This supplement brings together reflections from those who were there at the beginning, alongside stories that show how participation in the International Forum led to lasting improvements in the quality of care, safety, and leadership. https://internationalforum.bmj.com/
1996-2026 Special supplement
InternationalForumon QUALITY&SAFETY inHEALTHCA RE
Reflections from the past 30 years
The origins of the International Forum on Quality and Safety in Healthcare lie in a small misunderstanding.
We had invited Don Berwick to the launch of the journal Quality and Safety in Healthcare (now BMJ Quality & Safety ), and we were, of course, impressed by him and what he had to say. Some time later, I heard on the radio about an American professional body that held a major meeting in London at regular intervals. Knowing that the Institute for Healthcare Improvement (IHI) ran a successful forum, I contacted Don to ask whether their forum might be held in London one year. He thought I meant starting a new forum, and I thought, why not. Richard’s idea was simply to move the IHI Forum to London for one year to broaden its reach. We quickly found ourselves on the same page and welcomed an ongoing, annual international forum together, moving year after year from one European city to another. We never looked back. “A rolling stone that gathers moss,” Richard called it. And the rest, as they say, is history.
Richard Smith CBE Former editor The BMJ , 1991–2004
Donald M. Berwick KBE President emeritus and senior fellow, Institute for Healthcare Improvement (IHI)
Keynote reflection from Helen Bevan OBE In May 1996, I was invited to present my local improvement work from the Leicester Royal Infirmary, UK, at a new conference in London, UK: the European Forum on Quality and Safety in Healthcare, now known as the International Forum on Quality and Safety in Healthcare. I had been working in healthcare present my work in New Zealand. These opportunities expanded my world.
improvement since 1991, when there were far fewer improvers, people taking a systematic approach to improving healthcare delivery. That first International Forum was where I first met improvers from other countries, including Sweden, the Netherlands, Germany, and the United States. I felt I had found my community: peers, mentors, and potential collaborators, learning from different perspectives and broadening how we approached challenges and solutions. I was eager to attend the next meeting in Paris, where I joined a minicourse on improvement methods led by Tom Nolan and Paul Plsek. Although I was an experienced improver, the course crystallised my thinking and changed my practice. In Vienna in 1998, I led a workshop on the human dimensions of change, which led to an invitation to
Thirty years have now passed since 300 people met at that first gathering in London. I have taken part in every European meeting, and several in Asia and Australasia. It has persevered through major challenges, including the 2010 event in Nice, when the Icelandic ash cloud grounded flights and the programme was rewritten the day before it began, and the covid pandemic, when it moved online. The people I met through this community remain my professional home. Its impact in spreading actionable improvement methods, evidence, and relationships worldwide cannot be overstated. One of its most important contributions has been to normalise quality improvement and patient safety as core leadership and
clinical responsibilities, by bringing clinicians, people with lived experience, managers, improvement specialists, and researchers together to learn and share. Congratulations to BMJ Group and the Institute for Healthcare Improvement (IHI) on reaching this three-decade milestone. Thousands of improvers, including me, are grateful that you established and sustained it. Through this work, you have changed lives and, indirectly, saved lives. I still see myself as the enthusiastic healthcare improver from Leicester that I was 30 years ago, but my calling, career, and impact have been profoundly broadened by the global connections the International Forum
We first opened our doors in May 1996, and this year marks our 30th anniversary. This supplement brings together reflections from those who were there at the beginning, alongside stories that show how participation in the International Forum led to lasting improvements in the quality of care, safety, and leadership.
