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National Arrangements for
Safety and Quality of Health Care
in Australia
The Report of the
Review of Future Governance Arrangements
for Safety and Quality in Health Care
The Hon Dr Peter Toyne
Chair
Australian Health Ministers’ Conference
Dear Dr Toyne,
Review of Future Governance Arrangements for Safety and Quality in Health Care
On behalf of the members of the Review Team for the Review of Future Governance
Arrangements for Safety and Quality in Health Care, it is my pleasure to submit our Final
Report for the consideration of Health Ministers.
The Review Team has met regularly since September 2004 and has conducted an extensive
consultation process. Submissions were received from a large number of stakeholders and
consultation meetings have been held in all States and Territories. I would like to
acknowledge the valuable contributions of stakeholders during the Review.
Australia is well respected internationally for its efforts to improve the safety and quality of
health care, in large part due to the leadership of the Australian Council for Safety and
Quality in Health Care. There is still, however, important work to be done at all levels of the
health system to ensure that care is safe, effective and responsive to the needs of consumers.
I believe that the recommendations in this Report will, if adopted, improve current
governance arrangements, coordinate national action and lead to measurable improvement in
the safety and quality of patient care and the efficiency of health service delivery.
I commend the Report to Ministers.
Yours sincerely,
Ron Paterson
Chair
Review Team
28 July 2005
Acknowledgements
We wish to thank all the individuals and participants who contributed to the Review. In
particular, we wish to thank the following:
•
Professor Andrew Wilson for his generous contribution in undertaking the research,
analysis and documentation of the key issues relevant to the future governance
arrangements for improving safety and quality in health care.
•
Professor Bruce Barraclough AO, Chair, Australian Council for Safety and Quality in
Health Care and Council members for their assistance and information.
•
Mr Dermot Casey, Ms Kirsty Cheyne-Macpherson, Ms Vicki Grant and Ms Victoria
Willard of the Office of the Safety and Quality Council for their assistance and
information.
•
Ms Lynette Glendinning and Mr Douglas Smith of PALM Consulting Group for
facilitating the national workshop and preparing the workshop report.
•
Our contacts at each of the Health Departments, who are too numerous to name, for their
assistance with the consultation meetings. Their organisation of the venue, catering and
invitations for their State/Territory enabled the Review to reach a broad range of
stakeholders.
•
The many individuals and organisations that participated in the national consultation
process.
•
Mr Peter Harvey and staff of the Health, Community and Disability Services Ministerial
Council Secretariat for their assistance and advice.
•
The Review Secretariat: Beth Slatyer, Patricia Frake and Kathleen Kinmonth and, for
varying periods, Sonya Kelly, Teressa Ward and David Michell for their support and
assistance.
-i-
Table of Contents
Acknowledgements
i
Executive summary
iv
Recommendations
ix
1.
Review context
1
1.1
1.2
1.3
1.4
1.5
1
2
3
4
5
2.
Review of Council
2.1
2.2
2.3
2.4
3.
6
8
8
9
9
10
11
12
12
13
13
14
14
16
3.1
3.2
3.3
3.4
16
17
18
20
21
21
23
National safety and quality body
Scope of national action
Functions of the national body
Making it happen
3.4.1 Public Reporting
3.4.2 Roles of jurisdictions and other stakeholders
3.4.3 Responsibility for implementation
3.4.4 National Strategic Framework for Improving the Safety and Quality of
Health Care
Conclusions: what will success look like?
Designing a new national safety and quality body
4.1
4.2
4.3
4.4
4.5
- ii -
Approach taken by Council in addressing its Terms of Reference
Views from Review consultations
2.2.1 Acknowledged successes of the Council
2.2.2 Issues and concerns
Review Team’s view
2.3.1 Capacity to drive implementation
2.3.2 Engagement with jurisdictions
2.3.3 Strategic partnerships with other key stakeholders
2.3.4 Performance measurement and reporting
2.3.5 Communication and information dissemination
2.3.6 Questions of scope
2.3.7 Internal governance issues
Conclusions
6
Achieving a transformation
3.5
4.
Why safety and quality matters
Australian Council for Safety and Quality in Health Care
Terms of Reference for the Review
Review Team membership
Consultation process and background research
24
24
26
What are the governance problems that the features of a new national body must
solve?
26
What are the principles of good governance?
27
Are there suitable overseas models for a national safety and quality body?
28
Design of the national body – translating the principles of good governance into
governance arrangements for the national safety and quality body
28
Linkages and coordination
30
4.5.1 Linkages and coordination with jurisdictions
30
4.6
4.7
4.8
5.
Legal form of the national body and transition arrangements
5.1
5.2
5.3
5.4
6.
7.
4.5.2 Linkages and coordination with the Chairs of State and Territory safety and
quality bodies
31
4.5.3 Linkages and coordination with other stakeholders
32
4.5.4 Steering policy development on nationally agreed priority areas by expert
working groups
33
Diagram showing the essential features of the national body
35
Resources and timeframe
36
Conclusions
36
37
Legal forms/structures considered by the Review Team
37
Structural options
37
5.2.1 Committee reporting to Ministers – an enhancement of current Council
arrangements
37
5.2.2 Not-for-profit company limited by guarantee
38
5.2.3 A new statutory body
39
5.2.4 A new body under existing statute
39
5.2.5 Comparison of the options
40
Implementation of the Review: transition arrangements to new national body
41
Conclusions
42
Priorities for future national action
43
6.1
6.2
6.3
6.4
43
43
47
49
Stakeholder views
Review Team’s view
Process for identifying future national priorities
Conclusions
Enhancing the role of accreditation
50
7.1
7.2
7.3
7.4
50
50
51
52
52
53
54
7.5
Context
Stakeholder views and concerns about current accreditation processes
Current status of Council’s work on accreditation reform
Review Team’s view
7.4.1 Impact of accreditation
7.4.2 Reform of current accreditation processes
Conclusions
Appendix 1 Australian Council for Safety and Quality in Health Care membership as
at May 2005
55
Appendix 2 List of Council achievements
57
Appendix 3 Public submissions to the Review
59
Appendix 4 List of workshop attendees
62
Appendix 5 Consultation meeting participants
65
Acronyms
68
Bibliography
69
- iii -
Executive summary
The Review of Future Governance Arrangements for Safety and Quality in Health Care is
charged with proposing the best future governance arrangements to transform the safety and
quality of health care in Australia. Specifically, the Review Team was asked to advise on the
national leadership and co-ordination of safety and quality improvement efforts.
In its deliberations, taking into account submissions, consultation feedback and a review of
relevant literature, the Review Team has formed the view that there remains a place for a
national body to lead patient safety and quality improvement in Australia, but that its
functions and purpose must be clearly defined, it must have effective links with jurisdictions
and key stakeholders, and its advice must be implementable.
The Review Team considers effective links with jurisdictions and key stakeholders to be of
particular importance, because the national body is just one part of broader national
governance arrangements for safety and quality. These governance arrangements need to
ensure that jurisdictions and stakeholders are able to contribute to priority setting and policy
development and fulfil their responsibility for implementation of nationally agreed policies
and standards across public and private health care settings.
The Review Team considers that the broader governance arrangements will have been
successful if, in five years, there has been measurable improvement across a number of key
indicators in the quality of health care received by patients in Australia. Safety and quality
will no longer be seen as a series of discrete projects and will be operationalised at all levels
of the health system.
Achieving such a transformation has the potential to deliver sizeable dividends, not just in the
safety and quality of care, but in improved efficiency and utilisation of health resources.
Review of Council
The Review Team considers that the Australian Council for Safety and Quality in Health
Care (Council) has made a valuable contribution to raising awareness of safety and quality
issues (what the key issues are, how to tackle them and the importance of taking a systems
approach) particularly among clinicians and administrators involved in quality improvement
activities. The Council has also produced an extensive body of policy work which has led to
the development of important national policies and standards endorsed by Ministers.
Patient safety must remain a high priority and the valuable work begun by the Council must
be continued. It is important to fully implement those Council recommendations approved by
Health Ministers and progress key areas from Council’s current work plan. The Review Team
considers, however, that the future work of a national body should have a broad quality
improvement focus, across a range of health care delivery settings, with the aim of achieving
care that is safe, effective and responsive to the needs of consumers.
With the benefit of hindsight, aspects of the current Council arrangements, particularly the
lack of formal links and partnerships between Council, jurisdictions and other key bodies,
have hampered its effectiveness.
- iv -
The challenge is to develop a genuinely national approach, something that can best be
addressed by clearly defining the scope and governance arrangements for future safety and
quality action.
Achieving a transformation in health care safety and quality
Transforming safety and quality takes concerted action from a range of stakeholders working
towards common, clearly understood goals. Stakeholders want action – they want to know
the right things to do (clinically or in the way systems are organised) and for them to be done.
National action should seek to operationalise safety and quality at all levels of the health
system and achieve measurable improvement in the safety and quality of care. Informed by
the Review consultation process, the Review Team believes that achieving this
transformation will require:
•
•
•
•
•
a new national safety and quality body with clearly defined functions;
a quality improvement focus across the continuum of health care;
public reporting on the progress of safety and quality improvement as a key driver for
change;
clearly defined functions to be performed by jurisdictions, including responsibility for
implementation; and
a National Strategic Framework which promotes coordinated action from all key players.
The functions proposed by the Review Team for the new national safety and quality body
are:
•
•
•
•
•
lead and coordinate improvements in safety and quality in health care in Australia by
identifying issues and policy directions, recommending priorities for action,
disseminating knowledge, and advocating for safety and quality;
report publicly on the state of safety and quality including performance against
standards;
recommend national data sets for safety and quality, working within current multilateral
governmental arrangements for data development, standards, collection and reporting;
provide strategic advice to Health Ministers on ‘best practice’ thinking to drive quality
improvement, including implementation strategies; and
recommend nationally agreed standards for safety and quality improvement.
The Review Team has decided against recommending a national safety and quality regulator
because it is not convinced such a regulatory body would be effective in Australia’s federal
system. Furthermore, the Review Team believes public reporting is an under-utilised driver
for change which should be given the opportunity to “transform” safety and quality of care
before seeking to mandate change through national regulation.
The national body must fulfil its own specific functions, and establish strategic partnerships
with other key bodies so that in fulfilling their responsibilities they operate as part of a
nationally coordinated effort to improve safety and quality. This is particularly important in
the case of those other bodies with existing authority and mechanisms for regulation.
-v-
It is timely for jurisdictions to reassess their own arrangements and structures for supporting
improvements in the safety and quality of health care across the continuum. This should build
on what is already in place and ensure that the health system is operated in a way that
promotes safe, high quality care. Implementation should remain the responsibility of
jurisdictions, who need to ensure they have the capacity to effectively implement safety and
quality improvements in a comprehensive and coordinated way across public and private
health care settings. Additionally, in partnership with the national body, links need to be
established with key stakeholders to ensure implementation. The concerted action of all
interested stakeholders needs to be promoted through the development of a National Strategic
Framework for Improving the Safety and Quality of Health Care.
Collectively, the national body, the arrangements in place in individual jurisdictions, and the
National Strategic Framework form the core elements of national governance arrangements
for improving the safety and quality of health care in Australia.
Designing a new safety and quality body – essential features
The Review Team believes that to fulfil its functions the national body needs to be small and
focused. The body should report to Health Ministers who, as a group, are responsible for
ensuring that there are appropriate systems for the delivery of safe, high quality health care.
Its work should be led by an experienced, highly credible Chairperson and be supported by a
highly capable full-time Chief Executive Officer (CEO) as head of an expert office.
