Last month, Kuala Lumpur hosted the Asia Pacific edition of the 22nd biannual International Forum on Quality and Safety in Healthcare, which is a collaborative event by the Institute for Healthcare Improvement (IHI) and the British Medical Journal (BMJ). Bringing together over 1,000 healthcare professionals from over 35 countries, the three-day event was held at the Kuala Lumpur Convention Centre (KLCC). The forum boasted an intensive and insightful programme, featuring over 40 sessions and presentations delivered by more than 80 prolific experts, both local and international.

Designed in close partnership with regional strategic partners, the extensive programme promised to advance progress, recognise individual accomplishments—whilst discovering new pioneers and leaders, and inspire and instill fresh ideas—to improve the quality and safety of healthcare across the region.

The networking zone dedicated for delegates to connect and share ideas with one another.

The networking zone dedicated for delegates to connect and share ideas with one another.

It incorporated networking opportunities such as a nurses’ meet-up, a speed networking session at dedicated areas and a forum networking challenge, which encouraged delegates to complete a set of networking tasks before the end of the event.

Poster stage sessions presented in specific themes were also held where authors delivered short presentations about their project and answered any questions from the audience. Video posters were also shown within the refreshment breaks at the poster stage to allow delegates to share their work to a wider audience.

Interactive engagement: The poster stage where authors delivered short presentations to, and answered questions from, the audience.

Interactive engagement: The poster stage where authors delivered short presentations to, and answered questions from, the audience.
 
For easy navigation, the forum has introduced a comprehensive one-stop app that included the map, schedule, exhibitors and speaker list for the event. An in-app messaging feature was also included to allow delegates to connect with one another. In addition, speakers could upload their presentation slides, while the audience could add session notes within the app.

"The programme is comprehensive with something for everyone,” said Dr Milton Lum, co-chair of the Programme Advisory Committee, in his welcoming speech. “The scales and complexities of improvement in healthcare demand new ways of learning and engaging far more people in avocations that are more applicable,” emphasised Dr Lim, urging delegates to grab hold of the networking opportunities during this event to share and learn with one another.

Paradox events of under-development and urbanisation; the cause of rising rates of NCDs

The International Forum in Kuala Lumpur kicked off with a series of pre-conference events featuring experience day site visits—to showcase the state of healthcare in Malaysia and the innovative approaches taken to improve patient care—complemented with full day mini courses which aimed to transform healthcare and introduce quality improvement. The forum took it up another notch on the second day, witnessing the opening ceremony which was graced by the presence of The Sultan of Perak, Sultan Nazrin Muizzuddin Shah. In his opening speech, Sultan Nazrin raised alarm to the fact that the rates of non-communicable disease (NCDs), including heart disease, diabetes, respiratory illnesses and cancer, had increased considerably across the region in recent decades. (According to the World Health Organisation (WHO), South-east Asia now has the fastest rising NCD rates in the world.)

The forum, garnering more than 1,000 visitors, also witnessed Perak Ruler, Sultan Nazrin Shah officiating the event on 25 August 2017.

The forum, garnering more than 1,000 visitors, also witnessed Perak Ruler, Sultan Nazrin Shah officiating the event on 25 August 2017.
 
“From only around 40% in 1990, they now account for at least 60 – 70% of death and disease burden in the region,” he remarked. Sultan Nazrin attributed the cause of the rates to the initial under-development of the infrastructure and workforce of countries within the region. He called for a major transition, including evolving into better equipped and more sophisticated systems to cater for long-term acute and palliative care to a growing population.

While recognising the marked improvements in health status in many developing countries, Sultan Nazrin also pointed out that the situation was now being undermined by deteriorating diets and greater exposure to other NCD risk factors.

“Urbanisation is a key aspect, being associated with various risk factors, including stress, pollution, smoking and poor diet. Increased urbanisation also contributes to higher levels of stress—due to modern work patterns, environmental factors such as pollution, and poverty. And the impacts of stress were seen in high rates of hypertension, as well as in rising rates of mental health problems,” he explained.