has made possible. Helen Bevan OBE
Professor of practice in health and care improvement, Warwick Business School, strategic advisor to the NHS Horizons team, senior fellow at the Institute for Healthcare Improvement (IHI)
Special supplement | Stories of change
The Next Generation Advisory Panel brings early career perspectives into the planning and delivery of the International Forum on Quality and Safety in Healthcare, ensuring those closest to day-to-day care help shape improvement conversations, not just implement them. The panel emerged at the International Forum in Copenhagen in 2023 during discussions on multigenerational improvement. Early career clinicians often led change without influence over priorities. For Jamie Smyth and Emily Audet , both registrars, this highlighted the need to strengthen participation across career stages. Working with fellow International Forum Fellows, Riddhi Shenoy , Emma Tonner , Victoria O’Brien , Tom Hine-Thomas , and Maja Troj Larsen , and with support from the conference convening bodies, BMJ Group and the Institute for Healthcare Improvement (IHI), they formed NGAP from shared experience rather than formal design. The London International Forum 2024 marked the panel’s first formal year, chaired by Audet, with a provocation session bringing early career voices into senior discussions. In Utrecht 2025, the panel was embedded within the programme. Chaired by Smyth, NGAP has supported early career contributors to present, connect, and return as speakers, strengthening sustainability through multigenerational collaboration. From International Forum fellows to advisory panel Supporting early career voices in improvement work
For the first time, I felt my experience was being treated as expertise, not something I had to wait years to earn. Emily Audet Palliative care specialty registrar, Severn Hospice, UK
Empowering future generations of patients and professionals is essential. Only multigenerational collaboration can address the challenges facing health systems. Jamie Smyth Specialty registrar in public health, Imperial College Healthcare Trust, UK
In 2020, Monash Health, Australia’s largest public health service, began improving recognition of paediatric deterioration by partnering more closely with families. Through a co-design process with clinicians and consumers, a single proactive question was added to routine vital signs: “ Are you worried your child is getting worse? ” Early testing in emergency and inpatient settings showed strong family engagement, and over two years, outcome data confirmed a clear link between parental concern and critical illness. The work reached a turning point when preliminary findings were presented at the 2022 International Forum in Sydney. Beyond the formal presentation, informal conversations proved decisive. That introduction led to a national group of clinical leaders sharing data, aligning approaches, and testing feasibility across states. Publication of the Monash study in 2025 accelerated international uptake. UK interest grew with Martha’s Rule, aligning around proactive family involvement. By September 2025, New South Wales had embedded the question statewide, and Victoria adopted it after successful pilots. The work continues to evolve. Adaptation for adult services is underway, and new international links have formed, including discussions with clinicians in New Zealand following conversations at the 2025 Canberra International Forum. From one question to global practice change How connections made at the International Forum on Quality and Safety in Healthcare accelerate international improvement
Someone who’d done a fellowship at Safer Care Victoria introduced me to the chief paediatrician of New South Wales, and out of that conversation a nationwide community of practice was started. Erin Mills Clinical lead for the Safer Care for Kids ViCTOR Project, Melbourne, Australia
Scan for poster
Special supplement | Stories of change
In December 2022, the BMJ Research Forum convened more than 300 researchers, clinicians, and system leaders at BMA House in London, UK. The programme included a presentation on the Sandpit methodology, a structured interdisciplinary approach that connects research capability with real health system priorities and moves beyond discussion towards action. Among those in attendance was Dominique Allwood MBE , who recognised the potential of the methodology to support collaboration and co- production across complex healthcare systems. She subsequently adapted the approach within the UCLPartners Climate Collaborative, an initiative supporting delivery of the NHS Green Plan across University College London Hospitals NHS Foundation Trust. The collaborative spans 17 hospitals serving more than six million patients and brings together clinicians, nurses, estates professionals, and IT teams to embed sustainability as a shared operational priority. Learning from the BMJ Research Forum was later carried into the 2023 Copenhagen Forum, which attracted thousands of participants from around the world. The Sandpit approach was shared through a dedicated sustainability session chaired by Dr Allwood. Since 2022, the UCLPartners Climate Collaborative has translated convening into action by funding applied research projects to reduce energy use and carbon emissions, embedding interdisciplinary collaboration, and achieving national recognition through a highly commended award at the HSJ Partnership Awards 2025. Connecting communities to inspire change From convening to action on NHS sustainability
BMJ Group’s global reach and its ability to convene diverse audiences of leaders, innovators, and specialists are what make such knowledge-sharing and expertise exchange possible. The organisation has demonstrated its commitment to amplifying the voices that deserve to be heard, enabling experiences and insights to be shared, and inspiring individuals across functional and national boundaries. Dominique Allwood MBE Chief executive officer, Imperial College Health Partners, and director of population health, Imperial College Healthcare NHS Trust, UK
