01 October 2013

APAC 2013 forum

On Thursday and Friday I was able to attend the APAC Forum on Quality Improvement in Healthcare, held in Auckland at the Sky City conference centre. Over the two days of the conference a wide range of international and local health care improvement experts shared their experience and led discussions about the pressures affecting the New Zealand health system. Here’s a few highlights from the sessions I attended.

Carol Haraden (Vice President, Institute for Healthcare Improvement)

Carol's presentation discussed how health systems might learn from the serious failures at Mid Staffordshire in England, and how individuals and teams who are responsible for monitoring quality can detect warning signals and act on them effectively. She made what I thought was a particularly useful point when she noted that 'every system is perfectly designed to deliver the results it delivers' - the key is making sure that system design doesn't lose sight of patient safety and high standards of care, as they did in Mid Staffordshire. She also observed that the prevalence of the term ‘whistle-blower’ is an admission that the system has failed, not because problems have been identified, but because individuals have found no outlet for their concerns through the usual channels. She also cautioned against resting on the laurels of processes and measurement systems that are perceived to be effective, because in some cases the reality of day-to-day operations is far removed from the ideal world that gets signed off in reporting documents. This also has flow-on effects for training: ‘because we can’t acknowledge we’re not following policy, we can’t talk about bad practices or measure them’

Glenn Colquhoun (Horowhenua GP, poet / writer)

The keynote speaker for Day 1 was Horowhenua poet and GP, Glenn Colquhoun, who offered an atypical voice in a high-falutin' health care conference, and spoke movingly and comprehensively of the challenges faced by relatively impoverished and isolated rural communities. He said sensible things about inequality being a risk factor for disengagement with health services and society in general, but most of his time was spent painting a picture of health services and youth lifestyles in the backblocks. (Actually, the Horowhenua isn't that far from Wellington, but it's a radically different environment for young New Zealanders growing up there).

Dan Heath (Author, Senior Fellow at Duke University)

One of the advantages of having conferences like this is that international speakers are involved. I'm often rather wary of slick American experts, but Heath (the author of several highly-successful books) offered a entertaining vision of how to encourage positive change. In part, Heath argued, we need to avoid an ever-increasing focus on a managerial problem-solving cycle, to the detriment of a positive focus on bright spots that could offer new ways of improving. A stronger and more positive approach is to ask what is going well and how can we do more of it? He also stressed the importance of using a range of tools to convince stakeholders and the public to overcome the inertia that often stifles improvement initiatives; diligent use of data isn’t enough – a little motivation is needed to encourage change. This can often be provided by 'path interventions', simple initiatives to turn (in the words of one Heath anecdote) ‘jerks’ into ‘saints’. 

Hon Michael Kirby (Australian High Court judge, 1996-2009)

I'd not heard of distinguished former judge Michael Kirby, but his illustrious career in his native Australia and in international diplomatic forums has made him justly famed there, and it was a pleasure to hear an eloquent and persuasive senior statesman sharing his views. Only the week before the APAC conference he was in Geneva delivering a report from a commission he led to investigate human rights violations in North Korea. The New York Times reported the reaction of US ambassador to the UN's Human Rights Council:

“The great value” of the report, said Eileen Chamberlain Donahoe, United States ambassador to the Human Rights Council, is that it “has begun to shed light on the horrifying realities of life in North Korea and raise international awareness of the ongoing tragedy and barbaric conditions there.” She also said the findings represented a “small but significant crack” in the North’s “information blockade.”

Kirby's APAC keynote address, delivered whilst roaming amidst the full-capacity audience, focused on the North Korea report, the failure of the international community to meet the Millennium Development Goals that were set at the turn of the century, and the rising global health crisis brought about by patent restrictions on tier 2 and 3 anti-retroviral treatments for the HIV virus. Regarding the latter issue, I was unaware that the more complex HIV treatments are not being promoted and adopted in third world countries that are most at risk of HIV spreading, because the intellectual property restrictions in place mean that they are simply unaffordable and cannot be undercut by cheaper generic drugs. Kirby argued for a fairer balance between the inalienable right to decent health care and property rights, and cited the good work of former New Zealand Prime Minister Helen Clark, head of the UN Development Programme, who is working closely with UNAIDS to promote a new intellectual property framework for pharmaceuticals.
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