
The second is this opportunity to bridge innovation. There are wonderful things happening in high income countries, there are wonderful things happening in middle income countries, and there are wonderful things happening in low income countries. And by having a view of those three levels, you can try to build bridges that will help to accelerate the learning curve by connecting people and connecting knowledge. I’m just off the call with some friends in Greece who were keen to learn about some efforts in Brazil. So that’s just an example of the perspective that it gives you; having perspective so that you understand your own reality relative to others, and the possibility of building bridges through knowledge and innovation and improvement.
And the third thing is the opportunity to ground the work in pure humanity because, underneath our skin, underneath our bones, and our blood, is a sentient human who wants to do a good job, who is grounded usually in love, who is grounded usually in really good intentions, And by ignoring some of the labels, and the languages, and what country you come from, we get on the same plane, which is that we’re human beings trying to do good things for other human beings and with other human beings.
These three things are huge privileges that we don’t take for granted and we that we try to respect very much.
DMacA: When you talk about these values and you talk about IHI, I it sounds a little external or extrinsic, but I’d like to ask you about your own intrinsic values, because I’ve heard you talk about this concept of ‘violent inaction’.
PD: Over the last two years I’ve been very introspective. I feel the world is moving very fast and sometimes it’s moving in a direction that it doesn’t know, partly because we’re distracted all the time. Everybody’s on their mobile phones and social media and trying to respond. We’re in fifth gear all the time and we’re not changing gear. I think that this distracted process is potentially taking us backwards. We’re using violence as a solution to problems, and we have two wars very close to us in Europe, and when you’re using violence as a solution, it means that you’re confused, that you’re trying to search for something that’s deep and you don’t understand it.
We’re at a moment in time where I think technology is affording us wonderful opportunities, but it’s also putting some things at risk. So, over the last two years I’ve been very introspective. I’ve been thinking about what my purpose is, what am I trying to do in this world? We only have a very limited amount of time here, how can I make the most out of it? And I started by trying to write down my purpose. So I’ll start there and then move to values.
My purpose is very simple in words, but it took me a while to articulate it, and it may change in the next five years. But, it’s to reduce suffering and to enhance well-being, in community; in other words, to reduce suffering and enhance well-being with other people. To reduce suffering from the feeling that we’re not doing a good enough job, from feeling that we need to prioritize things that are counter to our values. And then, obviously, to reduce the suffering that comes from substandard care and substandard health. If you reduce suffering you also have the possibility to enhance well being. Nothing that we do in life is disconnected from other human beings. So that’s where I start, that’s what grounds me. And when I have a tough day, when I have a long day, when I have a long trip, when I have a tough conversation, I go back to those values. And if what I’m doing is grounded on that purpose, it’s worth it going through the pain of change. Because I primarily work in the sphere of change, trying to work with other people who want to bring about change.
My values are grounded on my own purpose, and they’re also connected probably to my upbringing and the global nature of what my life has turned out to be. Humanity first. Grounding ourselves in who we are and what we’re about as a collective rather than taking an individualistic view.
Equity is an important value. For too long and too often we continue to speak in ways that demean other people, to ignore data that telling us that some people are being left behind, and to talk about the problem as opposed to moving to solutions.
So, when talk about violent inaction, I am referring to how we can ponder a problem, we can criticize the fact that it is there, and we can criticize the people that are closest to the problem. But it’s very different to watch a football game from the stands and talk about the players than it is to be on the pitch while it’s raining, while it’s muddy, while the opponents are angry. It’s easier to comment that a player is not playing well enough or they’re not running fast enough than being on the pitch. But, we need to be on the pitch. We need to move from violent inaction to loving and proactive action that serves to reduce suffering, to enhance well-being, and to do that together in community. So, if you ask me about values, that’s what comes from the gut.
DMacA: I’ve heard you say that we need ‘we need to be unreasonable’. What do you mean by that?
PD: There’s a gravitational pull to normative behaviour. We create this narrative as human beings and somehow it becomes our reality and we act upon them. Sometimes that prevents us from asking the tougher questions – should it be different, and would the solution need a radical approach? Do we need to stop and think? Do we need to call it out? And you see that with kindness. You see that with our models of care. You see that with the way that we relate to other genders, other races, other ages, other nationalities, because we are grounded in the narrative that makes our collective soul. And those narratives tend to be generic, and it’s hard to extract yourself from that bubble and say- let me look at the fish tank from outside the fish tank and understand what I’m doing while I’m swimming with the fish. There is an opportunity for all of us to pause, to step outside and, perhaps, to be radical in questioning. Lovingly. I’m not talking about violence here. I’m talking about loving action that prevents violent inaction, proactively doing so. If we can get ourselves to pause and ask that question every so often, I think we’d be in a much better place.
Inertia is one of our biggest challenges. We do, and do, and do, and just don’t stop. And that builds on that collective narrative. And unless we’re willing to challenge it, we probably end up exhausting ourselves on the one hand. And, on the other, getting outcomes in whatever sphere of life we’re leading that are maybe not as coherent that we want with the thing that grounds us and the thing that guides us, which is love and the sense of humanity and connectivity and community. That’s what I mean when I talk about being radical at times.
DMacA: When we were talking a moment or two ago, you used the metaphor of the player on the pitch and the critic in the grandstand. But, of course, people may not know how that metaphor is part of your life because you’ve been an international professional footballer. Tell us about your football life and what experience brought you.
