What is your background and what led you to the International Society for Quality in Health Care (ISQua)?

I am a paediatrician who trained in South Africa and has worked in the UK for the past 25 years. My clinical interests are in children with long-term conditions starting with neuro developmental problems. As a paediatrician, I have worked both in the community and in hospitals. I became interested in patient safety early on, having managed large departments where safety issues came to the fore. I was a Health Foundation Quality Improvement Fellow at the Institute for Healthcare Improvement in Boston, US, and then Director of Patient Safety and Quality at Great Ormond Street Hospital, UK. This led me to my position at ISQua.

Can you talk about the Society’s work to inspire and drive improvement in the quality and safety of healthcare worldwide?

ISQua was founded to introduce standards in healthcare back in the 1980s. Since then, we have expanded to become a unique accreditation service to health and social care external evaluation organisations and standards developing bodies worldwide; we hold the premier international conference on quality and patient safety; and we 

Public health measures and primary care interventions could make a real difference if they went beyond the health sector and included housing, nutrition, sanitation etc.

have developed innovative education programmes with a focus on working with people in low income countries. Our current mission is to inspire and drive improvement in the quality and safety of healthcare worldwide through education and knowledge sharing, external evaluation, supporting health systems and connecting people through global networks.

Does the Society encounter barriers in this work? I.e. What is impeding improvement in the quality and safety of healthcare on a global scale?

The issue is culture and the way healthcare is planned, designed and financed. I believe that if we designed for safety and quality then issues such as universal health coverage and integrated care could become a more realistic possibility. However, health systems are based on hospitals, and most people do not have access to good healthcare, rather they have access to disease 
management. The safety movement has been reactive, and we now need to move to a proactive and preventative phase where the focus is on safe, high-quality care in the community. If we could share what we know with all people, then the changes and improvements would be phenomenal.

What would you say is the current state of healthcare worldwide? What are some of the most pressing issues?

The three reports that came out this year from the World Bank / Organisation for Economic Co-operation and Development / World Health Organization (WHO), National Academies Press 

and the Lancet Commission are pessimistic and offer solutions that may not work. Basically, they note the gap that exists which could be due to malalignment of resources, political inertia or misguided priorities, a misuse or poor use of funding and the focus on hospital care. For example, public health measures and primary care interventions could make a real difference if they went beyond the health sector and included housing, nutrition, sanitation etc.
We need to think differently and not replicate the old structures – there are many good examples of the application of quality improvement methodology and safety science theory in practice to meet the standards that we need to achieve.

With origins dating back to 1985, what are some of the Society’s proudest achievements to date?

ISQua is, at heart, a global community. For over 35 years we have evolved and adapted to circumstances. Our members continue to inspire and drive improvement. We have an extensive, vibrant and diverse community of members and experts who continually handle the constant moving targets of healthcare. It is through all of those connected with our extensive network and commitment to the mission of ISQua that our work is conducted, and positive results obtained.
Our own achievements have been many; from the development of our health and social care standards, now in their 5th edition; to 35 successful annual conferences; our International Journal for Quality in Health Care (IJQHC), a leading international peer-reviewed scholarly journal that addresses research, policy and implementation in healthcare quality worldwide; and now our recent work across Africa and Latin America to spread the good practice. 

Can you talk about your work in assisting WHO with technical and policy advice?

We have a strategic partnership with WHO as a non-state party that provides support for several key programmes, including national quality policy and strategy (NQPS), Patient 

Safety, Integrated Care, Maternal and Child Health. Our support involves sending experts to key meetings, reviewing and helping to develop policy and now to provide support to member states that need it to implement the frameworks to introduce high-quality and safe universal health coverage within the sustainable development goals. This collaboration is growing, and we will expand it going forward.

You are involved in the accreditation of national and regional healthcare facilities worldwide. Could you talk about the importance of this work?

To have quality healthcare one needs standards that are evolving and continually becoming more person-centred and outcomes-focused. We offer an independent third-party assessment process to validate existing systems and drive continuous quality improvement. Our International Accreditation Programme (IAP) enables organisations to demonstrate their credibility and benchmark their performance on an international level.
The accreditation process is an important element of achieving high-quality care. Our programme plays a large part in this process in many areas – yet it needs to be part of an overall change in culture and desire to change.

What are ISQua’s key goals in the next five to 10 years?

We intend to build on our current success and to move forward into supporting global regions with strategic alliances. We are looking towards developing innovative ways to improve quality and safety networks and will develop our existing programmes and expand our impact in all regions.
There are many organisations working in QI and patient safety – we all need to work together to make a real difference. 

What are your own hopes for the future of the quality and safety of healthcare worldwide?

We are now at a place where we know what works. We need to network together to ensure that every citizen, no matter where they live, has an equal chance to access high-quality care. We need to pay attention to the vulnerable and those living in fragile states, to those in war zones or failing economies. We in healthcare need to move from disease management to health promotion, and this is the real challenge. ■