In the 11 years he has directed the International Hospital Federation, Errol Pickering has faced a complete menu of medical challenges, a heaping plate of public health problems and a full glass of ideas on how to improve the way healthcare services are delivered worldwide.
Next February, Pickering will leave IHF headquarters in London for his native Australia, where he will consult, write and spend time at his new seaside restaurant near Sydney.
"In my youth, I fancied a career as a chef," the robust 59-year-old says. "But my father decided I had too much education and intellectual potential for the restaurant business."
Pickering will be succeeded by Per-Gunnar Svensson, who directs the Center for Public Health Research at the University of Karlstad (Sweden). Svensson, 54, previously spent six years as a health researcher for the World Health Organization.
The IHF director general oversees an organization that has members in 90 countries and links with healthcare associations and government health agencies in 75 nations. The IHF's goal is simple: to promote the worldwide cross-fertilization of ideas, techniques and practices in healthcare services management. The group also collects and disseminates international healthcare data and provides educational programming.
For instance, the IHF is spearheading an effort to standardize the collection of national health statistics so more meaningful comparisons can be made. Pickering notes, for instance, that in some countries spending on mental health is included in total health spending while in others it isn't.
"We need better ways to collect and analyze data to make relevant international comparisons," he says.
Despite the uncertainties about statistical accuracy, healthcare is one of the world's great growth industries and perhaps the most sensitive global political and social issue. Medical Research International of Boca Raton, Florida, estimates combined health spending in developed countries will reach $3.1 trillion by the year 2000, with an annual growth rate of about 7% a year. Sales of medical products alone should reach $506 billion annually by the new millennium.
Despite the rosy business conditions, Pickering has found conflict sometimes arises among the have and the have-not nations, and between those who believe limited healthcare resources should be devoted to public health concerns and others who favor hospital programs.
"Community health is the new focus, and that often means less support for hospital-related projects," he says. "The fact that the new director general has a community health background may help bring the two sides closer together."
The IHF faces a constant balancing act in creating programs and policies to help with the myriad challenges facing its diverse membership. While the IHF's Nov. 17-21 "Sharing Ideas for Better Health" congress in Melbourne will cover new technology, quality management, healthcare architecture, finance and information systems, other education programs concentrate on public health issues.
Next February, for example, the IHF is organizing a World Health Forum in Texas that will tackle "emerging plagues and resurrected pestilence." The invitation-only conference is co-sponsored by the Health Industry Council of Dallas-Fort Worth.
In addition to the biennial congress and the world forums, the IHF offers an annual eight-week seminar in healthcare management at England's University of Birmingham for administrators from less-developed countries. It also has conducted on-site field trips, such as last year's study on continuous quality improvement at Intermountain Health Care in Salt Lake City, Utah. Intermountain's president and chief executive officer, Scott Parker, who is the current IHF president, hosted representatives from 22 nations.
Parker's leadership role is just the latest American contribution to the IHF. The group traces its roots to the 1929 founding of the International Hospital Association, which held its first congress in Atlantic City, New Jersey, with delegates from 43 nations. The association suspended its activities between 1939 and 1947 because of World War II.
The group was reborn in 1948 as the IHF with financial assistance from the American Hospital Association and King Edward's Hospital Fund of London. The AHA remains a strong supporter of the IHF.
"Americans should not overlook their role and importance in the development of healthcare administration," Pickering says. "Moves to coordinate care, improve quality and set standards in the United States are watched and copied in many other countries."
The IHF operates with a staff of 10 and an annual budget of nearly $1 million.
Membership is divided into four categories:
75 national hospital associations or ministries of health.
400 other healthcare organizations, such as hospitals and university programs in health administration.
700 healthcare professionals.
20 corporate members that supply goods and services to hospitals.
The Melbourne congress is expected to draw 1,200 delegates from 50 countries.
The event also marks Pickering's return to Australia, where at age 32 he served as founding director of the nation's hospital accreditation council. He later became director of the Australian Hospital Association.
During his run as IHF director, Pickering is most proud of his work in poor and emerging nations. He developed health services management seminars in China, Egypt, Kenya and Malaysia, and assisted in the creation of hospital associations in Greece, Latvia, Romania and Uganda.
Svensson inherits an organization on firm financial ground. The IHF now owns its London office and has cash reserves of about $400,000.