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Jointly organised by the Institute for Healthcare Improvement (IHI) and BMJ Group, the International Forum on Quality and Safety in Healthcare has a rich history of supporting and energising the international movement for health and care improvement. Improvers from around the world attend the International Forum conferences every year as the place to get involved in key quality improvement discussions and learning, and forge relationships that drive improvement and innovation in health and care. The International Forum in Singapore will explore the key themes in health and care in the region and bring in perspectives and knowledge from around the world. The speakers and the programme have been announced! Keynote speakers, including Maureen Bisognano, Jonathan Perlin, and Steve Davis will share powerful insights on resilience, leadership, and driving meaningful change in healthcare. Register

Join Aqua for their national event, ‘Transforming Tomorrow Through Leadership and Improvement Today’ to connect, learn, and shape the future of health and care through co-production and partnership working. It will be bringing together healthcare leaders, innovators, and change-makers for an afternoon of insightful discussion and meaningful connections as we mark 15 years of the Advancing Quality Alliance being the leading improvement partners. With an exciting line-up of speakers and time for discussion and networking, this event is an opportunity for you to gain fresh perspectives and reconnect with peers. Register

Patient safety is the core foundation of healthcare quality. Unsafe care is a significant challenge globally, due to unsafe practices, processes, or structural inefficiencies within healthcare organisations, which in turn lead to patient safety incidents. This white paper from ISQua aims to address these challenging issues by providing a comprehensive framework to improve patient safety in hospitals and other healthcare settings. The white paper focuses on four foundation pillars that it identifies as critical for embedding patient safety into healthcare systems: 1) Advocacy and Leadership Advocate for prioritisation of patient safety within hospital policies, practices, and culture. Ensure that patient safety is embedded as a core organisational value in every level of healthcare delivery. Establish a strong hospital governance structure that ensures leadership commitment to patient safety and accountability. 2) Health Worker Education and Safety To empower health workers with the knowledge, skills, and tools to be proactive agents of patient safety within healthcare organisations through continuous education and training programmes. It prioritises the physical and psychological well-being of healthcare professionals to enhance workforce resilience to deliver safe and effective care. 3) Patient, Family and Carer Engagement and Empowerment To empower and engage patients, families, and carers in patient safety efforts. To ensure effective collaboration between healthcare providers and patients to improve safety and quality of care delivery 4) Improvement in Clinical Processes Adopt evidence-based practices to manage patient safety risks in clinical care. Ensure standardising care, utilising technology, and measuring progress and effectiveness.

This webinar will look at how we can collaboratively and effectively utilise clinical audit to continuously improve patient safety, prevent avoidable harm and work together within our patient safety systems. The Clinical Audit Hero Award for Patient Safety will be announced and there will be the opportunity to hear the winner present their project for wider learning for us all. The event is hosted by the National Quality Improvement (inc. Clinical Audit) Network (N-QI-CAN) and the Healthcare Quality Improvement Partnership (HQIP). Register for the event

This event will explore successful strategies for enhancing patient safety and driving quality improvement in mental health services. This timely event addresses the critical issues highlighted by recent high-profile incidents in mental health care. Keynote speakers, including Adrian James, the National Clinical Director of Mental Health, and Shubulade Smith, President of the Royal College of Psychiatrists, will share their experiences of leading organisations through challenging situations. Jonathan Warren, co-author of the Edenfield report, will also provide unique insights. Key themes: Supporting staff through traumatic incidents. Amplifying patient and family voices. Service redesign for safer care. Innovative use of data for improved outcomes. Learning from significant events to prevent recurrence. Balancing human rights with public protection. Interactive workshops will showcase best practices from pioneering trusts and innovative approaches, including assertive outreach and data-driven improvements. The event also provides valuable opportunities to network with peers and experts. This event is essential for clinicians, managers, trainees, and those in the voluntary sector aiming to navigate current challenges and shape the future of mental health care. By attending, you will: Attend learning lessons from serious high profile incidents in mental health – participants will learn how incidents have been managed, lessons learned and how to reduce prevention of similar events in future by service redesign Learn how to support staff affected by serious incidents – participants will learn successful strategies for supporting staff after serious incidents Hear strategies for re-designing services to reduce harm to patients including the use of date for quality surveillance Know how to balance the human rights of individuals against protecting the public. Register

The International Forum on Quality and Safety in Healthcare is a series of international conferences that inform and inspire healthcare leaders, practitioners and patients towards a better, safer and higher quality of care. With almost 30 years of history, the International Forum supports and energises the movement for patient safety and healthcare improvement by bringing in knowledge, ideas and expertise that inform quality projects and practice transformation worldwide. Over 5,000 participants from 80+ countries attend our International Forums each year and tackle today and tomorrow’s critical health and healthcare challenges. They connect to form long-term partnerships and to consider new ways of thinking about healthcare. Register