Sandra Brownlea , staff specialist in the emergency department at Royal Darwin Hospital in Australia, identified inequitable and culturally unsafe care for frequent emergency department attenders, particularly Aboriginal and Torres Strait Islander patients. Social complexity was often addressed through a biomedical lens, leaving patients exposed to stigma and systemic racism. In 2023, attendance at the International Forum on Quality and Safety in Healthcare in Melbourne provided a practical framework to address these challenges. Plenary sessions and case studies on co-design, consumer partnership, equity-focused service redesign, and workforce wellbeing demonstrated how frontline clinicians can implement context-specific interventions to improve outcomes and reduce avoidable emergency presentations. Building on these insights, Brownlea and colleagues secured Medical Research Future Fund support to pilot a culturally informed, patient- centred case support programme. Led by an Aboriginal health practitioner and grounded in co-designed care plans, early results were promising: emergency department attendance at Royal Darwin Hospital fell by 50%, 94%, and 84%; total admission bed days dropped from 27 to 9; and discharges against medical advice decreased from nine to one. Co-designing safer emergency care From international learning to local change
Attending the International Forum on Quality and Safety in Healthcare gave me insight into the value of co-design methodology and involving consumers, and also the value of workforce wellbeing and how all of those things can intersect and improve outcomes. Sandra Brownlea Staff specialist, emergency department, Royal Darwin Hospital, Australia
Special supplement | Stories of change
Hassan Mahmood’s work on STOMP demonstrates sustained leadership in learning disability and autism services, with a focus on quality improvement, equity, and system change. STOMP, a national NHS programme launched in England in 2016, aims to reduce the overmedication of people with a learning disability, autistic people, or both. By 2024, his clinical and partnership experience had sharpened concern about avoidable harm, particularly the intersection between overmedication and ethnicity. Attendance at the 2024 London International Forum marked a turning point. Hearing chief quality officer at East London NHS Foundation Trust, Amar Shah, speak about winning hearts and minds reframed improvement as relational work grounded in trust, inclusion and shared purpose. Mahmood left the conference with renewed confidence to lead differently and to move beyond established processes. Since then, he has strengthened leadership on STOMP within his trust through education for community learning disability teams and clearer prescribing governance for psychotropic medication. From early 2025, he has initiated community engagement events bringing together trust leaders, voluntary organisations, public health, and social care to address inequalities affecting people with a learning disability from ethnic minority backgrounds. From leadership inspiration to action Improving patient care and correct diagnosis to stop overmedication in learning disability and autism services (STOMP)
At the London 2024 International Forum, I was inspired by Amar Shah’s presentation about the importance of ‘winning the hearts and minds of people’. I left the conference with the confidence to lead, to move beyond established processes, and really innovate. Hassan Mahmood Deputy chief medical officer for learning disability and autism, Coventry and Warwickshire Partnership NHS Trust, and consultant psychiatrist specialising in learning disability and autism services, UK
Patients with limited English proficiency face measurable disadvantages in emergency departments, including longer stays, more diagnostic tests, and higher rates of unplanned return visits. Associate professor Roberto Forero’s research addresses these gaps by developing an artificial intelligence supported tool that helps clinicians interpret symptoms accurately across multiple languages and dialects. Forero draws on evidence from emergency care systems in the UK and Australia, including evaluations of the four-hour target, a benchmark requiring most patients to be admitted, discharged, or transferred within the four-hour target. While the target can improve patient flow, it may increase pressure on staff without clear evidence of better clinical outcomes. Working in south-western Sydney, where the Arabic-speaking population is three to four times higher than the national average, he observed delays when interpreters were unavailable outside weekday hours. Improving emergency care communication for diverse populations Using conference connections to inform the next phase of work
The International Forum has been very useful to think about how to build different stages… [It gave us] contacts from different parts of the world. Roberto Forero Associate professor, School of Clinical Medicine, University of New South Wales, Australia
Scan for poster
Arabic dialect complexity was an early driver for the tool, which integrates clinical context, linguistic nuance, and interpreter expertise to support assessment when real-time interpreter support is unavailable. Presenting an early poster at the International Forum on Quality and Safety in Healthcare, Canberra 2025, connected Forero with international colleagues, facilitated knowledge exchange, and informed the next phase of the project.
Special supplement | Reflections
The International Forum has always been shaped by moments when people were willing to stop, listen, and change direction. One of those moments came in 2014 when I attended the 19th annual International Forum in Paris, France, to give a keynote address. I travelled to Paris with my opening plenary prepared. However, on the overnight flight from Boston, MA, I read an article by Michael Barry and Susan Edgman-Levitan, longstanding leaders in shared decision making and patient- centred care. Deep within that piece was a single sentence that stopped me in my tracks: “You can’t only ask, ‘What’s the matter?’ We also have to ask, ‘What matters to you?’” I ripped up my talk then and there and rewrote it around one simple challenge: ask that question to the next patient you care for.What followed was unplanned. Within two weeks, stories began arriving from all over the world. People sent photographs, posters, drawings, and reflections describing how that one question changed conversations, relationships, and care. To learn from what was emerging, I started a monthly call where people could share stories, ideas, and lessons. Many years later, people from across the world still join those calls to learn together. What Matters to You quickly spread beyond patient and family conversations. The question began to be asked of staff, teams, and leaders. In many places, it has changed how people lead, how they listen, and how culture is shaped. It shifted the focus from problems and processes to people and purpose. Maureen Bisognano President emerita and senior fellow, Institute of Healthcare Improvement (IHI)