Sultan Nazrin emphasised that greater efforts must now focus on preventative measures and addressing other aspects of the NCD epidemic. “These include the substantial vested financial interests in the continued consumption of unhealthy products such as tobacco, alcohol, processed food and soft drinks, as well as greater regulation as part of prevention,” he added.

“Aim. Act. Achieve.” 


With a vision to elevate healthcare and outcomes for patients and communities, this year’s theme puts forward the hope to further inspire delegates to aim high for quality improvement, to act together across professions and with service users, and to achieve real success in improving healthcare worldwide. Reiterating the theme Dr Lum suggested to “do that, to make a difference to our patients.”

“Let us provide more care for our patients in this technological age. Let us move from “What is the matter with you?” to “What matters to you”. Let us reach out, connect and engage our patients. And when we return home, scale out and spread the quality and safety programmes in your institutions,” he elaborated.

Keeping in line with the theme, the programme was structured with five streams—building capability and leadership, population and public health, person and family-centred care, safety and quality, cost, value—which categorised the sessions and presentations across the three-day spectacle.

A plethora of experts from over 13 countries took to the stage and shared their experiences and research with other delegates. Comprehensively, the sessions allowed physicians, nurses and medical students to explore the multiple ways to strengthen the quality and safety of healthcare.

The top-down approach of putting patients first

Featured sessions included the guidance on how to apply quality measurement principles and methods to daily work, the discussion of the role of CEOs in putting patients at the centre of quality healthcare and debate on what is a good patient death, amongst others.

The session on the role of CEOs in patient-centred healthcare garnered a lot of attention, which was mostly attended by aspiring CEOs and CEOs of medical start-up companies. Panel speakers included Dato’ Amiruddin Abdul Satar, President & Managing Director of KPJ Healthcare Berhad; Dr Tan See Leng, CEO & Managing Director of IHH Healthcare, and Ms Artirat Charukitpipat, Chief Operating Officer of Bumrungrad International Hospital, Thailand.

(Left – right) Ms Artirat Charukitpipat, Dr Tan See Leng, Dato’Amiruddin Abdul Satar were the panel speakers for the session on the role of CEOs in patient-centred healthcare. The session was chaired by Goran Hendriks (far right), who was the Chair Emeritus of the event.

(Left – right) Ms Artirat Charukitpipat, Dr Tan See Leng, Dato’Amiruddin Abdul Satar were the panel speakers for the session on the role of CEOs in patient-centred healthcare. The session was chaired by Goran Hendriks (far right), who was the Chair Emeritus of the event.

Citing from their own experiences, Dr Tan said that a healthcare professional’s function “in terms of modus operandi is really to reach out to the patient and making sure that we can bring them the best clinical outcomes and offer them the best value-based healthcare.” 

He added that IHH’s approach has always been working towards consensus. Instead of emphasising on investments in resources to increase hospital beds or hi-tech machines, “the notion has always been that hospitals have and always have been paying attention to patient centricity—and now family centricity—as we continuously strive in our never-ending quest to create a healing environment.”

“Our strategies have always been to work internally and with all of our stakeholders to put the needs of our patients and their loved ones first,” elaborated Dr Tan, adding that patients should always be put in the centre of quality improvement.

He also encouraged a “safe culture and a very active whistleblowing policy for constructive criticism”—as hospital systems are constantly evolving and need improvement.  

Does good care include a good death?

(Left – right) Dr Lam Chee Leong, Dr Wang Yingwei and Dr Lai Siu Fai sharing their opinions and experiences of what encompasses a good patient death.

(Left – right) Dr Lam Chee Leong, Dr Wang Yingwei and Dr Lai Siu Fai sharing their opinions and experiences of what encompasses a good patient death.
 