The healthcare landscape is evolving rapidly, with increasing complexity in patient needs, technological advancements and regulatory requirements. As this complexity grows, ensuring patient safety remains a top priority. One of the most widely adopted strategies for enhancing safety is quality improvement (QI), but is QI the right tool for navigating and improving safety in an increasingly complex health system asks Patient Safety Learning’s Associate Director Claire Cox, in this blog for the hub. Understanding QI in healthcare Quality Improvement (QI) refers to systematic efforts to enhance healthcare processes and outcomes through data-driven interventions. QI frameworks, such as the Plan-Do-Study-Act (PDSA) cycle, Lean and Six Sigma, focus on continuous monitoring, identifying inefficiencies and implementing evidence-based solutions.[1] By targeting system vulnerabilities, inefficiencies and variations in care, QI initiatives aim to foster a culture of patient safety and deliver consistent safe and effective care. However, as healthcare systems become more complex, can QI alone address the multifaceted challenges of ensuring patient safety? The role of QI in enhancing safety within the NHS QI plays a crucial role in enhancing patient safety by adopting systematic, data-driven methodologies to improve healthcare delivery. Within the NHS, numerous organisations have established QI initiatives, teams and trained personnel to improve the safety and efficiency of care. The recently introduced NHS Impact framework aims to equip all NHS organisations, systems and providers with the skills and techniques required to embed continuous improvement into everyday practice.[2] Strengths of QI in enhancing safety Data-driven decision making QI frameworks rely on real-time data to identify trends, measure performance and implement solutions. This evidence-based approach helps in proactively addressing safety risks and reducing adverse events.[3] By leveraging robust data analysis, NHS organisations can identify systemic weaknesses and implement targeted interventions to enhance patient outcomes. Systematic and scalable interventions QI methods, such as Lean and Six Sigma, focus on standardising processes to minimise variability in care. This is particularly beneficial in high-risk environments, such as surgical units, emergency departments and intensive care units.[4] The NHS’s systematic approach ensures that successful QI initiatives can be scaled across multiple settings, fostering consistency and reliability in care provision. Continuous improvement culture A core strength of QI is its emphasis on continuous learning and adaptation. By actively engaging frontline healthcare professionals in problem-solving, QI fosters a safety-oriented culture that promotes innovation and accountability.[5] Within the NHS, the NHS Impact framework underscores the importance of building a shared purpose and vision, investing in people and culture, developing leadership behaviours, building improvement capability and capacity, and embedding improvement into management systems and processes.[2] Reducing costs while enhancing safety Preventing medical errors and reducing inefficiencies not only enhances patient safety but also lowers healthcare costs. Many hospitals have demonstrated significant financial savings by implementing QI-driven safety initiatives.[6] By reducing avoidable harm and improving workflow efficiencies, the NHS can achieve cost savings while maintaining high standards of care. Governance, patient safety and the quality dilemma Governance in healthcare, often referred to as clinical governance, is defined as “a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”.[7] This involves monitoring systems and processes to provide assurance of patient safety and quality of care across the organisation. A key challenge in QI implementation is navigating the quality and patient safety dichotomy. While quality improvement aims to enhance efficiency and effectiveness, it must not compromise safety. Balancing these aspects requires a structured approach, integrating QI methodologies with robust governance mechanisms to ensure that safety remains paramount. Limitations of QI in complex health systems 1. Resistance to change Implementing QI initiatives requires cultural and behavioural shifts, which can face resistance from healthcare professionals. Without strong leadership and engagement, efforts to improve safety may fall short.[8] 2. Fragmented healthcare systems Modern healthcare systems involve multiple stakeholders, including hospitals, primary care providers, insurers and policymakers. QI initiatives often struggle with alignment across these diverse entities, limiting their effectiveness in ensuring comprehensive patient safety.[9] 3. The need for holistic safety strategies Although QI is a powerful tool, it may not be sufficient on its own. Addressing safety in complex systems requires integration with other approaches, such as human factors engineering, regulatory frameworks and digital health innovations.[10][11] 4. Data overload and implementation challenges Although data is essential for QI, excessive reliance on metrics can lead to ’analysis paralysis’. Additionally, implementing QI interventions at scale can be resource-intensive, requiring time, training and financial investment.[12] In my experience, teams often seek more data, sometimes requesting information that we don’t have access to or that isn’t always reliable. There are times when data merely describes a potential problem rather than addressing it directly—but because gathering data is easier than implementing solutions, it can become the default focus, slowing progress. The use of emerging safety science tools for reviewing ‘work as done’ has yielded valuable insights into the discrepancies between ‘work as imagined’ and ‘work as actually performed’. These insights highlight the complexities and adaptive nature of real-world work practices, often revealing gaps between prescribed procedures and practical execution. However, while these insights provide a nuanced understanding of workplace dynamics, they do not always translate into tangible, quantifiable data that directly supports QI methodologies. QI relies heavily on measurable data to assess performance, identify inefficiencies and implement evidence-based interventions.