The Review Team is of the view that to be able to fulfil its purpose, the internal features of
the national body will need to conform to the principles of good governance applicable to any
enterprise. It must incorporate a mix of skills which will allow it to translate expert
knowledge on safety and quality across the continuum of care into feasible recommendations
to Health Ministers. The size of the body must be small enough to focus its energy on key
outcomes and support timely decision-making.
The Review Team believes that it is crucially important that the Australian Health Ministers’
Advisory Council (AHMAC) is formally part of the governance arrangements for the body
and that jurisdictions are fully aware of and able to participate in its work plan. Broad
stakeholder engagement is also essential to ensure that decision-making and priority setting is
well informed and relevant.
- vi -
The essential features of the new safety and quality body proposed by the Review Team are:
•
•
•
•
a small body of 8 or 9 members with skills in health systems improvement and corporate
governance (members would include an independent, part-time Chairperson, at least 1
AHMAC member, and 6 or 7 other experts of whom up to 2 could be additional
AHMAC members or their nominees);
a full-time CEO, capable of engaging government and non-government organisations at a
senior level, and an expert office;
an Inter-jurisdictional Committee, with representatives from all 9 jurisdictions and
chaired by the AHMAC member of the body; and
a Stakeholder Reference Group, with up to 20 members comprising Chairs of
jurisdictional safety and quality bodies and representatives of other key national
stakeholder bodies, and chaired by a member of the national body.
Legal form of the national body and transition arrangements
A range of legal forms are consistent with the essential features of the new national body
proposed by the Review Team and four options are presented for the consideration of
AHMC:
•
•
•
•
a Committee reporting to Health Ministers;
a not-for-profit company limited by guarantee, established jointly by Health Ministers;
a statutory body established under new legislation; and
a body established under existing legislation.
Decisions on the form of the new body need to be made as a matter of urgency, in order to
maintain momentum and to speed the implementation of national safety and quality
initiatives.
Priorities for future national action
The Review Team believes that the priorities for national action should both build on the
valuable work of Council and allow a refocusing of the agenda on measurable improvement
in safety and quality across the continuum of care.
The immediate priorities for the future should be to:
•
•
•
establish new national governance arrangements for safety and quality improvement by
June 2006 (responsibility of AHMC and individual jurisdictions);
take action to deliver on the functions of the new national body (responsibility of the
national body):
- develop a National Strategic Framework for Improving the Safety and Quality of
Health Care;
- prepare a National Report on the State of Safety and Quality;
fully implement the eight uniform national actions to improve patient safety previously
agreed to by Ministers (responsibility of all jurisdictions collaboratively, and with other
stakeholders) and create a National Minimum Data Set for Safety and Quality
(responsibility of NHIG and the new national body/Council);
- vii -
•
finalise key elements of Council’s work plan (responsibility of the national body and
Council in the interim):
- provide advice on the reform and streamlining of accreditation;
- provide advice on the implementation of the Open Disclosure Standard;
- develop an implementation plan for the Credentialling Standard.
The new body should also establish a transparent consultation process for setting priorities in
the future, involving all key stakeholders.
Enhancing the role of accreditation
At AHMAC’s request, the Review Team considered how accreditation arrangements could
best contribute to improving the safety and quality of health care.
The Review Team’s view is that accreditation is an important driver for safety and quality
improvement, but that stakeholders have legitimate concerns regarding current accreditation
processes.
The Review Team proposes that Ministers be provided with a plan to transform accreditation
arrangements, to enhance the role of accreditation in both quality improvement and in the
implementation of agreed national standards. In developing this plan, the national body (and
Council in the interim) should engage with multiple stakeholders, including jurisdictions,
accreditation bodies and the wider health industry.
- viii -
Recommendations
Recommendation 1 – New national safety and quality body
A new national safety and quality body should be established to succeed the Australian
Council for Safety and Quality in Health Care.
Recommendation 2 – Scope of national action
The work of the national body should have a safety and quality improvement focus across the
continuum of health care.
Recommendation 3 – Functions of the national safety and quality body
The national body should have the following functions:
•
•
•
•
•
lead and coordinate improvements in safety and quality in health care in Australia by
identifying issues and policy directions, recommending priorities for action,
disseminating knowledge, and advocating for safety and quality;
report publicly on the state of safety and quality including performance against national
standards;
recommend national data sets for safety and quality, working within current multilateral
governmental arrangements for data development, standards, collection and reporting;
provide strategic advice to Health Ministers on ‘best practice’ thinking to drive quality
improvement, including implementation strategies; and
recommend nationally agreed standards for safety and quality improvement.
Recommendation 4 – Public reporting on the safety and quality of care
Public reporting on the safety and quality of care should be used as a key driver for change.
Recommendation 5 – Related functions of jurisdictions
The related functions of individual jurisdictions (States, Territories and the Australian
Government) should include:
•
•
•
•
•
development of principles and mechanisms for advancing safety and quality in their own
jurisdiction (eg through the establishment of a safety and quality body and mechanisms
for consumer involvement);
appropriate governance and accountability arrangements to provide public assurance of
safety and quality;
implementation of agreed national standards within their jurisdiction;
development of coordinated mechanisms to ensure implementation is effective across the
public and private sectors; and
participation in national data collections on safety and quality.
- ix -
Recommendation 6 – Responsibility and mechanisms for implementation
Responsibility for implementation of safety and quality standards recommended by the
national body and accepted by Ministers should rest with States, Territories and the
Australian Government working collaboratively, and in partnership with private sector
providers.
Recommendation 7 – National Strategic Framework for Improving the Safety and
Quality of Health Care
The national body should develop a National Strategic Framework for Improving the Safety
and Quality of Health Care for endorsement by Health Ministers. It should be developed in
consultation with jurisdictions and stakeholders as an immediate priority (ie within the first
six months of operation). The National Strategic Framework will ensure a comprehensive
range of action is undertaken in a nationally coordinated way by leaders, decision makers and
public and private providers operating at different levels in the health system.
Recommendation 8 – National governance arrangements for safety and quality
National governance arrangements for safety and quality in health care should comprise:
•
•
•
the national body reporting to all Health Ministers;
the safety and quality arrangements established by jurisdictions; and
the unifying national strategic framework.
Recommendation 9 – Internal governance arrangements of the national body
To ensure good internal governance:
•
•
•
•
-x-
the Council should be succeeded by a smaller, more focused body, appointed by
Ministers;
the body should comprise 8 or 9 people, led by an independent, highly regarded Chair,
and include at least 1 AHMAC member. The remaining 6 or 7 should be chosen for their
collective competence in corporate governance, health system reform or change
management, safety and quality systems, and strategy development, and may include up
to 2 additional AHMAC members or their nominees;
the body should be supported by an office led by a CEO who is capable of engaging
government and non-government members at a senior level, and who is accountable to
the body; and
the body should formally report to all Health Ministers.
Recommendation 10 – The national body: formal linkages with jurisdictions through
an Inter-Jurisdictional Committee
To ensure adequate jurisdictional engagement in the work of the national body:
•
•
•
•
•
the AHMAC member of the body should convene an Inter-jurisdictional Committee;
the Inter-jurisdictional Committee should comprise high level representation from all
jurisdictions and be chaired by the AHMAC member of the body;
the Inter-jurisdictional Committee should meet frequently enough to provide an adequate
level of advice to the AHMAC member on the body;
the Inter-jurisdictional Committee should be responsible for providing advice to the body
on the adequacy of the process of policy development at key milestones in the
development of particular policy items; and
the Inter-jurisdictional Committee Chair should be accountable for ensuring that the
other AHMAC members are aware of new policy directions to ensure their local systems
can support the implementation of agreed national policies.
Recommendation 11 – The national body: formal linkages with stakeholders through a
Stakeholder Reference Group
To assist the decision-making and priority setting undertaken by the national body, and to
enable a broad range of stakeholder views to be informed about and involved in the work of
the body:
•
•
•
•
the body should formally convene a Stakeholder Reference Group;
the Stakeholder Reference Group should meet at least twice a year to obtain information
on, and provide input to, the safety and quality agenda;
in particular, the Stakeholder Reference Group should contribute to the regular
reassessment of national priorities for action; and
the Stakeholder Reference Group should be chaired by a member of the body and
comprise up to 20 representatives from key stakeholder groups.
Recommendation 12 – The national body: convening expert working groups and
linking with relevant national bodies
To ensure that the relevant range of expertise is drawn on in the development of new work in
the agreed priority areas, and that work being undertaken by existing national bodies in the
priority areas is coordinated nationally:
•
•
•
the body should convene, on a time-limited basis, expert working groups as necessary to
undertake work in the AHMC agreed priority areas;
the expert working groups must include an adequate range of expertise from external
sources, and may also draw on relevant expertise from the Inter-jurisdictional Committee
and the Stakeholder Reference Group; and
the body should establish formal agreements to embed national collaboration and
coordination on safety and quality with other relevant national bodies.
- xi -
Recommendation 13 – Resourcing of the national body
To ensure that the national body has adequate time and resources to fulfil and measure its
outputs and outcomes, it should be:
•
•
established for an initial period of 5 years; and
provided with sufficient resources to fulfil its purpose over this period.
Recommendation 14 – Legal form and transition arrangements
Health Ministers should determine the appropriate legal form/structure and agree that the new
body be established as soon as practicable. Transition arrangements should ensure a seamless
changeover from the current Council.
Recommendation 15 – Priorities for future national action
The Review Team believes the priorities for future action should be the following:
Priority 1 Establish new national governance arrangements for safety and quality
improvement as a matter of urgency
1.1
AHMC to establish a new safety and quality body to lead and coordinate the safety and
quality agenda in Australia.
1.2
Jurisdictions to review their own safety and quality arrangements to ensure:
•
•
•
•
•
•
an effective working relationship with the new body;
development of principles and mechanisms for advancing safety and quality in their own
jurisdiction (eg through the establishment of a safety and quality body and mechanisms
for consumer involvement);
appropriate governance and accountability arrangements to provide public assurance of
safety and quality;
implementation of agreed national standards within their jurisdiction;
development of coordinated mechanisms to ensure implementation is effective; and
participation in national data collections on safety and quality.
Priority 2 Take action to deliver on the functions of the new body (the new national body)
2.1 Develop a National Strategic Framework for Improving the Safety and Quality of Health
Care within the first six months of operation.
2.2 Prepare a National Report on the State of Safety and Quality by June 2007.
Priority 3 Fully implement previous AHMC decisions
3.1 Jurisdictions to fully implement the eight uniform national actions to improve patient
safety previously agreed to by Ministers.
3.2 NHIG and the new national body/Council to create a National Minimum Data Set for
Safety and Quality by June 2006.
- xii -
Priority 4 Finalise key elements of Council’s work (the new national body and Council in
the interim)
4.1 Provide advice on reforming and streamlining accreditation by June 2006.
4.2 Provide advice on implementation of the Open Disclosure Standard, including evaluation
of pilots, by December 2006.
4.3 Develop an implementation plan for the Credentialling Standard by June 2006.
Process for identifying future national priorities
Within the first 12 months of its operation, the new national body should conduct the first of
a series of regular priority setting processes involving all members of the Stakeholder
Reference Group.
Recommendation 16 – Accreditation
A priority for the new safety and quality body (and Council in the interim) should be to
provide Health Ministers with a plan to transform accreditation arrangements by June 2006.
- xiii -
1.
Review context
1.1
Why safety and quality matters
In Australia, the safety and quality agenda has reached a point of transformation. The national
effort is set to move beyond a specific focus on reducing patient harm to a broader focus on
systems improvement. This shift has the potential to yield substantial benefits in both the
safety and quality of care and the efficiency of care delivery.
