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