When was the last time a health system asked people for what they needed?

Margaret Kruk joins Salma to discuss health systems and one of their key components: the experience of patients. They start their conversation with an overview of the functions and components of a health system and highlight that, similar to other service industries, healthcare needs to function for the people it serves and should check-in with these end-users. Margaret revisits her early-on experiences as a family doctor in rural Canada and in Kigoma, Tanzania, where she realized health systems were not responding to people’s needs, despite being designed as systems that should perform well. The conversation then shifts to discussing The Lancet Global Health Commission on High Quality Health Systems, a joint effort of researchers, healthcare providers and health systems decision makers, to understand what data were available to track quality and what data were missing to respond to the most relevant questions of quality healthcare practice, finding that available measures of quality did not map to patients’ outcomes.

Shifting course, Margaret and Salma explore the People’s Voice Survey, a global survey currently measuring health systems’ quality in 23 countries based on people’s perceptions and confidence in the system. Margaret highlights the importance of confidence—reflecting security and endorsement of systems that people can count on when they need it—and the differences between mental health and chronic physical conditions.

Finally, they reflect on the future of primary care, starting with a brief recount of its history and mission. They examine the role of emerging technologies, and especially artificial intelligence, on empowering patients and getting them to demand better quality of systems, considering the improvement of health systems should be a shared endeavor.

This episode will invite you to reconsider what a truly patient-centered health system looks like, and what it takes to build one.

Notes:

Acronyms used in this podcast include:

• AI = Artificial Intelligence
• GDP = Gross Domestic Product
• QI = Quality Improvement
• UK = United Kingdom
• US = United States
• UN = United Nations
• UNDP = United Nations Development Programme

Useful resources:

• Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196-e1252. doi:1016/S2214-109X(18)30386-3
• Kruk ME, Pate M. The Lancet Global Health Commission on High Quality Health Systems 1 year on: progress on a global imperative. The Lancet Global Health. 2020;8(1):e30-e32. doi:1016/S2214-109X(19)30485-1
• Kruk ME, Kapoor NR, Arsenault C, et al. Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries. Tang S, ed. PLoS Med. 2026;23(5):e1004745. doi:1371/journal.pmed.1004745
• MAVEN-Primary Care: AI-Powered Patient-Provider Collaboration to Transform Chronic Disease Management. Digital Intelligence & Innovation Accelerator. 2026. https://di2accelerator.wustl.edu/digital-transformation-corps/2026-projects/maven-primary-care-ai-powered-patient-provider-collaboration-to-transform-chronic-disease-management/

If you have any questions or feedback, email us at healthierfutureslab@wustl.edu.

Host: Dr. Salma Abdalla

Editor: Zach Linhares

Producer: Catalina Melendez Contreras

Production assistant: Mateo Diaz Quiroz

Marketing and social media: Kinkini Bhaduri

Research for episode preparation: Mateo Diaz Quiroz

Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.