It is widely recognised that the Australian health system as a whole has reached a stage where
significant reform is both possible and necessary. While the system performs adequately
against a number of indicators, it is beset by problems such as inefficient use of resources,
difficulties with access, and overlapping roles and responsibilities between jurisdictions.1
There is growing recognition, in Australia and internationally, that the focus should be on
ameliorating these inefficiencies and performance deficits. Safety and quality improvement
can be the cornerstone of this modernisation and reform agenda.
Much has been done to address patient safety issues in Australia in the 10 years since the
Quality in Australian Health Care Study found an adverse event rate of 16.6% in hospitalised
patients,2 later revised to 10.6% following a comparison with a similar US study.3 At a
national, jurisdictional, and service delivery level, a multitude of safety and quality programs
and structures have been put in place in order to reduce the level of harm to patients.
While these initiatives need to be sustained and the current state of safety and quality
measured, the pressing issues facing the health system require a broader approach to
improving the health care delivery system as a whole. This is in line with current
international approaches, such as the National Health Service reforms in the UK under the
NHS Modernisation Agency. Crossing the Quality Chasm, the landmark publication of the
US Institute of Medicine, recognised that quality defects are even more widespread than
safety issues and have a greater impact on the performance of the health system.4 Its
conclusion is that “fundamental reform of health care is needed to ensure … care that is safe,
effective, patient centred, timely, efficient, and equitable.”5
The need for fundamental reform is a common cry in Australia at present. A quality
improvement focus has the potential to make a measurable difference for patient care and
deliver sizeable dividends in terms of improved effectiveness and efficient utilisation of
health resources. The improvement of the health system for patients and the realisation of
these dividends are the twin aims of this report.
1
Australian Government Productivity Commission (2005), Review of National Competition Policy Reforms:
Inquiry Report, p. XXXV.
2
Wilson, R.M., Runciman, W.B., Gibberd, R.W., Harrison, B.T., Newby, L. & Hamilton, J.D. (1995), ‘The
Quality in Australian Health Care Study: Iatrogenic injuries or adverse patient events in hospitalised patients,
Medical Journal of Australia, 163(9), pp. 458-471.
3
Thomas E.J., Studdert D.M., Runciman W.B., Webb R.K., Wilson R.M., et al. (2000), ‘A comparison of
iatrogenic injury studies in Australia and the USA, International Journal for Quality in Health Care, 12(5), pp.
371-8.
4
Institute of Medicine (2001), Crossing the Quality Chasm: A New Health System for the 21st Century, p. 2.
5
Ibid., p. xi.
-1-
1.2
Australian Council for Safety and Quality in Health Care
The Australian Council for Safety and Quality in Health Care (Council) was established by
Australian Health Ministers in January 2000 to lead national efforts to improve the safety and
quality of health care provision in Australia.
Its establishment originated from the Quality in Australian Health Care Study, which led
Australian Health Ministers to form a Taskforce on Quality in Australian Health Care,
followed by a National Expert Advisory Group on Safety and Quality in Australian Health
Care. Among the National Expert Advisory Group’s recommendations was the establishment
of the Council.6
The initial Council comprised 22 members, appointed by the Australian Government Minister
on behalf of all Ministers for their expertise in safety and quality. The Council has been
chaired from its inception by Professor Bruce Barraclough AO and reports annually to the
Australian Health Ministers’ Conference (AHMC).7
At the time of the Review, Council has 27 members, a number of whom were co-opted by the
Chair. Council has a decision-making Executive consisting of 8 members. Current Council
and Executive members are listed at Appendix 1.
The Office of the Safety and Quality Council (Council’s secretariat) consists of about 20 staff
led by an Executive Director. It is located within the Australian Government Department of
Health and Ageing.
The Council’s original term was for five years, but this was later extended by Health
Ministers until June 2006. The total funding allocation to the Council was $55 million over
its 6½ year term.
The Council’s Terms of Reference are as follows:
Role
To lead national efforts to promote systemic improvements in the safety and quality of health care
in Australia with a particular focus on minimising the likelihood and effects of error.
Tasks
1. Provide advice to Health Ministers on a national strategy and priority areas for safety and
quality improvement;
2. Develop, support, facilitate and evaluate national actions in agreed priority areas;
3. Negotiate with the Commonwealth, states and territories, the private and non government
sectors for funding to support action in agreed priority areas;
6
National Expert Advisory Group on Safety and Quality in Australian Health Care (1999), Implementing safety
and quality enhancement in health care: National Actions to support quality and safety improvement in
Australian health care.
7
The Australian Health Ministers’ Conference (AHMC) is a mechanism for consultation between Australian,
State and Territory Health Ministers. It provides a forum to facilitate a consistent and coordinated national
approach to health policy development and implementation. The Conference is assisted by the Australian Health
Ministers’ Advisory Council (AHMAC), the membership of which includes the heads of Australian and State
and Territory health departments.
-2-
4. Widely disseminate information on the activities of the Council including reporting to Health
Ministers at publicly agreed intervals.
In undertaking these tasks, Council will:
1.
Work collaboratively with stakeholders, in particular building on the existing efforts of health
care professionals and consumers to improve the safety and quality of health care.
2.
Establish partnerships with existing related national bodies and organisations, in particular the
National Institute of Clinical Studies (NICS) and the National Health Information Management
Advisory Committee (NHIMAC) to facilitate action in agreed priority areas.
3.
Consider and act to improve health care in the priority areas identified as a result of national
consultations undertaken by the National Expert Advisory Group on Safety and Quality in
Health Care including:
-
methods to enable increased consumer participation in health care;
-
implementation of evidence-based practice;
-
agreed national framework for adverse event monitoring, management and prevention
including incident monitoring and complaints;
-
effective reporting and measurement of performance, including research and development of
clinical and administrative information systems;
-
strengthening the effectiveness of organisational accreditation mechanisms;
-
facilitate smoother transitions for consumers across health service boundaries;
-
education and training to support safety and quality improvement.
4.
Co-opt members with specific expertise, and establish sub-committees and reference groups
as required.
The Council has established a number of working groups, mostly chaired by Council
members, to progress specific elements of its work. Links to jurisdictions are facilitated by
members on Council from each jurisdiction and the State Quality Officials’ Forum (SQOF).
1.3
Terms of Reference for the Review
On 29 July 2004, Health Ministers agreed to establish a Review of Future Governance
Arrangements for Safety and Quality in Health Care, to be completed prior to the cessation of
the current term of Council in June 2006.
The Terms of Reference of the Review are to:
1.
Review the work of the Australian Council for Safety and Quality in Health Care.
2.
Develop proposals for the future governance arrangements for leadership and
coordination for safety and quality in health care in Australia, and specifically:
2.1 Identify and describe the process to achieve national leadership and coordination
for safety and quality in health care in Australia; and
2.2 Identify priority areas for national action for transforming health care safety and
quality in Australia.
-3-
Health Ministers agreed to the appointment of a senior international health expert to Chair the
Review and senior health officials/managers from five jurisdictions (the Australian
Government, South Australia, Victoria, NSW and Queensland) were appointed as members
of the Review Team.
The Review Team was tasked with reporting to Health Ministers in July 2005.
At the request of the Australian Health Ministers’ Advisory Committee (AHMAC), the
Review Team also considered a range of issues related to the role of health service
accreditation in improving safety and quality.
1.4
Review Team membership
Chair
Mr Ron Paterson
New Zealand Health and Disability Commissioner
Members
Professor John Horvath AO
Chief Medical Officer
Australian Government Department of Health and Ageing
Dr Chris Brook
Executive Director
Rural & Regional Health & Aged Care Services
Victorian Department of Human Services
Dr David Filby
Executive Director
Health System Improvement and Reform
South Australian Department of Health
Ms Mary Montgomery
District Manager
Redcliffe/Caboolture District Health Service
Queensland Health
Dr Michael Smith
State Director of Clinical Governance
Health System Performance Division
New South Wales Health
The Review Team was supported by a small secretariat hosted by the Australian Government
Department of Health and Ageing on behalf of all jurisdictions.
-4-
1.5
Consultation process and background research
The Review Team conducted an extensive consultation process over the period September
2004 to March 2005, consisting of a call for submissions, a national workshop, and a series of
meetings with stakeholders in each capital city.
The consultation arrangements for the Review were designed to ensure that all jurisdictions
and non-government stakeholders had the opportunity to provide input. The Review received
80 submissions and close to 300 individuals and over 100 organisations were involved in
face-to-face consultation meetings with the Review Team. About 100 people attended the
national workshop.
Further details on the consultation process are at Appendices 3, 4 and 5. Publicly available
submissions and a thematic paper summarising the views represented in submissions are
available on the Review website: http://www.health.gov.au/safetyandqualityreview.
The Review Team was assisted by a background paper on governance issues, prepared by
Professor Andrew Wilson in January 2005, entitled National Governance for Leadership and
Coordination for Safety and Quality in Health Care in Australia – Issues and Options. The
paper provides an overview and literature review covering concepts of governance,
international approaches to governance for health care safety and quality, and possible
approaches for Australia.
At the request of the Review Team, the Council prepared a background paper on
accreditation, outlining the key issues identified in Council’s work on this issue.
Both of the above background papers are available on the Review website.
-5-
2.
Review of Council
Key Points
Council has made a valuable contribution to safety and quality improvement, particularly in
regard to:
•
•
•
raising awareness of the key issues and how to tackle them;
elevating the importance of taking a systems approach; and
producing policy work and standards.
The three most important limitations on the effectiveness of the Council have been:
•
•
•
inadequate links between Council, jurisdictions and other key stakeholders;
a narrow focus on safety in the acute sector; and
its large size and unwieldy internal arrangements.
More effective strategies should have been developed in partnership with jurisdictions and
other bodies in relation to:
•
•
•
implementation;
performance measurement and reporting; and
coordinated information dissemination.
2.1 Approach taken by Council in addressing its Terms of Reference
Council’s approach is set out in its five annual reports to Health Ministers. Its Terms of
Reference were endorsed by Health Ministers in July 2000 at the same time that Ministers
considered Council’s first report.8 This initial report also highlighted Council’s intended
focus on health care safety, as distinct from the broader quality agenda proposed by the
National Expert Advisory Group.9 The three priority areas on which Council would focus its
efforts were identified as:
•
•
•
better using data to identify, learn from and prevent error and system failure;
promoting effective approaches to clinical governance and accountability which address
both the competence of organisations and individuals; and
redesigning systems and facilitating a culture of safety in health care.10
As stated in its submission to the Review, although Council’s initial focus was on safety it
intended that other dimensions of quality (effectiveness, appropriateness, responsiveness,
access, efficiency and equity) would be progressively addressed as part of this focus. Council
explained its “safety first” focus by pointing to research showing safety is the issue most
8
ACSQHC (2000), Safety First: Report to the Australian Health Ministers’ Conference 27 July 2000.
National Expert Advisory Group (1999) op cit.
10
ACSQHC (2000) op cit., p.6.
9
-6-
valued by patients and their families, while also being of concern to health professionals,
health managers, funders and policymakers.11
Council has also focused on improving systems, promoting a cultural shift from blaming the
individual when things go wrong to identifying the underlying systemic causes of adverse
events. This systems focus also led Council to concentrate on the acute sector, where there
are clearly identifiable systems that can be used as an exemplar to other sectors.12
In its submission, Council sees its central achievement as setting the national agenda and
achieving widespread understanding and acceptance of that agenda among policy makers,
administrators, clinicians and consumers.
“It [Council] has established credibility as a national leader, with jurisdictions
adapting the agenda to suit local conditions and now implementing that agenda.
