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The healthcare quality improvement advocate speaks to SGS

Trying to pin Dr. M. Rashad Massoud down long enough for an interview is no mean feat. The smiling American-based, British and Russian-educated Palestinian doctor is seemingly always on the go. The morning sessions start at 9am and he might have been up until 1am, perfecting the next day’s line-up, updating the e-conferencing website, or discussing the improvement of quality improvement with other participants into the small hours, but the tiring schedule never shows.

Dr. Massoud is no stranger to the Salzburg Global Seminar. Now chairing the session ‘Making Health Care Better in Low and Middle Income Economies: What are the next steps and how do we get there?’, Dr. Massoud first came to Salzburg as a fellow in 2001. A student of Don Berwick, the outgoing Administrator of the Centers for Medicare and Medicaid Services and the former president and CEO of Institute for Healthcare Improvement in the USA, Dr. Rashad attended a session on Patient Safety and Medical Error. This first visit to Schloss Leopoldskron convinced Dr. Rashad of the value of the Seminar.

“The first seminar I came to,” Dr. Massoud explains over a hastily poured coffee, “followed the Institute of Medicine’s report ‘To Err is Human’ in which medical errors were described as between 48,000 and 98,000 errors per year, half of which are easily preventable. And what [Don Berwick, session chair] did, because safety was a poorly developed area generally speaking in healthcare, he brought in experts from aviation, from space, from road traffic accidents, from psychologists to meet with people who are in the area of improvement and that was the beginning of a major thrust in patient safety today. In fact some of the people who were here in 2000 are today some of the leaders in safety and healthcare. That was an amazing experience...

“The whole patient safety movement – a lot of them were here and that’s how the work started. The meeting here was certainly a significant milestone in the development of the safety effort in healthcare and it really moved things forward.” Dr. Massoud agrees he has similar high hopes for his session this week.

“I’d really like us to take the opportunity of this magnificent setting,” he says turning to look out of the Meierhof, across the lake and to the Untersberg mountain.

“The environment we have, the focus that we get out of having 60 people in the same place – not just for the session but for all the interactions outside of the sessions. Having been here already – these interactions were even more valuable than the formal sessions themselves.”

Indeed – Dr. Massoud is almost as great an advocate of late night discussions in the Schloss’ Bierstube as he is of improving healthcare.

“So if we can put all this together,” he continues, “what I’d like to come out with is a thoughtful way that all of us who are representing different groups – host country national governments, improvement efforts, representing implementers in the field, donor agencies, other stakeholders – all of us should think through how do we maximise and leverage everything we have that would enable us to improve healthcare in a different way, take the healthcare improvement effort, which has so far been very successful, to a whole other level.”

The session itself has been two years and dozens of hours of Skype conference calls in the making and brings together over 60 healthcare professionals, from physicians, donors, improvement advocates, government officials to civil society leaders, from over 35 countries.

“When John Lotherington [SGS Program Director for Health] approached me with the idea of a seminar on improvement science…my idea was that we probably don’t need just another conference or meeting to talk about it, however what we could do is a strategy conversation – something that would enable us to think through what have we accomplished to date, what are the challenges ahead and design an agenda that would take us through the next five to ten years. Everything followed from there. I invited partner organisations, colleagues to join the planning committee. We started to think through what would that agenda look like, what are the themes we have to discuss, who are the people we need to have in the room?”

Much of this week’s session has focussed on ‘Quality Improvement’, and although the physician-cum-Director of USAID’s Health Care Improvement Project is a strong advocate of the school of thought (that more isn’t always better – more resources, more money, more hospitals – and that healthcare professionals should strive to deliver the best level of care from the resources they have and constantly improve upon that level of care) he is not overly keen on the term. “If there was one thing I could do here it would be remove the word ‘quality’,” he laughs.

“Everything we’re talking about here is how can we ensure the patients get the best outcomes possible. What is the best medicine that we know? Can we deliver it to them correctly so that they benefit maximally from this? Can we do this in ways that are not wasteful and inefficient? Can we be mindful about meeting patients’ needs and expectations? Improvement is what we should be doing in the first place; good quality care is what we should be providing patients anyway.”

His enthusiasm for the topic is clear from the outset, driving conversations from the breakfast table first thing in the morning, through the day’s sessions, right up to in the Bierstube – the Seminar’s own on-site bar – last thing at night.

“He’s like this all the time,” says his research assistant, Nana Mensah Abrampah. Dr. Massoud just laughs, shrugs, and hurries off for another meeting.