Kevin Hardy talks to Dr Peter Lachman MD, MMed, MPH, MBBCh, FRCPCH, FCP(SA), FRCPI; CEO of International Society for Quality in Health Care (ISQua).

I was fortunate on my recent travels to London, to meet up with a man I have come to know well and with whom I enjoy sharing stories. There is a strong alignment between Peter and I, and between the vision and values that Peter leads for ISQua, and HardyGroup’s own vision and values. The ISQua values – Knowledge, Network, Voice are the core values and foundation on which HG was founded, and ones we hold strongly to, thirty years on.

Kevin: What excites you about the global role that ISQua plays in quality, safety and value in healthcare?

Peter: I have been involved in the quality and patient safety arena for my entire clinical career so I have had the opportunity to make a difference at a clinical level, and then organisational and national levels. I can now share my experience at an international level.

We have come a long way in the past 20 years, and I think we now know what to do and why we need to change. The challenge is how to make the fundamental changes needed to impact on the quality and safety of care.

ISQua as an international network has the opportunity to allow for the spread of ideas and to give people the opportunity to join forces in a common goal.


ISQua gives people the opportunity to join forces in a common goal.


I can give a few examples

  • ISQua recently announced our support of the Patient Safety Movement Foundation (PSMF) and their mission to eliminate preventable deaths in hospitals, with a signed cooperation agreement. ISQua and PSMF will work together to identify common projects in the field of patient safety and promote each other’s activities on an ongoing basis. ISQua and PSMF will hold joint sessions at their respective conferences, at ISQua’s 36th International Conference (20th – 23rd October 2019) in Cape Town, South Africa; and PSMF’s 8th Annual World Patient Safety, Science & Technology Summit in 2020.
  • Our work with the WHO is very well regarded and has the potential for great impact. ISQua’s ‘Declaration on Universal Health Coverage and Patient Safety’ was presented on the second day of the Fourth Global Ministerial Summit on Patient Safety, which took place in Jeddah, Kingdom of Saudi Arabia, from 2–3 March 2019, during the ‘Considerations by NGOs’ session. This year’s Summit focused on patient safety in low and middle-income countries and reducing adverse events. ISQua’s Statement on ‘Global Action on Patient Safety’ was submitted as an agenda item on Global action on patient safety of the 144th Session of the WHO Executive Board (February 2019). ISQua is a non-State actor in official relations with WHO. ISQua will be working closely with WHO to help establish and implement a World Patient Safety Day, to take place annually on 17 September.
  • ISQua is committed to incorporating the experience of patients, who are experts in living with their condition, within our conference, while ensuring they are neither excluded nor exploited. To this end, we have implemented the Patient Inclusion Scholarship. It is our aim to bring together delegates and speakers from across the world to learn from each other, and to test ideas, research findings and insights. It is our hope that attendees return to their homes to apply new knowledge and skills to the benefit of their patients. Since receiving the inaugural Patient Inclusion Scholarships, our Patient recipients are now key participants of our Board committees.

Kevin: If you project 3 years downstream what will be different about how quality and safety will be able to demonstrate through evidence the capacity to save lives?

Peter: The time has come for us to fundamentally assess the current design of healthcare worldwide. We have a number of challenges. The first is to redesign the services from the hospital-centric model to one of preventive healthcare in the broadest spectrum, with investment in prevention rather than treatment. This implies some difficult choices about what we should do.

We need to realign incentives so that high quality is the business model for healthcare rather than simply providing care.

This requires a culture change and the political will to change our concept of healthcare delivery. I believe we would not design healthcare in the way we currently deliver it. Therefore, we need big picture thinking utilising the latest in digital technology to make care affordable and effective.

Kevin: ISQua has members in over 70 countries worldwide. Given that cultures and context are different across the international healthcare arena, are there any examples that you have witnessed and confirmed as breakthrough strategies that we can all learn from?