Another insightful session, featuring a panel of three speakers—Dr Lam Chee Leong, senior lecturer and palliative care physician from University Malaya; Dr Lai Siu Fai, clinical professional consultant from the Chinese University of Hong Kong; and Dr Wang Yingwei, Director General in Health Promotion Administration of Taiwan—sharing their opinions and experiences of what encompasses a good death. The session highlighted that end-of-life care is a neglected aspect of care across the world, even more so for Asian countries.

In view of the different perspectives—of what defines a good death—being held by patients, their families and the multidisciplinary team delivering care, all three speakers urged that rather than attempting to deliver a standard universal approach to achieve a good patient death—care needs to be “tailored and individualised” to cater for the needs of all parties.

“We are very ill-prepared for dying. We run away because it makes us feel very uncomfortable,” said Dr Lam. “Generally, as doctors, we have to heal disease and illnesses; but, we also have to heal people and restore the kind of personhood to them,” he added, citing a paper, by a group of researchers from University of San Diego—led by Dr Dilip Jeste—which discusses the themes of a ‘good death’.

Dr Lam sharing the core themes of a good death from the paper written by a group of researchers from the University of San Diego.

Dr Lam sharing the core themes of a good death from the paper written by a group of researchers from the University of San Diego.
 
Dr Lai and Dr Wang both emphasised that spirituality and being reconnected to religion was also very important to patients. Particularly for the Chinese, where and how they died was important, according to superstition.

“Ultimately, I think all healthcare professionals are responsible for end of life care to ensure good care and a good death,” asserted Dr Lam.

The power of discontent from the perspective of a doctor-turned-patient

The event also featured four keynote sessions which focused on Malaysia’s healthcare system, breaking the rules for better care, innovating new models for emerging markets, improving healthcare quality as a strategy and the power of a discontent as a patient and a healthcare professional.

Saving the best for the last, the forum closed with a keynote session by Dr William Tan, a neuroscientist, medical doctor from Harvard University, world record holder and Paralympian from Singapore.

Dr Tan emphasised on the importance of quality and safety of healthcare through the story of his life. After contracting polio at the age of two—because he “missed out on the two drops of polio vaccine” as Singapore did not implement the immunisation programme—he was paralysed from the waist down. Notwithstanding his disability, he has shown outstanding strength in overcoming adversities. A world record holder of six endurance marathons, Dr Tan found passion in running marathons via hand-cycling and is a triple gold medallist

Dr William Tan sharing his life story – enlightening the audience about focusing on the power of discontent, from the perspective of a doctor-turned-patient.

Dr William Tan sharing his life story – enlightening the audience about focusing on the power of discontent, from the perspective of a doctor-turned-patient.
 
He likened the quality and safety of healthcare to his marathon journey, stating, “it is a journey that is long, arduous and has to be sustainable.”

He realised that “winning medals, trophies or prize money should not be an end to itself. It should be a means to further goodness and to help people.” Since then, he has devoted to championing and fundraising for needy causes worldwide, particularly for the cause of cancer—a cause he holds close to heart.

In 2009, Dr Tan was diagnosed with Stage 4 leukaemia, “making the doctor, the patient.”

“I have looked after many cancer patients in the past, and I was not very excited about being a cancer patient—going through the same kind of treatment,” explained Dr Tan, as he expressed his gratitude of having two caring oncologists, Dr Koh Liang Piu and Dr Benjamin Mow—who went out of their way to help him with his treatment.

“I was so touched by the fact that Dr Koh was willing to learn from the best and how he went about consulting with the best people around the world—cancer centres for example, the Mayo Clinic, Memorial Sloan Kettering, to name a few—on how to treat me, on how to modify a medicine cocktail to suit me,” reminisced Dr Tan.

“It is all about the tailored medicine, and the new paradigm indeed, is very much customised medicine. The quality of healthcare is all about customisation,” he added.

Drawing from that example, Dr Tan said there was no need for a special lesson to enhance the quality of healthcare. Instead, he reminded the audience of the basic lesson from medical school: To always put the patients first. MIMS

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