Editor’s Notebook: Common Themes
November / December 2007
Editor’s Notebook
Common Themes
I spent half of my workdays in October attending healthcare conferences: the 24th annual conference of the International Society for Quality in Health Care (ISQua), in Boston; the Annual Conference & Exhibition of the American Society for Healthcare Risk Management (ASHRM), in Chicago; and the Center for Connected Health’s Symposium 2007, in Boston. Conferences provide me the opportunity to hear from readers directly, assess new ideas and products, network with potential authors and sponsors, and generally keep my finger on the pulse of industry efforts to improve the safety and quality of healthcare.
These three conferences had complementary but different constituencies. ISQua drew 750 attendees — mostly clinicians — from 60 countries. ASHRM attracted 2,000 attendees involved in risk management; and the Connected Health Symposium drew 600 clinicians from settings as diverse as the Army, academic medical centers, and home health; entrepreneurs; venture capitalists; consultants; policy-makers; etc.
Hearing such a broad range of brilliant ideas in a short period of time left my head spinning. In search of overall themes, I reviewed my handwritten notes. Here is some of what I found:
At ISQua, two individuals working in opposite environments (Richard Alvarez, president and CEO of Canada Health Infoway, and Hamish Fraser, working in developing countries with Partners in Health) both reported that the barrier to improvement is not inadequate technology, but bad data, data that is incomplete or incorrect, sometimes because the clinicians who enter it don’t stand to benefit from it. Bad data is usually a people or system problem, not an IT problem.
In informal conversation at ISQua, Barbara Kutryba, from Poland, president of the European Society for Quality in Healthcare, said it’s difficult to sustain improvement efforts past the initial “romantic moment.” Don Berwick, president of the Institute for Healthcare Improvement, echoed her thoughts the following day in a different context. He focused his plenary talk on the difficulty of taking improvement efforts “to scale,” sustaining enthusiasm, and spreading change across huge institutions.
Grena Porto, senior vice president at Marsh, Inc., presented at ASHRM on the negative effect of disruptive behavior, drawing from an article she wrote for PSQH (July/August 2006). She ended her presentation early and opened the floor to comments, which turned into the liveliest group discussion I’ve heard in many years of attending conferences.
Connected Health provided two high-tech, interactive sessions: 1) a presentation of Second Life (secondlife.com), an open source communication platform that looks like a game (avatars in wild costumes) but isn’t, and 2) a provocative closing plenary, including a live Q & A, given remotely by David Brailer, former U.S. national coordinator for health information technology. The technology wasn’t a barrier, and some of his talk took me back to ISQua. Among other things, he wondered why so many small ideas don’t “go to scale.” He thinks “generalizability” is the challenge. Getting something to work in a controlled setting doesn’t guarantee that it will work in the larger, rough-and-tumble world.