The power of improvement: highlights from this year's International Forum on Quality and Safety in Healthcare

I’ve been going to the International Forum for several decades, but this year was my first opportunity to be more involved behind the scenes in our role as strategic host partner.

What struck me first was the breadth and scale of improvement work in the UK and internationally that shines through at the Forum.

There were over 300 speakers, over 110 sessions and even more posters. And it’s super competitive to get sessions accepted, so these sessions only represent a small number of the ideas that were submitted. 

Over 50% of the sessions had a Q member presenting, a real sign of our reach and influence on the international improvement stage now. 

I hope the influence of Q and the Health Foundation also helped with a Forum that felt broader in the range of topics and scale of change people are now tackling. 

It was a career high point to have 10 minutes on the main stage to reflect on how we can help more of the great ideas from the conference move to action. 

The scale of Q as a mechanism to support learning, sharing and collaboration is proportionate to the challenges facing the health sector, but also the wealth of examples and learning that’s out there. 

My hope is that our members will be central to taking the many ideas and examples from the Forum and helping translate them into practice. 

With such riches, it’s hard to pick highlights. Below, we’ve shared a few of the key things we took to the Forum and our favourite bits. 

This year, Amy Edmondson was the keynote speaker on Friday, presenting content from her recent book Right Kind of Wrong. 

Amy spoke about how the rhetoric of ​‘failing fast’ isn’t coherent or credible in high-risk environments like health care. 

To help understand failure more, Amy has developed a topography of failure. 

While some failures are ​‘bad’, they all present an opportunity to learn. But we will only be able to do this with good psychological safety. 

This was highlighted in a conversation café afterwards, where we reflected on our experiences and relationship with failure. 

On my table were people from Australia, Ireland, Saudi Arabia, and the UK, spanning frontline clinical roles to people fostering improvement and innovation in systems. 

It was quickly apparent how the level of clinical risk we had to deal with on a day-to-day basis has an impact on our perspective on failure.

In the keynote, Amy asked the audience two questions: 

• What percent of failures in your organisation are caused by blameworthy acts?
• What percent of failures in your organisation get treated as if caused by blameworthy acts?

It was a stark reminder of how important a learning culture is if we take the opportunities to improve and innovate from failures that occur. 

The next session looked at why quality improvement (QI) often doesn’t work – the value of rigour. 

This session identified four reasons why QI often fails: innovation (bad idea), demonstration (bad design), adaptation (not enough engagement with context) and spread (the model loses impact at scale). 

The panel, including Q member Amar Shah, along with Jonathan Burlison and Pierre Barker then explored some practical improvement tools that can help support future success, and help build more rigour into improvement work. 

These included the MUSIQ tool, St. Jude’s QI roadmap and IHI’s tools on scale and spread.

Our session about ​‘breaking the rules’, with Dr Stefan Cantore, explored boundaries: what they feel and look like, how we behave and interact with others, and what unexpected learning boundaries can provide. 

Of the various examples of barriers and boundaries that were shared, I noticed that most took the form of cultural norms, ways of doing things, typical and expected behaviours. 

This was a reminder that so much of the good in the health and care system comes back to the skills and energy of staff. 

Change depends on this energy and persistence to keep asking ​‘why not?’ in the face of boundaries. 

Staff are our biggest asset but also need to be supported to engage and help create the change. 

So, what rules will you be breaking to better serve patients, staff and communities?

Our Improvement as mainstream business briefing was the foundation for a session on tackling health care’s challenges. 

We explored the breadth of improvement work, how it’s deployed and the benefits of using improvement approaches. 

These approaches are not just a mechanism for incrementally improving care at a micro or team level. 

They are indispensable when it comes to tackling the biggest challenges that health care faces, such as the need to make greater use of technology and tackle waiting times. 

We used our cross-system improvement framework to explore what’s needed for a more holistic, joined up and impactful approach to improvement across organisations and, ultimately, systems. 

We’re working on how we can support members to embed Quality Management Systems (QMS) and we recently commissioned some work to explore learning from QMS. 

So, it was great to hear perspectives, enthusiasm and experiences on this topic across the conference. 

We heard from Pierre Barker and Nana Twum-Danso (featuring an interview with Amar Shah) in an engaging workshop on scaling up and spreading improvement work. 

They explored why many promising quality improvement projects struggle to have impact at the system level.

The session highlighted the need to move from an ​‘improvement mindset’ to an ​‘operational mindset’ and focus on management structures that value ​‘standard work’ and quality control. 

As part of the workshop, we reflected on the criteria for scaling and applied it to the projects volunteered by the participants in small groups. 

We also heard a session about igniting a culture of improvement: the power of a management system. Where Penny, Amar and Wendy Korthuis-Smith shared their experiences in supporting these systems. My main takeaways were: 

• Most organisations are not starting from scratch. There is existing practice within the areas of quality improvement, quality control and quality planning. So, we need to start recognising and building on the existing work already happening.
• Embedding a management system is not up to individuals, it’s a collective endeavour. Organisations with more connections tend to be more successful in embedding management systems.
• One way of nurturing connections across hierarchies and different departments is through using simple, common language.

Equity was a big topic at the 2024 International Forum, often linked to co-production. 

One session integrating equity: tried and tested tools from three initiatives explored quality improvement methods, critically considering how these methods can help address inequalities in health and care. 

Led by Q’s advisory board member Pedro Delgado, a panel showcased great examples of programmes with equity and their heart (eg CORE20PLUS5). 

Key to this session was the message that without deliberate focus to address inequalities, improvement projects can not only maintain existing inequalities, but make inequalities worse (which the speakers discussed in terms of ​‘structural violence’ and ​‘violent inaction’). 

The speakers advocated for approaching inequalities ​‘inch wide, mile deep’. This involves focused work with specific groups experiencing inequalities. 

They found that quality improvement methods can be helpful in specifically addressing inequalities, such as considering Deming’s system of profound knowledge. 

There are three quality improvement methods they found useful to support embedding equity: the Driver diagram, three-part data review, and Coaching for Improvement. 

Ultimately, it is not the tool or the method that will make a difference to equity, but the mindset, focus, and how we approach the challenge. 

Putting equity at the heart of improvement ensures that improvement work benefits those who have been disadvantaged by the existing structures. 

I hope this is helpful to share a few reminders for those who could be there and links for those who missed it.

 We’ve highlighted one of the keynotes here, but all were exceptional this year and can be watched online (see link below). 

I know the financial pressures in the system were felt in many people struggling to attend this Forum. 

Please do use Q to reach out to those who were there to help us share their knowledge. We can’t afford for it to stay trapped. 

The following resources mentioned above may be of interest for further reading:

• Amy Edmondson’s recent book Right Kind of Wrong
• Liberating Structures’ information on conversation cafes
• the MUSIQ tool
• St. Jude’s QI roadmap 
• IHI’s tools on scale and spread
• The Health Foundation’s Improvement as mainstream business briefing
• Q’s Improving across health and care systems framework
• Q’s Quality Management Systems (QMS) insight project
• CORE20PLUS5
• Deming’s system of profound knowledge