Effective working partnerships have been established and a range of tools and
resources developed to support safety and quality improvement. Together, these
have built a foundation for widespread systemic change.”13
The acceptance of this agenda by Health Ministers was evident when they agreed to an
implementation timetable, in public hospitals, for eight uniform national actions to improve
patient safety recommended by Council in April 2004.14 The eight decisions made and the
timelines for implementation endorsed by Ministers were:
•
•
•
•
•
•
•
•
require that a common medication chart be in used in all public hospitals in Australia by
June 2006;
require that public hospitals have in place a process of pharmaceutical review of
medication prescribing, dispensing, administration, and documenting processes for the
use of medicines by December 2006;
require that all public hospitals have an incident management system in place by January
2005 incorporating incident management, monitoring, investigation, analysis, and action
arising;
require all public hospitals to report all sentinel events, either to the State department or
to an agreed third party, no later than the end of 2005;
agree that all States and Territories will contribute to a national report on sentinel events
to be produced by the end of 2005;
require that all public hospitals adopt the five step correct patient, correct site, correct
procedure protocol for verifying the site of surgery and other procedures to reduce the
risk of wrong site procedures by the end of September 2004;
require that, by the end of December 2004, all public hospitals will provide each hospital
patient with a copy of the consumer booklet 10 tips for safer health care: what everyone
needs to know at or before the time of admission; and
require that all public hospitals will have in place a patient safety risk management plan
by the end of 2005.
11
Submission No. 53, ACSQHC, p.6
Ibid.
13
Ibid., p.9.
14
Australian Health Ministers’ Conference, Joint Communiqué: Health Ministers Agree to Reform Agenda, 23
April 2004.
12
-7-
Health Ministers later confirmed their commitment to progressing other quality initiatives put
forward by Council in its 2004 Annual Report to AHMC.15,16 The implementation plan for
these recommendations, which was developed by AHMAC and endorsed by Ministers in
January 2005, is discussed further in Chapter 6. The Council recommendations were in the
areas of:
•
•
•
•
Open Disclosure – a standard which aims to encourage greater openness about adverse
events by acknowledging when things go wrong and providing reassurance to patients
and their carers that lessons will be learned;
Performance Management – to address issues of corporate and clinical governance, and
the supervision of staff and staffing levels, in order to match human and physical
resources with the need to provide safe, high quality care;
Data Collection – specifically, the development of a National Minimum Data Set for
Safety and Quality to establish a common set of measures of the safety and quality of
health care in Australia; and
External Review – proposing that, at a minimum, participation in processes of
assessment should occur in hospitals across Australia.
The Review Team notes that Council’s original recommendations on the 12 items above were
intended to apply in a range of sectors. However, Ministers’ endorsement of the eight from
April 2004 was limited to the public acute sector (discussed further in Section 2.3.6).
Combined with other work on medication safety, health care associated infections,
credentialling, accreditation, workforce education and root cause analysis, the Council has
made significant progress towards developing the key components of a safer health system.17
2.2
Views from Review consultations
2.2.1 Acknowledged successes of the Council
There was broad recognition among stakeholders that Council has played a national leadership role
which did not exist before its creation. There was acknowledgement that within a short timeframe,
Council has:
•
•
•
•
•
•
become a respected body;
engaged clinicians and subject-matter experts;
produced authoritative advice to Health Ministers;
produced high quality policy standards and other products that have placed Australia among the
world-leaders in safety and quality interventions;
fulfilled its role of setting the national safety and quality agenda; and
focused on systems rather than individual blame for adverse events.
One of Council’s key achievements to date was perceived to be raised awareness of safety issues
among clinicians, consumers and the wider public, something seen as a necessary first step for
15
Australian Health Ministers’ Conference, Joint Communiqué: Health Ministers Agree to Continue Reform
Agenda, July 2004.
16
ACSQHC (2004), Maximising National Effectiveness to Reduce Harm and Improve Care: Fifth Report to the
Australian Health Ministers’ Conference, pp. 13-14.
17
A more complete list of Council achievements, taken from its submission to the Review, is at Appendix 2.
-8-
achieving change. For clinicians, raised awareness was seen to have prompted the attitudinal change
that is a precursor to cultural change at the health service level. Raising the public profile for safety
and quality issues was seen as a way of ensuring continued commitment from governments,
professional peak bodies and others.
Many stakeholders also acknowledged the significant contribution of the Chair of Council,
Professor Bruce Barraclough AO, whose tireless efforts in championing the safety and quality
agenda were regarded as central to Council’s achievements.
There was general consensus among stakeholders that there remains a role for a national safety and
quality body to lead and promote coordination of effort to improve the safety and quality of health
care.
2.2.2 Issues and concerns
One of the principal concerns raised in Review consultations was that, under current governance
arrangements for safety and quality, the Council lacks the authority to take action to effect change.
The Review Team perceived a degree of frustration among many stakeholders that important policy
decisions endorsed by Ministers were not always effectively implemented and that clinical best
practice, where it is identified and disseminated, is not always utilised.
As a result, it was asserted by many that there is little evidence that Australia has made any
measurable progress in improving safety and quality since the Quality in Australian Health Care
Study. The need for measurement was an important issue in its own right, with stakeholders
pointing to the lack of coordinated collection and analysis of relevant data to measure the progress
of safety and quality improvement on a national basis.
Examples of other issues raised by stakeholders include:
•
•
•
•
•
2.3
existing institutional arrangements do not provide a sufficient level of integration and
coordination of Council activities with the activities of:
- jurisdictions;
- other national bodies related to the safety and quality agenda; and
- consumers, professional groups, medical indemnity insurers, and the primary and private
health sectors;
Council has a very large work program with inadequate involvement of other key stakeholders
in priority setting. This has created difficulties for jurisdictions in driving local implementation
of the large volume of national initiatives;
Council did not adequately coordinate with other key bodies on the dissemination of safety and
quality information to service level providers;
Council’s large size made strategy development and timely decision making difficult; and
there remains an unacceptable level of risk in the health system, but there was a widespread
view that there should be a broader focus on quality across the health care system to achieve
the reforms that are needed for real change.
Review Team’s view
The Review Team acknowledges the significant progress made by Council over the past five
years and the individual contributions of Professor Bruce Barraclough and the members of
-9-
Council. Council’s achievements to date are notable given the complexity of the system in
which it has operated – a system involving nine sovereign jurisdictions and extensive private
and community care sectors. The Review Team also notes the international recognition
Australia has received for its efforts to improve patient safety.
The Review Team considers that the Council has been successful in raising awareness of
safety and quality issues and how to tackle them, particularly among clinicians18 and
administrators involved in quality improvement activities. Council has also elevated the
importance of taking a systems approach to safety and quality improvement.
To support its national agenda, the Council has produced an extensive body of policy work
which has led to the development of important national policies and standards endorsed by
Ministers. While the dissemination and implementation of this work has been somewhat
patchy, to a large extent this was a result of weaknesses in governance arrangements rather
than a reflection on the Council. For this reason, it is important that Council’s performance is
assessed in the context of what it was established to achieve and the broader institutional
arrangements in which it operated.
In identifying shortcomings in these arrangements, the Review Team does not wish to detract
from the efforts of individual Council members, the Council as a whole or its office.
However, the Review Team believes there have been limitations on the effectiveness of the
Council, the three most important of which have been:
•
•
•
inadequate links between Council, jurisdictions and other key stakeholder bodies;
a narrow focus on safety in the acute sector; and
its large size and unwieldy internal arrangements.
Additionally, the Review Team believes that more effective strategies should have been
developed in partnership with jurisdictions and other bodies in relation to:
•
•
•
implementation;
performance measurement and reporting; and
coordinated information dissemination.
2.3.1 Capacity to drive implementation
As was noted in Council’s own submission to the Review, Council was established as an
advisory body to Health Ministers with a limited capacity to implement change. Its role, as
specified in its Terms of Reference, is to “develop, support, facilitate and evaluate national
actions”, for example by making guidelines and tools widely available. The task of local
implementation rests with the responsible jurisdictions and health stakeholders.
In light of this, stakeholder views which highlighted a lack of implementation are mostly
viewed by the Review Team as criticisms of the current national governance arrangements
rather than as legitimate criticisms of Council. In particular, current national governance
arrangements provide inadequate mechanisms for linking the national body’s work program
with that of jurisdictions (see 2.3.2 below) or other key stakeholders (refer to 2.3.3 below).
18
The word ‘clinicians’ is used here to denote all health professionals and practitioners who are delivering
health care, including medical, nursing and allied health practitioners.
- 10 -
The Review Team notes that one of Council’s primary achievements has been to encourage
cultural change in addressing adverse events. The shift from a “blame culture” to a systems
approach has made the implementation of safety and quality improvement measures more
achievable at the clinician level.
The recent agreement of AHMC to implement Council recommendations (refer to 2.1) is seen
by the Review Team as a measure of success for Council in promoting and facilitating
implementation, at least in the public hospital sector. It should be noted that Council also
recommended implementation in private hospitals, but did not provide adequate
implementation plans outlining how this should occur. As Council notes in its submission to
the Review, it has struggled to find “manageable mechanisms for change in the private
hospital sector”.19
The Review Team also notes that Council has attempted to support implementation by
providing financial assistance to jurisdictions for implementation for some of its initiatives.
The Review Team concludes that to some extent Council paid insufficient attention to
implementation issues in its policies, standards and recommendations to Health Ministers.
However, problems regarding the implementation of Council initiatives were broader than
this and need to be addressed in the proposed governance arrangements for the future.
2.3.2 Engagement with jurisdictions
Early in its term, Council recognised the need for a mechanism through which jurisdictions
(as major funders/providers) could actively contribute to the Council’s national program.
While some Council members also work in jurisdictions, Council’s primary means of
engaging with jurisdictions is to utilise an existing jurisdictional forum – the State Quality
Officials’ Forum (SQOF). SQOF comprises quality officials from all States and Territories
and the Executive Director of the Council secretariat. The Chair of SQOF represents the
Forum on the Council Executive, and provides formal reports to and from the Council.
SQOF’s role, as outlined in its Terms of Reference, includes working with and supporting the
Council, raising awareness of safety and quality issues at the jurisdictional level, and
operationalising safety and quality projects.
It is the Review Team’s view that for a variety of reasons linking with SQOF did not provide
an effective vehicle for engaging health departments and Ministers, and they were not always
fully aware of and able to participate in Council’s work-plan. As SQOF was never formally
linked to AHMAC it was not able to perform as a mechanism for Council to engage AHMAC
members. Broader jurisdictional concerns were not taken into account when policy
recommendations were made by Council to Health Ministers (for example, the implications
of a policy recommendation for industrial relations). This lack of high level involvement also
impeded action to ensure that local systems, related policies and regulatory and financial
levers were able to be utilised to deliver nationally agreed policies in a timely and consistent
way. While Council did not have responsibility for implementation, this lack of connection
with jurisdictions meant there was not the necessary link to facilitate implementation.
19
Submission No. 53, ACSQHC, p.12.
- 11 -
During the Review consultations jurisdictions also raised issues regarding Council’s
engagement at other levels within jurisdictions, including:
•
•
•
a lack of formalised, collaborative partnerships with state-based quality bodies that
would otherwise enable national learning from local experience;
inadequate utilisation of the expertise of other state-based organisations; and
poor coordination of communication to service level providers, leading to their receiving
safety and quality information and material from a number of sources.
The Review Team believes that all of the above points to the need to establish stronger
mechanisms for linking Council with jurisdictions.
