US expert calls for NHS to reach “entirely new and better level” of safety
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2654 (Published 24 April 2013) Cite this as: BMJ 2013;346:f2654
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The International Forum on Quality & Improvement in Healthcare organised by BMJ and Institute for Healthcare Improvement (IHI) is probably the largest health quality forum in the world. It was attended in London in April 2013 by 3000 delegates from 85 countries, not counting virtual particpants.1 The issue of industry involvement at Continuing Medical Education (CME) or Continuing Professional Development (CPD) has lead to many professional societies, associations and licensing bodies producing guidelines around this.2,3 While traditionally this has focused on pharmaceutical companies it equally applies to all industries including quality organisations and non-health companies such as social media organisations.2,3
While IHI and BMJ have not-for profit status1 they are both providers of products, materials and courses with costs associated with them and other competitors in their respective fields. Maybe it is time for BMJ and IHI to be sponsors rather than hosts of this meeting and separate the conference from the potential commercial interests of these organisations.
The 2013 programme had a number of sessions that indirectly promoted products and programmes that have commercial value for the organisers including BMJ evidence based medicine products and IHI educational initiatives. The Accreditation Council for Continuing Medical Education (ACCME) standards state that the content or format of a CME activity or its related materials must promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.2
The programme also included Dr Mozart Sales, the Brazilian Secretary of Labour and Education for Human Health Resources, from the Ministry of Health of Brasil, who have recently become BMJ’s second biggest client (according to the BMJ presentation at the Australasian welcome) for Evidenced Based Medicine/Healthcare Improvement Tools which brings into question the impartiality of the Strategic Advisory Board and the organisers of the programme.
The forum in 2013 also actively promoted one social media forum for questions and comments and actively recruited members for this social media forum. This would appear to be questionable from an ethical standpoint given this is a commercial business where members are an important commodity to their business model in a very competitive environment.
A further striking observation was that presenters did not routinely begin with a slide outlining any conflicts of interest or indeed the absence of conflicts of interest, to inform attendees of their independence or not on the subject they were addressing. The ACCME standards state that for an individual with no relevant financial relationship(s) the learners must be informed that no relevant financial relationship(s) exist.2
In addressing conflicts of interest it is important for me to identify my own. I am a fellow of the Royal Australasian College of Physicians (RACP) and attended the Australasian welcome food and drinks provided by BMJ at the forum and had a coffee with the CEO of BMJ and have previously belonged to various social media groups.
In these days of public awareness and the establishment of ethical standards for relationships of commercial organisations and professional groups and individuals it is important that quality organisations are at the forefront of upholding the highest ethical standards.
From the Royal Australasian College of Physicians (RACP) Guidelines for relationships between physicians and industry it is noted; In general, special care should be taken that educational programs are free from the possibility of bias towards any commercial sponsor.
This means that for any such program:
• The group responsible for organising it should include a majority of individuals who do not have relevant conflicts of interest;
• Strict rules of management of dualities and conflicts of interest should be observed within the organising committee;
• The scientific, clinical and educational content should in no way be affected by the presence or nature of commercial sponsorship;
• Speakers should be meticulous about declaring dualities and conflicts and steps should be taken to ensure that their presentations are balanced; and,
• Processes should be established to assess the outcomes of the programs, including provision for feedback regarding possible biases from course participants.3
Feedback for this forum was in an email after the meeting. The lack of contemporaneous individual session feedback in my opinion will reduce the quality of the feedback. This may achieve the ACCME standard of having processes to assess the outcome of the programs, including provision for feedback regarding possible biases from course participants.3 Feedback though is something a quality organisation should be particularly strong on given this is a fundamental principle of quality improvement.
Is it time for the forum in 2014 to be independently organised and sponsored by the current hosts with a greater focus on conflicts of interest?
References:
1.http://internationalforum.bmj.com/abouttheforum
2.Standards to Ensure Independence in CME Activities with background rationale and answers to questions about compliance. Chicago: Accreditation Council for Continuing Medical Education. www.accme.org. Accessed at; https://www.urmc.rochester.edu/medialibraries/urmcmedia/center-experient... Accessed 27 April 2013.
3. Guidelines for Ethical Relationships between Physicians and Industry - 3rd ed. 2006; The Royal Australasian College of Physicians. Accessed 27 April 2013.
Competing interests: No competing interests
Re: US expert calls for NHS to reach “entirely new and better level” of safety
Dear Editor,
We are grateful to Stephen Dee for his communication to the Journal, and post this reply on behalf of the Institute for Healthcare Improvement and BMJ.
The issues he raises are significant ones and we broadly agree with his concerns of which both BMJ and IHI take very seriously. We make every effort to follow best practice in transparency and declaration of competing interests in all of our events.
To answer some specific points, we do ask all speakers to start with a slide at the beginning of their presentations declaring any competing interests. We are aware that some speakers failed to do so this at the 2013 forum, however we will ensure that all speakers now do this as a matter of course at all future forums.
As a regular attendee of the Forum, Mr Dee will be aware that we have been running only online feedback for sessions since 2010, when we took the decision not to distribute individual paper forms for each session. To do so would require over 45,000 individual forms for 3,300 delegates, which is environmentally unfriendly and logistically almost impossible to process. Since 2010 we have requested feedback via email on the last day of the Forum using a comprehensive online questionnaire and we evaluate all the responses received.
The joint IHI-BMJ Forum Governance Board will meet to discuss the matters raised in August, where robust policies on declaring competing interests will be agreed and implemented before the 2014 Forum in Paris. We hope you will be able to join us then, and want to thank you for the manner in which you have raised this important issue.
On behalf of BMJ and the Institute for Healthcare Improvement
Competing interests: No competing interests