[13] Traditional QI approaches, such as PDSA cycles, Lean and Six Sigma, are data-driven, emphasising statistical analysis and process metrics.[14] In contrast, the insights derived from safety science tools often emphasise qualitative aspects, such as human factors, resilience engineering and system complexity.[15] While these insights enrich our understanding of organisational performance, they may not always align with the structured, empirical requirements of QI methodologies. Bridging this gap requires integrating qualitative insights with quantitative data collection methods. Techniques, such as ethnographic observations, safety culture assessments and frontline worker narratives, can complement QI initiatives by providing context to numerical performance indicators.[16] The way forward: Integrating QI with broader safety strategies To maximise its impact, QI should be integrated with other safety-enhancing approaches: Human factors engineering: Designing systems that account for human limitations can reduce errors and enhance safety.[17] Regulatory and policy support: Strong governance structures and safety regulations can reinforce QI efforts.[18] Digital health solutions: Leveraging artificial intelligence, electronic health records and predictive analytics can complement QI initiatives for improved safety outcomes.[19] Interdisciplinary collaboration: Engaging multiple stakeholders—patients, families, carers, clinicians, administrators and policymakers from differing healthcare sectors across the system—can ensure a holistic approach to safety improvement.[20] Conclusion QI is a vital component in enhancing patient safety within the NHS, providing a data-driven, systematic approach to continuous improvement and cost reduction. The NHS Impact framework ensures that governance and patient safety remain central to healthcare delivery.[21] However, in an increasingly complex system, QI should not be viewed as a standalone solution. Instead, it must be integrated with broader strategies, including human-centred design, technology, policy support and cross-sector collaboration.[22] A safety management systems approach, as highlighted in Healthcare Safety Investigation Branch (HSSIB) reports, is essential to embedding a proactive, system-wide perspective on patient safety.[23] Additionally, aligning QI efforts with patient safety standards and Patient Safety Learning standards ensures a structured, evidence-based approach to mitigating risks and driving sustainable improvements.[24] Furthermore, regulatory frameworks, such as the National Patient Safety Strategy and the NHS Patient Safety Incident Response Framework (PSIRF). provide additional guidance for fostering a learning culture and improving incident response. In conclusion, while emerging safety science tools offer profound insights into the realities of work as done versus work as imagined, these insights must be systematically incorporated into data-driven QI frameworks. By integrating qualitative and quantitative approaches, organisations can achieve a more comprehensive and effective strategy for continuous improvement and enhanced safety performance. The key challenge for healthcare leaders is not whether QI is essential, but how to optimally combine it with these frameworks and strategies to build a resilient, high-quality healthcare system that continuously evolves to meet patient safety needs. References Institute for Healthcare Improvement. The Model for Improvement, 2020. NHS England. About NHS Impact, 2024. [Accessed 21 February 2025]. Berwick DM. The science of improvement. JAMA, 2008; 299(10): 1182-4. Graban M. Lean hospitals: Improving quality, patient safety, and employee engagement. Taylor & Francis Group, 2016. Batalden PB., Davidoff F. What is "quality improvement" and how can it transform healthcare? Quality & Safety in Health Care, 2007; 16(1): 2-3. Makary MA, Daniel M. Medical error—the third leading cause of death in the US. BMJ, 2016; 353, i2139. NHS England. Governance, patient safety, and quality, 2024. Greenhalgh T., et al. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly, 2004; 82(4), 581-629. Shortell SM., et al.  Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Quarterly, 1998; 76(4), 593-624. Carayon P, et al. (Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 2014; 45(1), 14-25. Carayon P, Schoofs Hundt A., Karsh, B-T, et al. Work system design for patient safety: The SEIPS model. Quality and Safety in Health Care, 2014; 15(Suppl 1), i50–8. Pronovost P.J, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 2006; 355(26): 2725-32. Institute for Healthcare Improvement. Quality improvement essentials toolkit, 2021. Deming WE. Out of the crisis. MIT Press, 1986. Hollnagel E, Woods DD, Leveson N. Resilience engineering: Concepts and precepts. CRC Press, 2006. Vincent C. Patient safety. John Wiley & Sons, 2010. Reason J. Human error. Cambridge University Press, 1990. Leape LL, et al. Transforming healthcare: a safety imperative. BMJ Quality & Safety 2009; 18(6), 424-8. Wachter RM. The digital doctor: Hope, hype, and harm at the dawn of medicine’s computer age. McGraw-Hill Education, 2015. Grol R., et al. Improving patient care: The implementation of change in health care. John Wiley & Sons, 2020. NHS England. The NHS Impact Framework: Embedding Continuous Improvement. 2023. Dixon-Woods M, Martin G. Does quality improvement improve quality? Future Hospital Journal, 2016; 3(3): 191–4. Healthcare Safety Investigation Branch. Safety management systems: an introduction for healthcare. 2023. Patient Safety Learning. The Patient Safety Standards. 2020.