2.3.3 Strategic partnerships with other key stakeholders
Another issue raised in Review consultations is that there is insufficient integration and
coordination of national priorities with those of key stakeholders (including other national
bodies) contributing to the safety and quality agenda. While the Review Team is aware of
several examples of Council collaboration with other stakeholders, it is questionable whether
these could truly be regarded as strategic partnerships.
Certainly, from the Review consultation process, it is evident that some key national bodies,
such as the National Health and Medical Research Council (NHMRC) and the Australian
Institute of Health and Welfare (AIHW), believe that Council did not comprehensively
engage and utilise their expertise and networks. This view was reflected by other important
organisations, such as the Australian Council on Healthcare Standards (ACHS), groups
representing clinicians, consumer organisations and specific sectors of the health care system
(eg general practice).
In regard to consumer engagement, while Council and its consumer representatives were
given credit for consistently articulating the need for a consumer focus, Council’s perceived
neglect of organised consumer networks was felt to have limited the wider dissemination of
its message.
The Review Team considers that the capacity to develop effective strategic partnerships is an
issue that needs to be addressed in the establishment of future governance arrangements.
Although the Council’s Terms of Reference specifically tasked it to “work collaboratively
with stakeholders” and “establish partnerships with existing related national bodies and
organisations”, this placed the onus for establishing these relationships on Council alone,
rather than providing a more coordinated approach to the establishment of partnerships
between key national bodies and other stakeholders.
2.3.4 Performance measurement and reporting
As noted earlier, the lack of national capacity to measure the progress of safety and quality
improvement was a frequently raised issue in Review consultations. On this issue, the
Review Team believes that inadequate links with jurisdictions contributed to a failure to use
existing multilateral mechanisms to design safety and quality data sets. Effective public
reporting is dependent on the availability of data. There is a notable gap in what is known
about the current extent of safety and quality problems, what effect recent initiatives have
had, and the capacity that exists for improvement.
- 12 -
The Review Team notes the significant achievement of Council in facilitating the
development of a National Report on Sentinel Events and believes that this was an important
first step in the publication of safety and quality data. The crucial next step is the
development of a National Minimum Data Set for Safety and Quality, for which Council
obtained AHMC agreement in January 2005.
The Review Team notes that in early 2005 the Statistical Information Management
Committee (SIMC) of the National Health Information Group (NHIG) and Council have set
up a working group to develop the data set. The Review Team believes the time is overdue
for a regular authoritative national report on the key indicators of the state of safety and
quality, and that urgent progress is needed on SIMC and Council’s joint work to develop the
relevant data.
2.3.5 Communication and information dissemination
Inadequate links between Council, jurisdictions and stakeholders has led to ineffective
dissemination of Council initiatives. Communication issues figured prominently in Review
consultations and, although there are examples of successful communication (eg the wide
dissemination of the high-risk medication alert on Potassium Chloride), there does not seem
to have been an effective overall communication strategy. The Review Team regards this as
an important weakness in Council’s efforts to build momentum for change at all levels of the
health system, within the political and bureaucratic sphere and among the general public.
Good communication is also often a key factor in facilitating implementation of safety and
quality initiatives.
It should be noted that one of Council’s primary means of communication and dissemination
has been through utilising SQOF to reach the public acute sector in each jurisdiction, and
through Council’s Consumer Reference Group to reach consumers. The Review Team
believes it is imperative that other stakeholder networks are utilised in a comprehensive
fashion in order to communicate and disseminate effectively at all levels of the health system.
2.3.6 Questions of scope
The Review Team is of the view that Council’s initial focus on safety in acute hospitals was
warranted, particularly in light of the safety issues raised by the Quality in Australian Health
Care Study. However, Council’s work plan was wide-ranging and policy development has
been slow. Important initiatives, such as credentialling and accreditation, which were
identified as urgent priorities early in Council’s existence and on which Council has
undertaken significant work to develop national standards and approaches, have not
progressed as quickly as desirable. A tighter, more focused approach on such important
issues may have been more effective.
The Review Team also notes that while Council provided advice and recommendations
which were intended to address the entire acute care system,20 Health Ministers’ decisions
tended to be confined to the public acute system. One explanation for this is that Council’s
recommendations did not adequately address the particular implications of implementation in
the private sector, leading to a lack of identified mechanisms to readily do so. Feedback from
20
Submission No. 53, ACSQHC, p.12.
- 13 -
stakeholders suggests that a lack of engagement with the private sector underpins the lack of
decisions to implement safety and quality policies in that sector. This is problematic given
that private hospitals account for almost 40% of hospital admissions.21
Other stakeholders have expressed the view that other highly relevant sectors of the health
system do not feel engaged in the national safety and quality agenda (eg primary care,
specialist practice, mental health). General practice is a particularly notable omission, given
that GPs are the initial source of care for most Australians. Stakeholders also expressed the
view that, while efforts to improve safety should continue, the focus should shift to
improvements in the effectiveness and responsiveness of care. This would yield further
improvements in safety and achieve efficiencies in the system that allow for a retargeting of
health resources.
2.3.7 Internal arrangements
The Review has found that Council’s internal governance arrangements are unwieldy and
overly reliant on the efforts of a large body of part-time safety and quality experts. The size
of Council (initially established with 22 members and now numbering 27) and the relative
lack of members with corporate governance skills or a national systems level view, has
contributed to difficulties in identifying priorities and in managing the workplan. Council has
struggled to agree on national strategies for improving safety and quality, resulting in
Council’s energy being dissipated across a number of initiatives which have reached various
points in the policy/implementation process.
A further problem is that Council membership did not include an AHMAC member, and had
no other formal link to AHMAC (as discussed in 2.3.2), and so had difficulty in engaging
jurisdictions in its work, which, in turn, did not facilitate implementation.
The current secretariat arrangements have the benefit of the effective provision of secretariat
support by a host jurisdiction, but may obscure who is accountable for the timely completion
of the work plan. A common complaint has been that these arrangements were characterised
by a high rate of staff turnover and loss of corporate memory.
Stakeholders also made it clear during the consultation meetings that current mechanisms
(such as SQOF and the Consumer Reference Group) have not been effective in involving
stakeholders in the priority setting process.
2.4
Conclusions
The consultation process identified consensus that considerable progress has been made by
the Council over the past five years and that there remains a key role for a national safety and
quality body to lead and coordinate improvements in the safety and quality of health care. In
this sense, the criticisms of current arrangements do not suggest that there is no need for
national leadership, but rather reflect concerns about the current capacity, authority and
strategies of all relevant bodies to act in concert to achieve national action.
21
Australian Institute of Health and Welfare (2005), Australian Hospital Statistics 2003-04: Health Services
Series No. 23, p.9.
- 14 -
The consultation process also demonstrated a strong desire to follow through on the
Council’s current body of work, including implementing Council recommendations already
agreed to by Health Ministers.22
In designing future arrangements for safety and quality, there is a need to address the
concerns of stakeholders and the problems outlined by the Review Team in this Chapter.
Particular requirements for the future include:
•
•
•
stronger engagement with jurisdictions and other stakeholders in the national safety and
quality agenda to support:
- the development of effective strategies and coordinated action to implement safety
and quality improvements nationally;
- better mechanisms to enable a contribution to priority setting by all relevant
stakeholders;
- the development of nationally consistent safety and quality data sets and national
reporting using existing inter-jurisdictional arrangements; and
- more effective dissemination of safety and quality information and initiatives;
an expansion of scope for the national body beyond the public acute sector (especially to
engage the private health and primary care sectors); and
enhanced internal governance arrangements.
Developing a genuinely national approach is an ongoing challenge and can best be addressed
by clearly defining the scope and governance arrangements for future safety and quality
action. In Chapter 3, the Review Team recommends a focus of this national action and the
critical roles and responsibilities which need to be performed in order to transform health care
safety and quality in Australia. In Chapter 4, the specific governance issues that have been
raised in this chapter will be addressed in designing the future national safety and quality
body.
22
Refer to Chapter 6.
- 15 -
3.
Achieving a transformation
Key Points
The Review Team believes that national action should seek to operationalise safety and
quality at all levels of the health system and achieve measurable improvement in the safety
and quality of care. Informed by the Review consultation process, the Review Team believes
that achieving this transformation will require:
•
•
•
•
•
a new national safety and quality body with clearly defined functions;
a quality improvement focus across the continuum of health care;
public reporting on the progress of safety and quality improvement;
clearly defined functions to be performed by jurisdictions, including responsibility for
implementation; and
a national strategic framework which promotes coordinated action from all key players.
Collectively, the national body, the arrangements in place in individual jurisdictions, and the
National Strategic Framework form the core elements of national governance arrangements
for improving the safety and quality of health care in Australia.
3.1
National safety and quality body
The Review Team’s extensive consultation process has informed its view that there remains a
key role for a national body to lead and coordinate efforts to improve the safety and quality of
health care in Australia. The ongoing need for leadership from a national body received
unanimous support during Review consultations, with stakeholders continuing to desire an
authoritative national voice to advise governments, health bodies, clinicians and consumers
on ways to improve health service delivery.
There was also a common view that national action was necessary to ensure a comprehensive
and coordinated approach to the improvement of safety and quality. This role should include
working with other key bodies involved in the safety and quality agenda and advising on
linkages and gaps, so as to realise the obvious efficiencies to be gained by avoiding
duplication of effort. A national body can also promote consistency in the delivery of care, in
whatever part of the country it is delivered, to ensure that all patients receive care based on
the same knowledge and standards.
In recommending that there remains a place for a national body to lead patient safety and
quality improvement in Australia, the Review Team emphasises that the body’s functions
must be clearly defined, it must have effective links with jurisdictions and key stakeholders,
and its advice must be implementable.
Effective links with jurisdictions and key stakeholders are of particular importance, because
the national body is just one part of broader national governance arrangements for safety and
quality. These governance arrangements need to ensure that jurisdictions and stakeholders are
able to contribute to priority setting and policy development and fulfil their responsibility for
implementation of nationally agreed policies and standards.
- 16 -
Recommendation 1 – New national safety and quality body
A new national safety and quality body should be established to succeed the Australian Council for
Safety and Quality in Health Care.
3.2
Scope of national action
The Review Team has heard a clear message from stakeholders that there remains a
significant level of avoidable patient harm across the Australian health care system. Patient
safety must therefore remain a high priority and the valuable work begun by the Council,
individual jurisdictions, and other health stakeholders must be continued.
There was a general view in Review consultations, however, that the scope of national action
should be expanded and that the future work of a national body should have a quality
improvement focus across the continuum of health care. The Review Team supports this
notion and believes it will both build on the work of Council and allow a necessary
refocusing of the agenda.
Improvements in the appropriateness of care delivery and the effectiveness of chosen
interventions will lead to more efficient service delivery and the potential to reallocate
resources to pressure points in the system, for example to improve access. Similar gains can
be made by improving the interface between different care settings, for example, by
standardising approaches to discharge summaries and ensuring patient information is
delivered from hospitals to GPs and vice versa.
While the focus on safety had as one of its primary goals the prevention of major health care
failure, a broader quality improvement focus can yield significant dividends in terms of
improved efficiency and utilisation of health resources. As stated in a recent Productivity
Commission report, “an efficiency improvement of 10 per cent in service delivery in this
sector [health] would provide cost savings equivalent to around 1 per cent of GDP.”23
Improving the safety and quality of care can create cost-efficiencies which counter arguments
that greater rationing is the only response to pressures on health resources. The Review Team
recommends an approach which aims for optimum efficiency and effectiveness in health
service delivery across primary, acute, rehabilitative, aged and community care, in the public
and private sectors.
