It’s all the little things.

This week I have been privileged to be at “the Forum” or to give it it’s full title, the 19th International Forum on Quality and Safety in Healthcare.

The Forum is an impressive event – there were over 3000 delegates from 78 countries, and over the week the virtual presence of the event was significant. At one point delegates were asked to refrain from ‘pledging’ at the top of the Arc de Triomphe as the authorities were concerned that there was some sort of effort to start a revolution (which was sort of the intention, but not in the way they thought….)

The keynote speakers were impressive, global leaders in patient safety, healthcare improvement, and have led some of the revolutions in how we deliver healthcare, and how we think about healthcare in the last few decades. The delegates were impressive too – leaders of national, international and global efforts to improve care for patients.

The keynotes I attended often included a call for action – Maureen Bisognano ¬†@maureenbis¬†asked us to strive to reach escape velocity, not just 10% better but 10 times better than we are doing at the moment – to break the shackles that hold back improvement, and flip to a new way of “doing” healthcare. Indeed – she asked us to move beyond healthcare, and start to focus on health as the outcome we need to improve.

On Thursday was the turn of a giant in healthcare – Don Berwick [@donberwickforMA] to rally the troops. Don’s call to arms was a little different though, and, I felt, was a big risk. Instead of concentrating on the technical tasks of improvement, the challenge of balancing ever more demand with ever higher costs, and diminishing resource, he took us all to a different place.

Don spoke from the heart about his grandson, and the visceral joy it brings him to be with Caleb. And building on Maureen’s wish to see health as the goal, Don set out the case (medical and scientific) for flipping healthcare, and encouraged us to consider how we could wholeheartedly aim for health and wellbeing. He name checked gurus in what might be considered alternative thinking on healthcare, and used a word which was new to me, but got me excited – salutogenesis. (In later conversations with other delegates, it seems I am behind the curve on this one) the keythemes he wished to see included in the debate in the future are in there slide below:

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But what about the hard thump of reality that is waiting for me when I get home? I don’t think I will be able to go to my medical director an say outright that we need to create a salutogenetic environment in our hospital and expect to be taken up on the scheme immediately. So for the non-superstar improvers, those who haven’t sparked revolutions yet? What did the conference hold for them?

Well, this was in fact the true message of this conference for me. The big, bold visions and calls to action were great, and my experience would have been less rich without them. BUT – taking a bit of time out to see the posters, and listening to the messages from many sessions on how to implement change, capture learning, use data effectively, I got a very different message.

It is all very well aiming for 10 times improvement in outcomes by flipping healthcare, and helping our patients achieving wellness, but the road to all of this is made up of tiny steps. Be that the simple, but massively influential #hellomynameis idea from Kate Granger @grangerkate or the rearrangement of clinical equipment stores to reduce time taken to get kit together from 2min41s to 26s) at St George’s Hospital, or learning how to tell your story to engage others – it is only through many thousands and millions of small changes, all anchored in the visions set out by the big players that we will achieve any of that vision.

The greatest moments for my own learning came through chatting about a problem I have to deal with at work with a few other delegates – very small, very personal, but it will start to introduce the changes my Hospital needs to make to reach a vision of enhancing health in the population it serves, not just delivering more and more health-care.

So – as one of the many quotes I noted at the conference says – we need to keep our feet on the ground, and our heads in the stars.

I hope that you will be able to make use of the conference resources or the ideas that delegates broadcast via the #quality2014 tag on twitter (even if you out don’t sign up its worth looking at twitter as a reference source for events like this) to start out on your own small change – however small that might seem.

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