What happens in Gothenburg doesn’t stay in Gothenburg

Four members of our Quality Improvement team were able to attend the Internation Forum on Quality and Safety in Healthcare held in April in Gothenburg, Sweden. Sarah White, Quality Improvement Adviser, offers this round-up of their experiences, thoughts and learning.

Four head to Sweden

Having overcome the vagaries of booking systems to organise our planes, trains and automobiles, the team set off for Gothenburg; a fairly epic trans-European trek across the hinterland of well, Belgium!

As you would expect, the conference was hugely popular and well attended with over 3,000 delegates from all over the world, including India, Australia and the USA – who presumably made far more epic treks than me in order to get there!

There is no doubt, it is exciting to be part of such a big and well-respected event and our Quality Improvement team was proud to be presenting two posters on key projects: PreCePT (Prevention of Cerebral Palsy in Pre-term births) and Don’t Wait to Anticoagulate.

The Godfather of Improvement Science

My week started first thing on Wednesday morning with Don Berwick giving the keynote speech. Natasha and I secured front row seats and settled back to enjoy the Red Bead exercise on the main stage.  If you’ve not heard of it, it’s a good tool for demonstrating that…

We as workers most of the time have no control over our experiences. We the worker did not make the company – our bosses did – and we should not be held responsible for most of the mistakes. Yes, we can control about four out each 100 problems but not the other 96. They are problems created by the system.


It was great to have the solid theories and principles showcased that inspired all the work we were about to see.

There was lots of talk about patient flow. Steve attended some interesting sessions on learning from supply chain management in managing patient flow, highlighting that the concept of ‘emotional flow’ is really important.

Learning and leading

Also, in support of our West of England Academy, the international stage is finding evidence that a coaching approach can be the key ingredient in successful improvement. The Vinnvard research programme demonstrated that improvement is best based around specific improvement projects, and that ‘learning by doing’ is critical, demonstrated by the experience from the Vastra Gotaland region.

In a ‘learning stuff for QI’ way, Natasha managed to get hold of a useful tool for our toolkit. In a session entitled Accountability in Care she learnt about what motivates us in the workplace and changing from a Quality Assurance culture to a Quality Improvement culture. An exercise using Polarity Maps made her think about how we get a balance between two concepts: how we identify if the balance is wrong and how we can correct it. Natasha was so enthused by the session that 1) she didn’t stop talking about it and 2) she would love to deliver something similar for our team sometime in the future.

The Sheffield Microsystem Coaching Academy team was represented by Tom Downes, whom Steve found particularly inspiring. A key piece of advice was to start each improvement meeting with a patient story to help maintain engagement with improvement work.

(I should probably mention at this point, that the conference was fuelled by coffee and cake; Fika heaven and the breaks provided loads of opportunities for networking, which seems much easier when sugar and caffeine are combined.)

Steve and I presented the PreCePT poster – tag teaming the information like we’d done it before! For me, this gave an opportunity to reflect on the work we have done as a team and what we have achieved during the last two years. Our poster was a great success; one conference attendee picked up a handful of leaflets saying…

“I will be shamelessly stealing this project and implementing it in my hospital in Scotland!”


The reception evening was held on Wednesday and delegates stayed on after the sessions finished to enjoy canapes and wine.  We spent a good deal of time speaking to our AHSN colleagues from other regions and also the delegates from East London Foundation Trust (ELFT).

The work that ELFT is doing is truly inspiring and they seem to be at the forefront of QI in secondary care in the UK, presenting four sessions during the conference and contributing to another panel discussion.  We were able to tag along with our new ELFT friends to sample some another of Gothenburg’s cultural highlights: Thai food. This was an excellent opportunity to reflect on the first day with a group of delegates and swap stories and experiences.

Thursday brought another full day of total immersion into all things QI. I found the Q Foundation’s session on Mobilising Improvement and Learning at Scale across Systems particularly interesting for the networking analysis that they undertook. It demonstrated the power of creating and sustaining viable networks across the country for sharing knowledge. The delegates were asked to indicate how comfortable they were with change and uncertainty using a clock face, acknowledging that both ends of the comfort scale were required to successfully run a programme.