In recommending this broadened scope, the Review Team emphasises that it must be
accompanied by clearly defined functions and a tight work plan, focused on pressure points
in the system that are not being addressed by others. The ultimate aim will be to demonstrate
measurable improvement in providing care that is safe, effective and responsive to the needs
of consumers.
Recommendation 2 – Scope of national action
The work of the national body should have a safety and quality improvement focus across the
continuum of health care.
23
Productivity Commission (2005), op cit, p. XLIII.
- 17 -
3.3
Functions of the national body
When stakeholders were asked what they sought from a national safety and quality body, the
following were their leading requirements:
•
•
•
•
leadership of a national agenda for safety and quality improvement;
national reporting on the progress of safety and quality improvement;
expert advice and standards to promote safety and quality improvement; and
successful implementation to ensure that the work of the national body translates into
actual improvements across all levels of the health system.
The functions of the national safety and quality body proposed by the Review Team are
designed to address the identified needs of jurisdictions and stakeholders and to fulfil the
fundamental requirements of national action to improve safety and quality in the Australian
health system. The proposed functions are as follows:
National voice
There continues to be a need for a national body to lead and coordinate the safety and quality
agenda in Australia. Specifically, this body should recommend priorities for action, identify
emerging issues, disseminate knowledge and advocate for safety and quality. This would
require the national body to collaborate or consult with other key bodies already working in
the safety and quality area to advise on linkages and gaps.
As discussed later in this Chapter, the initial priority will be to develop a National Strategic
Framework for Improving the Safety and Quality of Health Care to promote coordinated
action from all stakeholders involved in the safety and quality agenda.
Public reporting
The view of the Review Team, confirmed by stakeholders during the consultation process, is
that the time is now overdue for an authoritative national report to the public on the safety
and quality of patient care in Australia. The purpose of such a report (and for subsequent
reports) would be to (a) inform the public about the current state of health care safety and
quality and progress in quality improvement and provide assurance that it is being monitored
at a national level; and (b) promote quality improvement by engaging clinicians, health care
organisations, funders, and consumers (in the public and private sectors) to learn from
successful delivery systems and practices.
Key features of any report should include reporting on progress by jurisdictions in
implementing nationally agreed policies and standards and improvements in the quality of
care delivery. It will not include data on individual practitioners, facilities or health services,
although over time there may be a case for publication of such comparative data (at least at
the service level).
The first report should be completed by June 2007, with subsequent reports every two years.
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Data and analysis
The Review Team believes that the lack of coordinated collection and analysis of safety and
quality data seriously hinders efforts to manage safety and quality problems and improve
systems. Moreover, we do not know if the health care system has become safer as a result of
recent efforts, because “there is insufficient information at a state or national level”.24
The lack of data utilisation also impacts upon the health system’s ability to routinely feed
information into a cycle of improvement. As cited by the Royal Australasian College of
Physicians (RACP) in its submission to the Review, “clinicians do not have ready access to
meaningful information about clinical practice”, despite evidence-based practice being reliant
on timely access to such information.25
A key function for the new national body will be to analyse the progress of safety and quality
improvement in a meaningful way. In order to do this the body will have a key role to play,
within current multilateral governmental arrangements, to ensure that a minimum data set for
safety and quality is created and maintained. This will allow for a comprehensive assessment
of the state of safety and quality of health care in Australia, filling a notable gap in what is
known about the current extent of safety and quality problems, the impact of recent
initiatives, and the capacity that exists for improvement.
Strategic advice
It is widely supported by stakeholders that there is an ongoing role for a national body to
recommend to Health Ministers what interventions (eg, adoption of new policies, use of
funding or regulatory levers, liaison with other national bodies such as NICS, the National
Health Information Group (NHIG) and the Pharmaceutical Health And Rational use of
Medicines (PHARM) committee) will be most effective to drive quality improvement
nationally. The purpose of such advice would be to capture ‘best practice’ thinking in
Australia and internationally, and to give Ministers a strategic overview and inform the
exercise of their funding and regulatory powers and agenda-setting role, in their own
jurisdictions. The Review Team believes this will assist jurisdictions in making effective use
of their existing regulatory and funding powers to build systems that support continuous
quality improvement.
The body would also have a role in recommending implementation strategies, so that its work
translates into actual improvements across the health system. While the Review Team
recognises that implementation remains the role of respective jurisdictions and health
stakeholders, it believes the national body has a key role in facilitating implementation, by
consulting with jurisdictions and devising strategies to support the implementation of its
initiatives. Implementation needs to be better designed, planned and negotiated, with the
needs of different sectors (public hospitals and services, private hospitals, rooms based
specialist practice, primary care, aged care etc) taken into account.
The new national body should also advise Ministers on the specific partnerships needed
between key national bodies so that there is comprehensive engagement and utilisation of
expertise relevant to safety and quality improvement.
24
Wilson, R (2005), ‘The safety of Australian healthcare: 10 years after QAHC’, Medical Journal of Australia,
182 (6), pp.260-1.
25
Submission No. 9, RACP, p.6.
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Policy standards
The Review Team believes that another role for the national safety and quality body is to
identify and disseminate ‘best practice’ policies and standards that are demonstrably effective
in improving patient care. National standards are required to address key areas of patient
harm (eg medication misuse, health care associated infections, inappropriate use of blood
products, patient falls, and pressure ulcers), but should also focus on continuous quality
improvement.
There are certain principles in designing safe, high quality systems that could be nationally
consistent, while allowing jurisdictions flexibility in the way they manage their health
systems. Examples include national standards in regard to Open Disclosure and
Credentialling and protocols for medication use.
The dissemination of national standards will avoid duplication of effort and ensure
consistency in the delivery of care, in whatever part of the country it is delivered. It will also
promote the coordination of care across the continuum (eg between GP clinics and hospitals,
whether public or private).
Recommendation 3 – Functions of the national safety and quality body
The national body should have the following functions:
•
•
•
•
•
lead and coordinate improvements in safety and quality in health care in Australia by identifying
issues and policy directions, recommending priorities for action, disseminating knowledge, and
advocating for safety and quality;
report publicly on the state of safety and quality including performance against national standards;
recommend national data sets for safety and quality, working within current multilateral
governmental arrangements for data development, standards, collection and reporting;
provide strategic advice to Health Ministers on ‘best practice’ thinking to drive quality
improvement, including implementation strategies; and
recommend nationally agreed standards for safety and quality improvement.
3.4
Making it happen
An overwhelming message received from stakeholders in Review consultations was the need
to “make it happen”. As discussed earlier, the Review Team perceived a degree of frustration
that important policy decisions endorsed by Ministers have not always been effectively
implemented and that clinical best practice, where it is identified and disseminated, is not
always being utilised. As a result, there was some support among stakeholders for a
regulatory body, or at least one with authority derived from legislation.
Despite these views, the Review Team decided against recommending a national safety and
quality regulator. The primary reason is that it is not convinced such a regulatory body would
be effective in Australia’s federal system, in which jurisdictions and health stakeholders
possess the regulatory control and/or influence required to ensure appropriate systems are in
place to provide safe and high quality care. The Review Team recognises that the risk in not
having a regulatory body is that action fails to happen, but believes that other methods of
promoting change have yet to be fully utilised. In particular, public reporting is an underutilised driver for change which should be given the opportunity to “transform” safety and
quality of care before seeking to mandate change at the national level. As will be discussed in
- 20 -
Chapter 7, the role of accreditation as both a quality improvement tool and a lever for
implementation could also be enhanced.
3.4.1 Public Reporting
Given that the safety and quality body will not have a direct role in regulation or
implementation, the power to report independently on health system performance will be its
key mechanism for promoting national action to achieve safety and quality improvement.
There is growing international evidence that public reporting leads to safety and quality
improvement, both at the facility level and more broadly across the system.26 Public reporting
will also provide Australians with the information on health services to which they are
entitled, empowering consumers to advocate for improvements in the system. There should
also be increased public confidence in the health system as awareness grows that the safety
and quality of care is being independently monitored and improvements are being made. The
Review Team believes that public reporting will also be of assistance to jurisdictions and
health stakeholders, by highlighting and publicising areas of improvement.
The ability to monitor and report on the progress of safety and quality improvement does not
provide assurance that the body’s standards and policies will be adopted, and means that the
national body is ultimately reliant on the actions of other players in the fulfilment of its
agenda. The Review Team believes, however, that the ability to report publicly will increase
the likelihood of successful implementation.
Recommendation 4 – Public reporting on the safety and quality of care
Public reporting on the safety and quality of care should be used as a key driver for change.
3.4.2 Roles of jurisdictions and other stakeholders
Before and during the life of Council, individual jurisdictions and stakeholders have moved
to establish safety and quality governance arrangements within their own spheres of influence
and control.
All States and Territories have a safety and quality committee or council of some form and
some States have developed formal governance and accountability arrangements for their
health services, providing clear roles and responsibilities for the safety and quality of care.
The Australian Government is supporting quality improvement in a range of areas, including
general practice, pathology, medication use and residential aged care.
Similarly, within the private hospital sector there have been varying degrees of progress in
developing risk management and continuous quality improvement approaches. Private health
funds have also been active in this area, with some developing safety and quality frameworks
within their contracting regimes.
Medical and nursing colleges have also established programs to improve the safety and
quality of clinical care. Examples that were brought to the Review Team’s attention included
26
Marshall, M.N. et al. (2000), ‘The Public Release of Performance Data: What Do We Expect to Gain? A
Review of the Evidence’, The Journal of the American Medical Association, 283(14), p.1872.
- 21 -
the RACP’s Clinical Support Systems Program, 27 the Royal Australasian College of
Surgeons’ (RACS) Audit of Surgical Mortality, 28 the Australian and New Zealand College of
Anaesthetists’ (ANZCA) State Anaesthesia Mortality Committees and Maintenance of
Professional Standards Program, 29 and the Magnet Recognition Program promoted by the
Royal College of Nursing, Australia (RCNA).30
The Review Team believes that individual jurisdictions and other stakeholders should build
on what is already in place, to ensure that the health system is operated in a way that
promotes safe, high quality care.
Specifically, jurisdictions should have their own structures in place to improve safety and
quality, and to build an effective working relationship with the national body.
Attention also needs to be paid to governance and accountability arrangements at all levels of
the health system, from Health Ministers to interns. Responsibility for delivering safe, high
quality care needs to be clearly defined, including the responsibility for:
•
•
•
sound strategic and policy leadership in clinical safety and quality;
ensuring the existence of appropriate safety and quality systems; and
ensuring organisational accountability for safety and quality.31
Jurisdictions have important ongoing roles in ensuring effective implementation of safety and
quality measures within their jurisdictions and in contributing to national data sets. The
former is a critical function which the Review Team believes should remain the responsibility
of jurisdictions and health stakeholders.
The Review Team recognises that in many instances jurisdictions do not have direct control
over particular health services. They do, however, have significant influence and the capacity
to work with key stakeholders to achieve change. It is only by working with all stakeholders
that change will be possible across the health system.
Recommendation 5 – Related functions of jurisdictions
The related functions of individual jurisdictions (States, Territories and the Australian Government)
should include:
•
•
•
•
•
development of principles and mechanisms for advancing safety and quality in their own
jurisdiction (eg through the establishment of a safety and quality body and mechanisms for
consumer involvement);
appropriate governance and accountability arrangements to provide public assurance of safety
and quality;
implementation of agreed national standards within their jurisdiction;
development of coordinated mechanisms to ensure implementation is effective across the public
and private sectors; and
participation in national data collections on safety and quality.
27
Submission No. 9, RACP, p.2.
Submission No. 57, RACS.
29
Submission No. 38, ANZCA, p.2.
30
Submission No. 37, RCNA, pp.7-8.