My first memories of the International Forum are very literal heart-in-mouth moments. It was small, uncertain, and deeply human. We invited people to submit posters for the first gathering in London in 1996, peer reviewed them, and I remember sitting at my parents’ kitchen table, going through the reviews, wondering whether enough would come in and whether anyone would care. Around 200 did. At the time, it felt enormous. Looking back, it marked the beginning of something that both reflected what was happening in healthcare and quietly helped to shape it. Fiona Moss CBE Former director of medical and dental education commissioning for London deanery, Royal Society of Medicine, founding editor, Quality & Safety in Healthcare (now BMJ Quality & Safety ), UK The ongoing relationship with the Institute for Healthcare Improvement (IHI) brought me to the first International Forum in London in 1996. Each year until my retirement in 2011, the conference gave me fresh inspiration, new hope, renewed strategy, practical tools, and many warm professional contacts. For me, it is very special and stimulating to see that in 1996 I was the only participant from my country, and that over the next 30 years this grew to 400–500 participants each year from the Netherlands. Improving quality and safety in healthcare has never been more necessary or more rewarding. Wim Schellekens Former chief medical officer, Reinier de Graaf Gasthuis, Delft, former national lead for hospital quality improvement in the Netherlands, former International Forum strategic advisory board member The International Forum is a wonderful place to share ideas with colleagues who work in different health systems. Together, we learn both to deliver better care but also to reposition “caring” at the heart of our work. I always find it inspiring and fun that each gathering has a distinct national character while consistently reminding participants how much they share in common. We are not cogs in a machine. We are humans who harness our individual passions and expertise to make a better world. The conference is a microcosm – even in the hardest of times – of how good we can be. Kamran Abbasi FRCP Edin Lon Editor in chief, The BMJ
Special supplement | Reflections
I co-chaired the local organising committee for the second Singapore Forum in 2016. What stays with me most are not the sessions but the people: speakers, colleagues from the Institute for Healthcare Improvement (IHI) and BMJ Group, organising committee members, and the attendees who brought the International Forum to life. Many of the friendships formed then endure today. When Singapore hosted the conference again last year, it was reassuring to draw on that same network of trusted colleagues and friends. It is people who make quality improvement possible and sustain it over time. Lee Chien Earn Deputy group chief executive officer, Regional Health System, SingHealth, Singapore During a keynote at the International Forum, Paris 2014, with my colleague Mats Bojestig, a Swedish healthcare leader, we argued that improvement must extend beyond individual projects to whole system change. To illustrate the point, we jumped off the stage, only realising mid air that the drop was greater than expected. The sudden silence in the room reinforced the message: improvement requires courage and a willingness to step forward before the ground feels secure. Another defining moment came in 2010, when the International Forum was held in Nice, France, during the week European airspace closed because of volcanic ash. Many participants were unable to travel, yet hundreds arrived by train, car, or bicycle. Rather than cancel, the programme adapted, using early satellite links to enable remote contributions. It demonstrated how the International Forum responds to disruption by sustaining learning and connection. Göran Henriks Senior strategic advisor, Region Jönköping County, Sweden
Seventeen years of involvement with the International Forum has made me come to realise that improving healthcare means learning from beyond your own organisation, city or country. For 30 years, BMJ Group and the Institute for Healthcare Improvement (IHI) have convened improvement teams from more than 80 countries, creating a space for open exchange about what has worked, what has not, and the realities of implementation. My huge thanks go to the International Forum community - all our speakers, improvers, clinicians and partners - whose willingness to share their experience is what has sustained the conference for the past three decades. Ashley McKimm Director of partnership development, BMJ Group, editor, BMJ Innovations , former director of the International Forum powerful it was to be among people so committed to improving care. I longed for more colleagues from Hong Kong, Singapore, Malaysia, Taiwan, and across the region to experience that same sense of belonging and shared purpose. At the International Forum, Paris 2014, I explored whether it could come to Asia and connected with Ashley McKimm, discovering BMJ Group felt the same. Together, we made it happen, and when it arrived in Hong Kong in 2015 and later in Singapore, Kuala Lumpur, Melbourne, and Taipei, it opened the door for hundreds more to join this global community. Siu-Fai Lui Adjunct professor, The Chinese University of Hong Kong, Jockey Club School of Public Health and Primary Care; Hong Kong Since 2008, I have attended the International Forum, often as one of very few participants from Asia, each time feeling how
1996, London 1997, Paris 1998, Vienna
2009, Berlin 2010, Nice 2011, Amsterdam 2012, Paris 2013, London 2014, Paris 2015, London 2015, Hong Kong 2016, Gothenburg 2016, Singapore 2017, London 2017, Kuala Lumpur 2018, Amsterdam 2018, Melbourne 2019, Glasgow 2019, Taipei
2020, Copenhagen | Virtual 2021, Europe | Virtual 2021, Australasia | Virtual 2022, Gothenburg 2022, Sydney 2023, Copenhagen 2023, Melbourne 2024, London 2024, Hong Kong
1999, Stockholm 2000, Amsterdam
2001, Bologna 2001, Sydney
2002, Edinburgh 2002, Singapore 2003, Auckland 2003, Bergen 2004, Copenhagen 2005, London 2006, Prague 2007, Barcelona 2008, Paris
2024, Brisbane 2025, Utrecht 2025, Singapore 2025, Canberra 2026, Oslo 2027, Lisbon
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16Powered by FlippingBook