Hi Bob, welcome back. Thanks for joining us again. Could you just remind everyone who you are. >> Yeah, hi everybody. Nice to see you again. My name is Bob Klaber. I'm a pediatrician and Director of Strategy, Research and Innovation at Imperial College Healthcare. >> Great, thanks Bob. Looking now to the future in quality improvement, what do you see is the role of quality improvement in a modern health system? Will we still need to use these approaches in 10 years time? >> Well, I'm really pleased to say I'm absolutely convinced that we will definitely need them. I think the sign of any good health care system is one that's constantly looking to learn, constantly looking to improve, and there's many, many challenges ahead. I think in terms of direction and strategic direction. The big thing I would go after would be an honest reflection that our healthcare systems across the world have really focused on illness and how we support people who become unwell. We are called the National Health Service in the United Kingdom. Really, where the national illness service, that's what most of our care is focused on. What our friend, Don Berwick would call the repair shop, and I'm really convinced that if we're really serious about taking forward the health care challenges that society across the world has. That has to be about a big shift into focus on the health and well being of our citizens, our communities, and our population. So for me, you guys are doing the right masters here. You're focused on how quality improvement can improve population health. I'm absolutely convinced that, that's key, and even for us working in an acute provider. Traditionally, our work has really only been in the context of hospitals, we're doing more and more work in integrated care. Were thinking about how we work as an integrative care system. But how do we work with colleagues to improve health and well being of populations? That's got to be the direction we're going in. I see quality improvement being an absolutely crucial method at the heart of how you make those improvements. >> Great, thanks Bob. Is there anything particularly you think we should be focusing on within that, within the population health area in terms of where quality improvement might be able to add particular value? >> Thanks, Tom, I think there's a really important question about the value of quality improvement in population health. And I would probably go for data as being the key piece on this. So all of the things that people like you and I have learned in our careers around measurement and how we measure and how we use that as a driver for improvement. We're excitingly in a world where the possibilities around data seem to grow exponentially all the time. And by definition, thinking about a larger number of people who're within a population and some of the signal that data may be able to tell us about things that put different of them at certain risks. and that'll enable us to personalize care more or taylor care more are really, really exciting. So the possibilities around the data side of population health, population health management are key. And I think many of the skills that we learn through quality improvement are going to be very, very useful in that setting. So I see that as being a very key area. >> Great, thanks Bob. In terms of the actual methods of quality improvement themselves, where do you think the gaps are? What are the key questions for research and practice that are still unanswered? So when I think about what we know and what we don't know around the impact of quality improvement. We're generally pretty poor at applying quality improvement with the fidelity and rigor that it deserves. And I think there's a tension here. We're not great at it in the NHS because they sort of focus on delivering the service or meeting the need that's in front of us or meeting the demand that's in front of us can really dominate. And we can get a bit short sighted about that and we'll get on and do lots of plans and dos, but not enough studies and the second PDSA cycle. We don't run very many randomized control trials using quality improvement method, in a way this sort of depth of research work around it is perhaps not where it should be. On the other side of things, we have a research problem that things take 17 years to get on into practice. Now I think the trick is how do we combine the best of both worlds. Again, COVID's been extraordinary on that we were setting up trials in five or six days. We were setting up research committees looking at ethics, looking at data governance, getting the right people involved in hours and days, literally hours and days. And so I think that's shown us some new ways about how we can get rapid learning. We were changing our clinical protocols within a few weeks based on research that hadn't been done at the beginning, so some extraordinary things going on. They just show us perhaps our old approaches really weren't good enough and were actually letting patients down in the way we work. So there is something about the speed and rapidity of this, but also bringing in research rigor to really know and understand where we've got. I think the two can live together. I don't think we've been perhaps thoughtful or smart enough about how the two do live together. And I hope that many people listening who I very much see as our sort of health care leaders of the future. We need to be able to front that up and allow those two key pieces to live together. So I would hope that that's a really key area for us as we go forward. The only other thing I would mention is around much, much greater involvement of patients of local citizens, of local communities in our understanding around quality improvement. As we build up our scholarship and our learning around it, I'm absolutely convinced we need to be much, much clearer. Again, if you think about the first question in the model for improvement, what do we want to achieve? We need to be achieving things that really matter to our patients, to our communities, why wouldn't we be co-designing what that is right up front? And medicine's got a pretty poor history of that being dominated by what the doctor thinks would be the best thing to do. And maybe some other members of the health care team and much less say patients. I think that needs to be turned on its head, so I'd really hope that there's a big big move in that direction going forward. >> Great, thanks Bob. That makes a lot of sense. And there's a great agenda for some future work. What do you think the most important thing people working in health care systems can do to contribute to improving the quality of healthcare going forward? >> So great question. I'm going to reference a really wonderful bit of work that was done out of the Health Foundation. And a lovely colleague who used to work with us, Hadjer, along with Bill Lucas, did called, The Habits of an Improver and you'll reference it, I'm sure, and people can look it up and have a read. I think this is a really super bit of work because it focuses on the behaviors that and habits, is a nice word you know habits to me is about behaviors that you keep doing, and you practice. And then they become quite just natural and the thing you do without even thinking about it. So the habits of an improver, the behaviors are totally key to this. The one thing that all of us can control at all times is how we behave and how we behave to other people. So our approach to the different habits around encouraging about being curious, about being open minded, about listening. About not having a fixed mindset about things, about creating the right sort of tone and temperature to how an environment feels for other people. To be able to go and make these changes happen are absolutely crucial. And this piece of work is a lovely bit of work, will be much more sort of comprehensive than the sort of little list that I gave, and I think that's where I'd really advise people to go. It really, it ultimately comes back to leadership and it's leadership of self about how we all behave to encourage ourselves. the teams around us and our wider system to be a learning and improving place. >> Great, thank you Bob. That's been fantastic. Really great to talk to you again and thank you so much. [MUSIC]