31
Wellington H., Much Ado About Boardrooms, 2nd Australasian Conference on Safety and Quality in Health
Care, August 2004. Available at http://www.aaqhc.org.au/resources/conf2004/tues/wellington.pdf
28
- 22 -
3.4.3 Responsibility for implementation
In proposing national governance arrangements that ensure coordinated action at all levels of
the health system, the Review Team recognises that a national body which is not a regulator
needs to be complemented by other stakeholders – especially in relation to the use of
regulatory levers to support implementation.
The Review Team is of the view that implementation should remain the responsibility of
jurisdictions, who need to ensure they have the capacity to effectively implement safety and
quality improvements in a comprehensive and coordinated way. Additionally, in partnership
with the national body, links need to be established with key stakeholders to ensure
implementation.
It is important that the focus moves beyond implementation in public hospitals to include all
health care settings (including private hospitals and specialists’ rooms). To achieve this,
jurisdictions and stakeholders will be responsible for taking action in their own spheres of
influence and control. This may require jurisdictions to act collaboratively in identifying the
most effective levers to support implementation. It may also require partnerships between
jurisdictions, clinicians and private providers, in cases where implementation requires the
coordinated action of a range of stakeholders. Some jurisdictions have created clinical
governance arrangements to ensure clinician leadership of quality improvement efforts, and
these provide an effective vehicle for involving clinicians in implementation. All stakeholders
must take responsibility for safety and quality improvement, although Ministers are
ultimately responsible for using their regulatory and funding levers to ensure implementation.
The national body will have a role in advising on implementation, and in doing so Health
Ministers should be assured that change can and will happen. To ensure that change is
possible, advice from the national body must be robust and take into account the issues
relevant to key players so that national policies are implementable. To ensure change will
happen, the broader governance arrangements linking all the key parties must assign
responsibility and accountability so that all key decision-makers act in concert to ensure
coordinated and complementary action.
As discussed earlier, the national body should also have a mandate to report on
implementation, providing it with some capacity to hold jurisdictions and stakeholders
accountable for the pace of change. Ultimately, however, the implementation of measures to
improve the safety and quality of care will be the responsibility of jurisdictions and
stakeholders.
Recommendation 6 – Responsibility and mechanisms for implementation
Responsibility for implementation of safety and quality standards recommended by the
national body and accepted by Ministers should rest with States, Territories and the
Australian Government working collaboratively, and in partnership with private sector providers.
- 23 -
3.4.4 National Strategic Framework for Improving the Safety
and Quality of Health Care
Throughout Review consultations, stakeholders repeatedly called for a national strategic
framework to ensure coordinated and complementary action at all levels of the health system.
The perception is that there are numerous stakeholders and bodies involved in the safety and
quality agenda, many with overlapping agendas, and that it is time for a coordinated
approach.
The Review Team agrees that a transformation in safety and quality will require the major
players in health care – jurisdictions, state-based safety and quality bodies, professional and
sector specific bodies (eg professional colleges, health funds etc) – to be clear about their
respective roles and responsibilities. A national strategic framework will ensure an inclusive
approach to safety and quality improvement, including the comprehensive range of actions that
will be undertaken in a nationally coordinated way by leaders, decision makers and public and
private providers operating at different levels in the health system.
The new body will be charged with developing a National Strategic Framework for
Improving the Safety and Quality of Health Care, in consultation with jurisdictions and
stakeholders, as a priority to be completed in its first six months of operation. This will be a
test of the national body’s commitment to a consultative and inclusive approach to safety and
quality improvement. The National Strategic Framework will be provided to Health Ministers
for endorsement.
Recommendation 7 – National Strategic Framework for Improving the Safety and Quality of
Health Care
The national body should develop a National Strategic Framework for Improving the Safety and
Quality of Health Care for endorsement by Health Ministers. It should be developed in consultation
with jurisdictions and stakeholders as an immediate priority (ie within the first six months of operation).
The National Strategic Framework will ensure a comprehensive range of action is undertaken in a
nationally coordinated way by leaders, decision makers and public and private providers operating at
different levels in the health system.
3.5
Conclusions: what will success look like?
Collectively, the national body, the arrangements in place in individual jurisdictions, and the
National Strategic Framework form the core elements of national governance arrangements
for improving the safety and quality of health care in Australia.
The Review Team considers that the new arrangements will have been successful if, in five
years, there has been measurable improvement across a number of key indicators in the
quality of health care received by patients in Australia. Safety and quality will no longer be
seen as a series of discrete projects and there will be a nationally consistent approach that
leads to operational implementation at all levels of the health system.
Achieving the above will take concerted action from a range of stakeholders working towards
common, clearly understood goals. Stakeholders want action – they want to know the right
things to do (clinically or in the way systems are organised) and for them to be done. The
- 24 -
approach proposed by the Review Team in this Chapter will refocus the agenda and provide a
clear purpose.
The Review Team believes that the national safety and quality body it is proposing will
provide the necessary leadership, reporting and advice to transform the safety and quality of
health care. The body will report to all Health Ministers, for they, as a group, are responsible
for ensuring that systems are in place to deliver safe and effective health care. Through
Ministers, the national body will report publicly on the performance of the health system,
encouraging systems improvement and providing consumers with information on the safety
and quality of health care.
The national body will have been successful in fulfilling its purpose if, in five years, it has
delivered on each of its functions and its recommendations to Ministers have been translated
into policy decisions which can be implemented across the continuum of care. The successful
implementation of new policies, while not being the responsibility of the national body, will
reflect the strength of its strategic partnerships with jurisdictions and other bodies.
The Review Team emphasises that the national body is just one part of the governance
arrangements that need to extend across the entire health system, unified by a national
strategic framework to promote coordinated action. The key role played by jurisdictions and
other health stakeholders is critical for success.
Recommendation 8 – National governance arrangements for safety and quality
National governance arrangements for safety and quality in health care should comprise:
•
•
•
the national body reporting to all Health Ministers;
the safety and quality arrangements established by jurisdictions; and
the unifying national strategic framework.
- 25 -
4.
Designing a new national safety and quality body
Key points
To be able to fulfil its purpose, the national body will need to:
•
•
•
•
have internal features which conform to the principles of good governance applicable to
any enterprise;
incorporate a mix of skills which will allow it to steer national system level change by
translating expert knowledge on safety and quality across the continuum of care into
feasible policy recommendations to Health Ministers;
be small enough to focus its energy on key outcomes, and support timely decisionmaking; and
establish and steer time-limited expert working groups to deliver technical advice on
priority areas of work.
To fulfil its role as one of a number of bodies involved in the national governance of safety
and quality by Health Ministers, the body will need to establish effective external linkages
with the other key decision-makers in the health sector. These links must:
•
•
•
•
•
provide a role for AHMAC in providing guidance to both the national body and the
Inter-jurisdictional Committee;
provide adequate engagement with senior health department officials (through an interjurisdictional committee) to flag policy directions and inform implementation strategies;
enable effective consultation with key stakeholders bodies (through a Stakeholder
Reference Group) to support national learning from local enterprise in safety and quality
and more coordinated information dissemination to service level providers;
provide a more effective process for stakeholder input into national priority setting; and
enable new policy directions to be flagged to the Stakeholder Reference Group, so that
stakeholder bodies are able to implement these policies in their areas of responsibility.
The formalisation of working arrangements between the national safety and quality body and
other relevant national bodies will enable better coordination and reduce duplication in the
national effort for safety and quality.
4.1
What are the governance problems that the features of a new national body must
solve?
Chapter 3 indicated that a number of key bodies are involved in supporting the safety and
quality of health care in Australia, and that there remains a key role for a national body in this
context. It also identified the specific functions which the national body would undertake as
its contribution to the national arrangements for safety and quality.
Chapter 2 indicated that a number of features of the current governance arrangements need to
be addressed if the future body is to be effective in delivering on its purpose. A future body
would need to incorporate:
- 26 -
•
•
•
members with corporate governance skills and a systems level view, and be small
enough to focus its energy;
formal linkages to support engagement between the body and a number of key
stakeholders, including:
- AHMAC;
- individual jurisdictions;
- state-based safety and quality bodies;
- relevant national bodies;
- private sector bodies; and
- professional peak organisations;
adequate processes for consumers and other stakeholders to contribute to the
identification of national priorities.
The new national body will need to be designed to conform to the principles of good
governance applicable to any enterprise.
4.2
What are the principles of good governance?
Good corporate governance for any entity, whether it be a committee, statutory body or other
form of body, can be considered in terms of three central elements:
“Understanding success: Those in control of an entity need to be clear about what the entity is to
achieve and communicate that effectively to management. This involves the establishment of a clear
sense of purpose and the development of clear expectations of performance.
Organising for success: Once an entity has developed an understanding of what it needs to achieve, it
should be organised appropriately.
-
-
[The] … organisation … [should be structured] … in a way that is most likely to assist it to achieve
its objectives … [The structure should be] … designed … to support (rather than impede) the
operation of governance.
Power must be … delegated … [and] … limited … to manage risk, … [and] … exercise[d] … in a
responsible manner.
[A]ll parties within the governance framework must have a clear understanding of their roles and
responsibilities, including their personal accountability.
Making sure success is achieved.
Governance is about ensuring individuals responsible for performance understand what outcomes they
are required to achieve, and are provided with the capacity to achieve them, [and]
32
- … power and responsibility [should be linked to] performance and review.”
Within this schema, Ministers, as the owners (on behalf of the Australian people), must
provide clear direction to the national body on the functions the body is to fulfil and the
outcomes the body is responsible for achieving. Members of the governing body must act in
good faith to further the interests of the entity, rather than providing representative views or
specific expertise, and would have four key roles:
1.
2.
to set policy directions ie vision, mission, values and culture;
to devise and implement strategies which take the mission forward;
32
Uhrig J. (2003), Review of Corporate Governance of Statutory Authorities and Office Holders,
Commonwealth of Australia, pp. 2-3.
- 27 -
3.
4.
to ensure that management performs effectively in executing the strategies;
to ensure conformance with financial, legal and other obligations. 33
4.3
Are there suitable overseas models for a national safety and quality body?
In considering the particular governance issues to be addressed for safety and quality in
Australia, and the general principles of good governance, the Review Team considered the
governance models used overseas to organise safety and quality improvement efforts – in
particular in the UK and the US.34
Much can be learnt from government bodies such as the National Patient Safety Agency in
the UK and the Agency for Healthcare Research and Quality in the US, and non government
organisations such as the Institute for Healthcare Improvement and the Institute of Medicine
in the US. However, the broader systems of government and the health system in those
countries are very different to those in Australia.35
It is the Review Team’s view that none of these models are easily adaptable for Australia’s
mixed public/private health system and federal system of government. The key difference is
the level of linkages required in a federal system and the need for networked governance
arrangements. A national body in Australia is reliant on its independence and authority,
together with good relationship management and strategic partnerships to drive national
efforts.
4.4
Design of the national body – translating the principles of good governance into
governance arrangements for the national safety and quality body
Chapter 3 makes clear the purpose of the national body for safety and quality by setting out
its functions, roles and responsibilities and what it is to achieve. It is important to recognise
that this body is only one player in a health system comprising multiple decision-makers, and
can only be held accountable for those actions under its control (eg strategic advice on policy
directions including comprehensive implementation strategies, but not implementation for
which jurisdictions and other key bodies are accountable).
Effective governance arrangements will underpin the capacity of the new national body to
achieve its purpose. In considering this issue the Review Team was cognisant of problems
with the internal operations of the current Council (set out in 4.1).
