The USA National Forum on Quality Improvement in Health Care—organised by the Institute of Healthcare Improvement (Boston USA)—attracts many people from outside North America. At the 1999 meeting 20 countries were represented. A session on “Quality improvement around the world” was included in the pre-conference programme to bring together people working in many countries to explore and compare their experiences in a programme of short presentations (table 1). This article draws together some of the themes that emerged from the presentations and from the discussion.

Understanding different worlds

The world is getting smaller and more accessible. Travel is quicker and cheaper. Places that were mysterious, remote, and even dangerous have become packaged for tourists. Information that was once the provenance and property of specialised groups is now available to the millions of people worldwide who use the internet. But many aspects of health care remain mysterious, remote, and even dangerous to patients using these services. Most healthcare systems operate as a set of distinct, unconnected worlds rather than as one coherent system. Even in emerging nations such as Tanzania the vertical nature of hierarchies in health care are a challenge. Making connections between many different worlds is crucial work for those who understand that quality improvement (QI) can make a real difference for patients. This was an overarching theme echoed by all of the presenters.

Health care, politics, and the media

Health care is a political issue. Costs, access to care, allocation of resources, and other aspects of the healthcare system quite properly are part of political discourse. Often, however, political debate takes on such a short term outlook that responses to problems are expedient and opportunities for actions that could have important long term benefit for patient care missed. …