Safety and Quality in Australia

Challenges for the Future

Robert Wells

Director Policy and Planning (Health)

Australian National University Canberra

9 August 2004

Australian Context

Strong track record as a safe and high quality health care system

Longevity Top performer in 5 country comparison, major

disease outcomes for 2004 Internationally competitive health and medical

research sector High standards and professional training

Australian Council for Safety and Quality in Health Care

Unique internationally as: A national body (supported by all nine jurisdictions) & reports

directly to all nine health ministers Independent Evidence-based approach Strong links with health system administrators and health

professionals Track record of achievement in setting national standards, eg

sentinel events monitoring, credentialing Keeps safety and quality on the national agenda Measures proposed by Council key to national health reform

agenda

Other Initiatives

State/Territory safety and improvement, health advisory bodies

Non-government bodies State/Territory safety and quality plans Performance reporting in some states Institutional plans and improvement activities Australasian conferences now an established and

invaluable part of the scene

The system

We can only get out of the system as much as it is designed to deliver

In Australia there are 9 systems: states/territories/Commonwealth

Within each system there are sub-systems (eg health regions) and different funding streams which can add to confusion and distort behaviour

Accountability not often clear

The challenges

Accept that we will retain multiple systems with separate funding and accountability streams

What can we do to improve within that at the national level?

Commit to a national measure of accountability Do better with our established ‘national treasures’

Accountability

Accountability is diffuse and there is no easily recognised measure of how Australian system performs in safety & quality nor of comparing one part with another

It is complex and there are statistical and policy issues

Look what has been done with road safety- focus on one statistic-fatalities- has resulted in comprehensive changes

Better organising what we have

We have many ‘national treasures’ in the health system, eg:

Australian Council on Safety & Quality in Health Care

National Health & Medical Research Council National Institute of Clinical Studies Australian Institute of Health and Welfare State safety & quality improvement bodies

Better organising (2)

Non-government disease and consumer advocacy groups Health and medical research centres both independent and

in hospitals and universities Various intergovernmental bodies, eg National Health

Priorities Action Council, Standing Committee on Aboriginal and Torres Strait Islander Health

They all do great work and make a wonderful contribution to Australia and the rest of the world

Better organising (3)

But they suffer from the ‘rail gauge’ problem- they sometimes travel on different tracks

There is often overlap and duplication If we could harness these national treasures into a

coordinated national resource surely we could do much better in allocating our research and quality improvement resources.

Conclusion

Two immediate challenges for Australia to think about: Establish a credible national reporting arrangement

which provides the Australian people a simple set of measures by which to understand how well their health systems are performing

Bring together our ‘national treasures’ into a powerful cohesive network of research and quality improvement