Unsurprisingly, I chose the ‘five past twelve’ position which is Very Comfortable with change, but it was clear that both ends of the comfort scale are required for successful projects as someone needs to have the plan!

Different things stood out for different team members; different things resonate based on the work they’re engaged with. Here are some of the highlights…

King of Lean

Steve’s highlight was two presentations from Gary Kaplan and Jack Silversin from Virginia Mason Hospital on engaging doctors in transformation, although the learning was applicable to all clinical staff.

I also attended this session and was impressed by focus on human factors demonstrated by Virginia Mason as they transform the patient experience of healthcare, stating that organisational change is most effective when lean management method engages employees at all levels — from leaders, to providers, to frontline staff. When lean tools and methods are used at every level of the organisation, focused improvement will create value, eliminate waste and reduce the burden of work.

So I may not be a Lean convert just yet, but maybe, in time…

Rebels with a Cause

The final day came far quicker than expected and it started with Lois Kelly talking about a subject close to my heart; Rebels at Work. Lois was inspiring us to be a ‘brave-hearted rebel’ at work and empowering change within our organisations.

Improving healthcare starts one rebel spirit at a time, daring to embrace new ideas, new people, new ways of working, and our true, naked-hearted selves. Lois Kelly of the Rebels at Work movement opened our heads and hearts to what it takes to shake up healthcare-as-usual, from running with rebellious wild packs and communicating like an activist to having difficult conversations and developing practices of resiliency and optimism.

I loved this. It was inspiring and challenging but realistic. Lois also talked about knowing when to back down, which is absolutely as important as knowing when to rebel.

Innovation for Life

This was followed by Jaideep Prabhu talking about Frugal Innovation: How to Do More with Less. Jaideep Prabhu discussed the creation of better and cheaper solutions that employ fewer resources—and how it helps to meet the unmet needs of large numbers of people around the world in core areas such as health, education, energy, and financial services.

This session highlighted examples of such innovation by entrepreneurs, NGOs, emerging market firms and multinationals in the North and South, and discussed the challenges and opportunities for small and large organisations alike.

Round the World

After the obligatory coffee and cake break, we found ourselves back in the auditorium for a round the world trip in Quality Improvement in Mental Health.

This session consisted of Pecha Kucha style presentations from different groups around the world that are applying quality improvement techniques to tackle complex problems in mental health services. We got a glimpse into the breadth and scale of mental health improvement work taking place across the globe.

Don’t Wait to Anticoagulate

Friday also brought us the opportunity to show off our Don’t Wait to Anticoagulate poster.

We saw some impressive work that had a huge impact on a small scale from colleagues in Sweden and Denmark. After the group session we stood with the poster and talked to more people who were around for the session but were not in our group, and generally collared people to show off our work. It was engaging, and a great way to share learning.

Museums Theatre and Health

Finally for me there was a session on Culture on Prescription.  This session explained how undertaking cultural experiences actively can contribute to improve health and enhance rehabilitation. This was really powerful with interesting stuff on holistic healthcare emanating from School of Health Science, Jönköping University.

What I found so interesting was the massive influence on people’s lives that a seemingly simple intervention can have. The study was small with only 76 participants but showed that over 50% were able to go back to work following the project. Small changes making big impacts once again!

Twitter Meltdown

The whole team really got into the Twitter culture at Gothenburg and although the spirit was willing, the technology was weak.  The internet connection dropped out every time the audience got excited about something as we were all tweeting like mad!

Horsing Around

Any international travel is an opportunity to sample the local cuisine and our little team found some great food in Gothenburg.  The first night was spent in what could only be referred to as Hipster Heaven – bearded young men in too-short trousers drinking artisan beers, and us!  The food and ambience was great though and the team had an opportunity to plan out the sessions and seminars that we would be attending.

Poor Natasha was upset that we didn’t get a selfie with Don Berwick – but his keynote speech kicked off the conference with a good dose of ABBA!  This got two Quality Improvement leads swaying in their seats and waving (imaginary) ‘WE LOVE DON’ banners!

Gothenburg is lovely, the rain held off until the last day, the hotel staff were pleasant and effective and the public transport was on time every time.  Although, it has to be said that there are some more eccentric sights to be seen…

Posted on May 6, 2016 by Sarah White, Quality Improvement Adviser, West of England AHSN

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