Article Text

Download PDFPDF

On acquiring a socially transmitted discovery (STD) in Berlin—and Paris, and Prague
  1. David P Stevens
  1. Dr David P Stevens, Adjunct Professor and Director, Quality Literature Program, Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Street, Lebanon, NH 03766, USA; david.p.stevens{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The improvement of healthcare quality and patient safety is at its heart a social act. I am particularly aware of this each year when I attend the International Forum on Quality and Safety in Health Care. In March 2009 in Berlin, I spent one of the most pleasurable evenings I can remember in a restaurant with colleagues from the UK, Sweden, Spain, Australia, Netherlands, Italy and the USA—a group with whom I meet annually at the International Forum. We enjoyed a similar evening in Paris last year, and in Prague the year before that. I am inevitably the beneficiary of the learning that comes from such a diverse and expert international group. As I reflect on these gatherings, I am reminded that I am the beneficiary of many Socially Transmitted Discoveries (STDs) that are highlights of the annual Forum.


I live in the USA. We Americans have a reputation for being quick to give advice. Fortunately, the USA now has national political leadership that counsels listening. The US healthcare system is a troubled enterprise,1 so we have a lot of listening to do. Granted, American medicine generally provides complex and valuable healthcare. Yet US healthcare per capita costs are about twice that of the next most costly system in developed countries, and its health outcomes are some of the worst.2 So, there is plenty of room for improvement. In this regard, Don Berwick3 taught me early in my improvement career that diffusion of innovation happens more quickly when we share and make use of the really good ideas that we learn from each other.4 Attendees from over 60 countries gathered in Berlin. Hence, the considerable value—in this American’s opinion—of an American listening to the many knowledgeable colleagues who attend the International Forum each year.


But the formal parts of the Forum are also wonderful examples of colleagues who have reflected carefully on what they can teach the rest of us. For example, I would go anywhere to spend an hour learning from Trisha Greenhalgh, one of last year’s plenary speakers. So, the hour spent listening to her in Berlin was absolutely memorable. You can see and hear her talk online at the Forum Site.5 Other plenary presentations are there as well. You will see what I mean about innovation and learning.

In addition to the plenary sessions, I also benefit generously from the many excellent original posters6 and breakout sessions. But I confess the real value for me in a meeting like this is the social interaction where I can learn, question and discuss. Restaurants are certainly excellent venues for learning, but there is much to learn in chance encounters with colleagues in the hallways and coffee and tea breaks. This is where STDs abound. Truth be told, I have a colleague from Cleveland who confesses that his principal strategy for attending most large meetings like the Forum is to stake out a space at coffee and tea breaks, and then wait for colleagues to arrive and catch up with what has transpired in their institutions over the previous year.


The Forum is, of necessity—like most large international conferences—expensive to host, so the BMJ and IHI must levy a sufficient attendance fee to meet these costs. It also costs a lot for attendees to travel to the meeting. I have learnt some effective cost-saving innovations over the years. For example, I know of many colleagues who always submit their most recent work in well-crafted posters. If they have been accepted for the Program, they take them to their managers and/or department leaders, and show them what they are doing to share their local success with others. Institutional leaders often are willing to contribute to support attending the Forum when such attendance adds to the good reputation of the institution. It often requires a deft negotiation, but it is the principal way that many delegates are able to raise funds to attend.

So, please go to the Forum website to see examples of successful abstracts from Berlin. Pick several that you think are particularly well presented. They provide opportunities to learn presentation strategies that you can use to present your own original work. The QIR7 and SQUIRE Publication Guidelines8 will also be helpful. They are intended for scholarly publications, but they can be adapted to presentation of original improvement work in abstract and poster formats as well.

Here is another STD from last year. The Jonkoping County Council, Sweden, a particularly innovative healthcare system, is dealing with very difficult financial times like we all are. They are so good at healthcare quality improvement that they generally send dozens of improvement professionals to the Forum. In 2009, to save transportation costs, they chartered a motor coach, and all attendees travelled from Jonkoping County to Berlin together. I am told that, while en route, they inescapably spent countless hours working and learning from each other. And think of the krona they did not spend and the carbon they did not release into the atmosphere.


Finally, health profession students have unique opportunities for reducing their costs of attendance while taking advantage of learning opportunities that are specially targeted to their interests and professional level. There is now a Student Forum—actually a Forum within a Forum—organised by an international group of visionary educational leaders that include Michael Bergstrom and Jill Duncan.9 Students can benefit from learner-focused strategies, many of which are actually student-organised. Participants in the Student Forum have the opportunity to apply for scholarships to attend the larger Forum.


As a confirmed introvert, it always surprises me how much I enjoy the Socially Transmitted Discoveries that I acquire at the annual International Forum for Quality and Safety in Health Care. I anticipate that the 2010 Forum in Nice will be no exception.10 I hope to see you there.


In the spirit of transparency, the author shamelessly “borrowed” the idea for the title of this editorial from his friend, Dr Iris Litt—then the Editor-in-Chief of The Journal of Adolescent Health—while discussing writing and editing in a restaurant in San Diego, California.11



  • Competing interests: DPS is Editor-in-Chief of Quality and Safety in Health Care, which is published by the BMJ Group. BMJ is a co-owner of the International Forum and stands to benefit from its success. Moreover, every Forum attendee receives a subscription to QSHC as part of their full registration, so QSHC in this sense also stands to benefit from the Forum’s success.