PD: I love talking about this topic and you may have to stop me! I fell in love with football when I was three and it was my uncle, who sadly passed away when I was six, who taught me how to kick a ball and somehow I developed this addiction to being connected to a ball. My best friend for a long time was the football. And I had a weird obsession with just practicing. I could juggle the ball a thousand times by the age of eight or nine. I had a wall at the end of the cul-de-sac where I lived in Caracas, the city I grew up in. I used to draw goals on the wall and hit free kicks and so on. Eventually, I ended up playing for the National under 15 and under 17 team in Venezuela in the South American Cup. I ended up getting a scholarship to go and study in the US and then play professionally both in Venezuela and in Northern Ireland.
But beyond that, the wonder of football and of sports in general, is what it leaves you with for life. Football happens to be my passion but I play other sports too. And, if I was to compare my learning in an academic formal setting, versus my learning on a football pitch, I would tell you that I’ve learned a lot more on a football pitch than I have academically. I’ve learned about discipline, I’ve learned about dedication. I have learned about teamwork, I’ve learned about humility. I have learned about taking responsibility for your own performance rather than blaming the conditions. I’ve learned about how to lose. I have learned about enjoying when you win, I have learned about cultural differences by playing with international players in international tournaments. And so football has been, for me, a development vehicle that I could trace back as the roots of my passion for improvement. I don’t think quality improvement is just a method to improve health care. Improvement is a trait of every human being. From the time that we learned to latch on to our mothers to breastfeed, we try, we test, we fail, we try, we test and then eventually we get it. Then we learn to walk. Then we learn to run. It’s all testing and improving. So we are inherent improvers. But if I were to trace my own journey beyond learning to breastfeed, learning to walk, learning to run, it’s about football. Because I knew that if I just became a player who was happy with juggling the ball three times and thought that was great and having a relatively good first touch, and training kind of okay, I wouldn’t have gotten anywhere with football. I never thought that I was going to be a professional player, it just happened. But it happened because of improvement, because I wasn’t happy juggling three times, and asking how can I get to ten, can I get to 20, now can I get to 100, can I get to a thousand? I wasn’t happy with the structure of my training, so I thought, what can I tweak in order to improve my stamina, my reaction speed. I was an improver before I knew that I was. And that was before we had all these mad and wonderful data science driven approaches to sports. We didn’t have heart monitors, or GPS to know our distance, and we didn’t have nutritionists telling us to eat broccoli after training and to drink. It was more intuitive.
So I trace back the root of my passion for improvement to football. Its been a school for life for me, and it continues to be. By the way, I will only stop playing football when my legs say you need to be doing something different. In the meantime, it’ll be part of my life.
DMacA: And, you continue to have athletic challenges. So finally, let me ask you about your major challenge this year- that amazing climb in South America.
PD: What a wonderful opportunity. And again, what a privilege. With a group of four very close friends we tried to go to the top of Aconcagua, the highest peak in South America, at almost 7000 meters. Climbing Aconcagua requires training and a lot of preparation because you’re exposed to lack of oxygen at altitude and extreme weather conditions. Getting on to the mountain was incredible.
My philosophy was about three things. One was about safety. I wasn’t keen to be a superhero. I wanted to be safe. Secondly, it was about joy. I wanted to enjoy every step of the journey. And thirdly, it was about celebration and learning. Celebrating every step. So, we got to base camp, we got to camp one, we got to camp two, and every time I arrived, it felt like I had achieved my goal because it was something that I had never done before. And it was about learning because I went back to being a beginner, which is something that I’ve always tried to do in life, to be on the beginner mode.
The journey had incredible challenges, incredible beauty, and a unique landscape. The challenges included some of the interpersonal dynamics in the group, when people are at different levels, feeling anxiety about different things, being ambitious in different ways and to different degree, and being daring or not. And when you’re in a group, you cannot just go on your own. You have to stay with the group and understand the dynamic of that. The beauty was unparalleled. I’ve never seen anything like it. Aconcagua is in the very southern tip of South America, which means that the latitude also matters, not just the altitude.
And then the last thing I would say is that it gave me perspective on the speed of life. There is no way to run, perhaps there are superhumans who can do it, but above four and a half thousand meters, it is very difficult to go fast, even on a fast walk. You’re walking very slowly, every step is a breath, inhale, exhale, inhale, exhale. And you do that for eight hours, and with every step your mind opens up a little bit more than just daily checking on emails, WhatsApp and social media. And it gave you a different sense of possibilities intellectually, because you free up their mind to be just a little bit more creative. An amazing trip, highly recommended.
DMacA: Thank you very much for sharing so much of your life, your personal philosophy, your professional work, and indeed your sporting challenges.
Pedro Delgado
Pedro Delgado is Vice President at the Institute for Healthcare Improvement, overseeing IHI’s work in Europe and over the years, also in Latin America and Australasia. His has been a driving force is IHI’s global efforts for over a decade, working with thousands to bring about improvement of health and healthcare for millions. He’s an Instructor at the Harvard TH Chan School of Public Health and a Senior Atlantic Fellow for Health Equity.
Professor Domhnall MacAuley
Domhnall MacAuley currently serves on the International Editorial Board for BMJ Leader.
Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.