Australian Commission on Safety and Quality in Healthcare

Enhancing healthcare safety and quality

The Australian Commission on Safety and Quality in Healthcare (the Commission) came into being in January 2006, as the next developmental stage in progressing safety and quality in Australian healthcare. This builds on the successful work of the previous Australian Council for Safety and Quality in Healthcare.

The Commission has been funded by the Australian, State and Territory Governments to improve safety and quality in the Australian healthcare sector.

Information

The Commission is establishing national data sets and will use these to monitor and publicly report the state of safety and quality across the nation including performance against agreed standards. It also has an advice, leadership and advocacy role, including provision of strategic advice to Health Ministers on best practice thinking to drive quality improvement.

Data collection and monitoring need some standard definitions and agreements. Work is underway to establish these in conjunction with the Australian Institute for Health and Welfare and other key stakeholders. There is a wealth of material within current administrative collections which are being examined for additional usefulness in measuring safety and quality.

Accreditation

A national review of accreditation arrangements is currently underway. The review, a key deliverable which will have a significant impact on safety and quality in Australian healthcare, will result in recommendations to Health Minsters by December 2007. Accreditation recommendations will ensure the system accommodates changes in disease and disorder patterns, technologies, drug regimes and health services delivery through accreditation processes which evolve and keep pace with those changes. In addition, a new model is required if accreditation is to remain a sustainable process which delivers quality improvements into the future.

Accreditation of settings of care needs to encompass hospitals, General Practices and specialists’ “rooms”. The latter is becoming an increasingly important location for procedures given the technological & pharmaceutical developments of the last few years. Many procedures which used to take place in hospitals (within the cocoon of their accreditation standards compliance) are performed, under local anaesthetic, in shopping centres and skin cancer clinics.

Handover

The Commission is representing Australia in the WHO Patient Safety Alliance’s High Fives Initiative. This is a seven country collaborative project that will leverage the implementation of five standardised patient safety solutions to prevent avoidable catastrophic events in hospitals. Of the five solutions, we have chosen to lead on Clinical Handover.

The Collaborating Centre will work with the participating countries to refine the current draft solutions through the development of standardised operating protocols.

The High Fives Initiative targets areas of known safety and quality risk and seeks to test intervention models to prevent or mitigate iatrogenic harm.

Handover is a major safety and quality issue both within and across settings of care and across time. A series of pilot projects will be developed with an emphasis on identifying current successful initiatives and developing these into product that can be successfully transferred to multiple settings. The Commission will work in collaboration with State and Territory Governments on this important initiative.

Consumers

Consumer engagement is integral to the Commission’s work. The Commission considers the patient/consumer’s perspective as the lens through which its success should be judged. Consumers participate on committees and project working groups as well as consultation processes managed by the Commission.

Formal agreement has been reached with the Consumers’ Health Forum (CHF), the peak consumer organisation for health in Australia, to engage and involve health consumers across Australia in improvement in safety and quality in healthcare.

Expected outcomes include:

• Greater understanding and awareness among health consumer organisations and their networks about safety and quality improvement in healthcare and the work of the Commission
• Informed and strategic consumer expertise and the provision of advice to the Commission on ways to engage consumers in the implementation of improvements in safety and quality in healthcare
• The provision of informed and strategic consumer expertise and advice for other key stakeholders about consumer perspectives on safety and quality in healthcare
• Information provision to CHF members and other interested health consumers on improving safety and quality in healthcare
• Increased capacity in the CHF network of consumer organisations to participate in, and respond to, emerging issues in the implementation of safety and quality improvements in healthcare

The Commission looks forward to working with the CHF and other individuals and consumer organisations.

Safety and quality through the consumer’s experience

Much is made of the development of clinical pathways to improve the care of patients with particular clinical problems. However, we have not yet taken up the cause of consumer pathways which move through the maze of clinical departments and units that define the boundaries of our own comfort zones in work settings. The increasing importance of chronic disease in our society calls for a much more involved consumer of health services, who also needs to share responsibility for best practice management of their disorders.

Not only are we moving into the domain of chronic disorder management but are also faced by an ageing population which is increasingly accompanied by multiple disorders in the one person. Providing quality care to a person with, for example, adult-onset diabetes, hypertension, mild heart failure & arthritis is proving almost impossible without some form of computerised assistance, let alone the number of elderly people on Warfarin who have great difficulty with their dosage changes. The transaction load to keep the HbA1C within an acceptable range, recall for eye checks at the approved intervals, and aggressively follow-up on the heart failure to prevent unnecessary hospital admissions & disease progression are too much for paper systems. The use of interoperable electronic health records in the world of primary and ambulatory care will give the best chance of successfully co-managing these disorders into healthy old age.

Into the future

The Commission has been created for five years to make sustainable improvements to Australian healthcare safety and quality and to fulfil the responsibilities outlined for it by Health Ministers. It will do this building on the work of former initiatives and based on Australian experiences and research as well as international input.

All this and more can be achieved by integrating our work into the activities of the many partners that work within the Australian health system. The people we care for together increasingly need to manage their chronic illnesses with us, and we must ensure that their “consumer pathways” are not made more risky by the system boundaries we have built for our own purposes.