Peter: We are seeing reverse learning from low-income countries to high-income countries. There is still the desire of the former colonial powers to spread knowledge vertically without realising that if one empowers people in resource-poor countries they will come up with inventive solutions. An example is our work in Mozambique where we had an effective programme enabling local leaders to deliver solutions that could be applied in other countries and contexts. The tendency is for us to continue the power imbalances. I believe ISQua can make a real difference in spreading knowledge, building networks and giving people the voice to learn and share innovative practice.

In our conferences and communities of practice, we look for ways we can build networks of learners. This has been translated into tracks in our conferences as we try to explore new ways to bring Knowledge and Voice to the people who deliver care.

Kevin: What leadership qualities and skills are essential in leading a global organisation?

Peter: The key is respect and humility. An understanding of context and the challenges that people face in different cultures is essential. I always respect the local climate and the challenges people face. My aim is to learn and to spread the learning. One of the focuses I have had is to make ISQua truly international and to focus on lower-income countries while at the same time not neglecting the middle and high-income countries who are our main funders. We also need to look at the different constituencies’ world-wide, our external evaluation focus which has become more relevant as we set standards, the quality and safety needs of the majority of the world’s population, and the need to be person-centred in all what we do.

Kevin: What are the key risks in the Quality and Safety field in the future?

Peter: The major safety challenges depend on context. Medicine safety and safe surgery are key as are infections and antimicrobial stewardship. Most of what we deal with now – falls, pressure ulcers, infections etc. are problems we have created. However, we now have a deeper understanding of the

theory and methods to be safe. These need to be applied and lead to the biggest danger – a culture that does not place safety and quality as the reason for our being in healthcare. Lack of knowledge and the failure of medical schools to adopt a new way of thinking and to include safety and quality theory and methodology as integral parts of undergraduate and postgraduate teaching mean that the next generation will be as safety and quality illiterate as the current one.

Kevin: In your current leadership role, what have you learnt about yourself as a leader?

Peter: I am by nature an innovator and big picture person. I know I need to have detail-oriented people to work with me so that there is focus, and that I do not miss out on key issues. I like to think laterally, and my best pleasure and inspiration comes from the QI Scholars I mentor. I also have had to learn how to manage up, and sometimes I am too far ahead of the curve and I need to reign myself in. But I have learnt how to distribute leadership and grow the team I am fortunate to have. I have learnt that to be a good leader one needs to trust those with whom you work and to allow them to learn and grow.

Kevin: How could all the different organisations in this field work better together in order to enhance alliances and relationships and make the patient even more central to the business of care?

Peter: I think that the growth of organisations in the field is a good phenomenon. However, I view the growth of vendors of solutions to be potentially problematic.

The answer is in developing the skills and enabling those in the front line to improve.

We have been fortunate to have a number of alliances – the International Hospital Federation ((IHF), IHI, WHO, PMSF etc. By working together, we will have a lasting impact – after all, the ocean of quality improvement and patient safety is vast – we need to work together and not compete to bring quality to all.

About ISQua

ISQua, the International Society for Quality in Health Care, was established in 1985 as an independent, membership-based, not-for-profit community with a vision to promote quality and safety in healthcare through international co-operation and collaboration. ISQua is dedicated to making this vision a reality. ISQua offer community membership, a range of education programmes, external evaluation services, communities of practice, and a number of regional and international events and conferences. http://isqua.org/

Each member of the community is provided with ISQua’s three core values: Knowledge, Network and Voice.

  • Knowledge: Learn from a wide range of international experts and start making improvements within your own personal context.
  • Network: Expand your professional network, make new contacts and become a valued member of our community.
  • Voice: Share your thoughts, ideas and opinions, and showcase your research with like-minded peers. Be recognised for your contribution to the community.

Our extensive network of healthcare professionals spans over 70 countries and six continents, and our members are at the forefront in developing and delivering solutions to improve the quality and safety of care. ISQua has one of the most extensive international healthcare partnership networks in the world, including official relations with the World Health Organization (WHO).