To effectively steer the safety and quality agenda, the body will need members with the right
set of skills to enable them to interpret policy directions, devise strategies for effective health
system change and take them forward over time. Expertise in safety and quality will not be
sufficient. The Review Team is of the view that the national body must incorporate the
expertise to engage at a senior level with key stakeholders, design and steer the work of the
body, and understand and work within the processes of government, to maximise the
likelihood that implementation is undertaken throughout the health system. Collectively,
members of the body should be competent in corporate governance, health system reform or
change management, safety and quality systems, and strategy development.
33
Tricker R.I. (1994) International Corporate Governance, pp. 244-5
Wilson, A., National Governance for Leadership and Cooperation for Safety and Quality in Australia? Issues
and Options. Unpublished.
35
Ibid, pp.7-11.
34
- 28 -
It must also be small enough to make decisions readily. Authority and accountability is too
diffuse in a larger body of experts in safety and quality, creating difficulty for decisionmaking. The process of generating agreement to policy and strategy is time consuming. A
body of between 8 and 9 members should allow for effective decision-making processes. As
a governing body becomes larger, the capacity to reach agreement and make decisions readily
becomes increasingly difficult and can paralyse the performance of the body.
While all relevant stakeholders could not be involved in its internal governance, the body
would still be able to broaden its scope to work across the continuum of care as stakeholder
interests would be managed through its formal linkages with other bodies (see 4.5. below). In
drawing on advice from stakeholders, a small decision-making group is better placed to come
to agreement on how to achieve results.
In light of the above, the Review Team believes the national body should be designed as
follows:
•
•
•
a small body of 8 or 9 members with skills in health systems improvement and corporate
governance would be:
- responsible for effectively steering the national body, and providing assurance to
Ministers that the corporate strategy will give effect to their policy intentions;
- accountable for conformance with legal, financial and other obligations.
Members would include an independent Chair, at least 1 AHMAC member, and 6 or 7
other experts of whom up to 2 could be additional AHMAC members or their nominees,
and would be appointed by and report to Health Ministers.
the Chair would be an experienced, highly credible part-time Chairperson who brings
integrity and respect to this role, and would be:
- responsible for leading the body; and
- accountable to Ministers and the public.
a full-time CEO, capable of engaging government and non-government organisations at a
senior level, would be:
- responsible for developing the work plan to execute the strategies determined by the
body, and managing the budget on a day to day basis;
- responsible for recruiting and managing an office comprising staff with a mix of
policy development and administrative skills; and
- accountable to the body.
Either the Chair or the CEO should have observer status at AHMAC/AHMC.
- 29 -
Recommendation 9 – Internal governance arrangements of the national body
To ensure good internal governance:
•
•
•
•
the Council should be succeeded by a smaller, more focused body, appointed by Ministers;
the body should comprise 8 or 9 people, led by an independent, highly regarded Chair, and
include at least 1 AHMAC member. The remaining 6 or 7 should be chosen for their collective
competence in corporate governance, health system reform or change management, safety and
quality systems, and strategy development, and may include up to 2 additional AHMAC members
or their nominees;
the body should be supported by an office led by a CEO who is capable of engaging government
and non-government members at a senior level, and who is accountable to the body; and
the body should formally report to all Health Ministers.
4.5
Linkages and coordination
4.5.1 Linkages and coordination with jurisdictions
A strong theme emerging from stakeholders is the need for a more effective mechanism for
linking a new national safety and quality body with jurisdictions. This would enable
jurisdictions to formally advise the national body on the adequacy of the process to undertake
high level policy development (eg has the consultation process been adequate? has the right
range of expertise been canvassed? have cost/benefit issues been adequately addressed? has
existing jurisdictionally-based work been taken into account?). It would also allow the heads
of health departments to ensure that local systems and processes are in place to consistently
and comprehensively roll out the policy decisions taken by Health Ministers. Stronger
linkages with jurisdictions would also assist better coordination of effort.
As outlined in Chapter 2, while Council recognised a need for such a mechanism and
established a link with an existing jurisdictional group – SQOF – there were notable
weaknesses in the use of SQOF as a mechanism for linking Council to jurisdictions and, in
particular, AHMAC.
The Review Team considers that it is crucially important that AHMAC and jurisdictions are
formally part of the governance arrangements for the national body, to ensure the body’s
work is well flagged and that all parties understand their roles and accountabilities in
delivering on the work plan. As described in Chapter 3, under the new arrangements
jurisdictions will need to make better use of their existing regulatory and funding powers to
build systems which will support continuous quality improvement. The national body will be
better placed to assist them in this once better linkages are in place.
Responsibility and accountability would be assigned as follows:
•
an Inter-jurisdictional Committee, with representatives from all 9 jurisdictions and
chaired by the AHMAC member of the body, would replace SQOF and would be:
- responsible for advising the body on the adequacy of the policy development
process, in particular the implementability of policies, and
- accountable for ensuring that health departments are aware of new policy directions
and able to review local systems accordingly;
- 30 -
•
•
AHMAC would be represented on the national body and the inter-jurisdictional
committee, and would be:
- responsible for providing guidance to both bodies;
- accountable to individual Health Ministers for providing advice to enable the review
of systems, policies and levers in each jurisdiction to ensure that national policies are
implemented comprehensively, consistently and in a reasonable timeframe;
Health Ministers, as the parties jointly responsible for the performance of the health
system, exercise the power to make the final decisions on national policies, the related
budget and outputs.
Recommendation 10 – The national body: formal linkages with jurisdictions through an Interjurisdictional Committee
To ensure adequate jurisdictional engagement in the work of the national body:
• the AHMAC member of the body should convene an Inter-jurisdictional Committee;
• the Inter-jurisdictional Committee should comprise high level representation from all jurisdictions
and be chaired by the AHMAC member of the body;
• the Inter-jurisdictional Committee should meet frequently enough to provide an adequate level of
advice to the AHMAC member on the body;
• the Inter-jurisdictional Committee should be responsible for providing advice to the body on the
adequacy of the process of policy development at key milestones in the development of particular
policy items; and
• the Inter-jurisdictional Committee Chair should be accountable for ensuring that the other AHMAC
members are aware of new policy directions to ensure their local systems can support the
implementation of agreed national policies.
It is anticipated that the Inter-jurisdictional Committee would focus on providing its Chair (ie
the AHMAC member on the body) with advice on the adequacy of the process rather than
contributing to the content of policies under development. To this end the Chair would
consult with the Inter-jurisdictional Committee at a number of points along the policy
development pathway, prior to the body making a recommendation to AHMC.
Inter-jurisdictional Committee members with relevant expertise may also be directly involved
in expert working groups which will undertake developmental work in priority areas agreed
by Health Ministers (refer to section 4.5.4).
4.5.2 Linkages and coordination with the Chairs of State and Territory
safety and quality bodies
As indicated in Chapter 2, stakeholders have also commented on the need for better linkages
between the national body and state-based safety and quality bodies. This would assist with
information sharing, priority setting and alignment of national and state/territory strategies.
The Review Team recognises that these state-based bodies have developed a central and
critical role to support clinical improvement locally. They also provide feedback to health
departments on health system performance, in the defined areas of the health system for
which they have responsibility (which vary by jurisdiction). For this reason, the Review
Team believes that a formal relationship between the national body and the Chairs of
- 31 -
state-based safety and quality bodies, through a Stakeholder Reference Group
(Recommendation 11 below), will be vital to the effective coordination of the national effort
for safety and quality.
The Review Team has given close consideration to the suggestion, made in one submission,
that the national body comprise the Chairs of the state-based councils or committees. 36 The
strength of this proposal is that such bodies are well connected with health departments,
professional/peer policy development and regulatory mechanisms, and service providers at
the local level. However, utilising the Chairs as a group to steer the national body would not
best enable the body to fulfil its functions across the continuum of care. The Chairs generally
represent the same skill set (ie senior clinicians) and most are focused on the public, acute
care sector.
4.5.3 Linkages and coordination with other stakeholders
The Review Team has given consideration to the most effective way of linking with a range
of stakeholders, including state-based safety and quality councils. The aim would be to create
a more effective mechanism for involving key stakeholders in national priority setting and
also provide these players with sufficient information on policy under development to enable
them to implement effectively.
A Stakeholder Reference Group should be established and be:
•
•
•
responsible for providing information to, and drawing on the views of, a wide network of
individuals on the priorities and policy directions of the national body;
responsible for ensuring their home organisation is sufficiently informed and able able
to implement national policy; and
accountable to the body for providing high quality advice.
The group should have up to 20 members, comprising Chairs of jurisdictional safety and
quality bodies and representatives of other key national stakeholder bodies, and be chaired by
a member of the national body.
Members would be expected to use their existing organisational networks to draw on the
views and provide information to a much wider range of interested individuals. They would
also be in a strong position to support their organisation to make changes in their area of
responsibility to achieve national consistency. It is anticipated that a member of the national
body would Chair the Stakeholder Reference Group and act as a conduit of information to
and from that group and the national body.
As shown by the number of participants in the consultation process for the Review, there are
a wide range of key stakeholders with an interest in safety and quality improvement.
The Review Team believes that it is essential for the Chairs of each of the State and Territory
safety and quality bodies to be represented on the Stakeholder Reference Group.
36
Submission No. 33, Western Australian Council for Safety and Quality in Health Care and the Office for
Safety and Quality in Health Care (WA Department of Health), pp 6-8.
- 32 -
There are a number of other “communities of interest” from which representatives on the
Stakeholder Reference Group can be drawn, and a range of bodies which themselves include
broad representation of relevant stakeholders, including:
•
•
•
•
•
•
•
consumers eg CHF (it is expected that at a jurisdictional level the relevant consumer
group will be represented on the state/territory safety and quality body);
private sector providers and funders (private hospitals, day surgeries, diagnostic facilities
and insurers) eg APHA, AHIA;
peak professional bodies for clinicians eg CPMC, RCNA;
national committees focusing on safety and quality for a sector (aged care, primary care
etc) or therapeutic area (quality use of medicines, safe and appropriate use of blood
products, etc) eg PHARM, the Safety and Quality in Aged Care Expert Working Group;
national bodies that concentrate on clinical best practice eg NICS, NPS, NHPAC;
national bodies covering broad cross-cutting areas of health reform (workforce, e-health
etc) eg AHWOC;
national bodies responsible for information management, data and performance
monitoring eg NHIG, AIHW, NHPC.
The national body should determine appropriate representation for the Stakeholder Reference
Group from these communities of interest and develop publicly available appointment
processes and Terms of Reference for the Group.
Recommendation 11 – The national body: formal linkages with stakeholders through a
Stakeholder Reference Group
To assist the decision-making and priority setting undertaken by the national body, and to enable a
broad range of stakeholder views to be informed about and involved in the work of the body:
• the body should formally convene a Stakeholder Reference Group;
• the Stakeholder Reference Group should meet at least twice a year to obtain information on, and
provide input to, the safety and quality agenda;
• in particular, the Stakeholder Reference Group should contribute to the regular reassessment of
national priorities for action; and
• the Stakeholder Reference Group should be chaired by a member of the body and comprise up to
20 representatives from key stakeholder groups.
4.5.4 Steering policy development on nationally agreed priority areas by expert working
groups
It is also expected that once Health Ministers have agreed in principle to policy development
on priority areas the body will convene, on a time-limited needs basis, working groups which
include an adequate range of expertise to undertake work in the agreed priority areas.
As described above, the Stakeholder Reference Group would be consulted in the
identification of priority areas and key issues, and the Inter-jurisdictional Committee would
be consulted on the appropriate processes and expertise to be utilised. Individuals from the
Stakeholder Reference Group, the Inter-jurisdictional Committee and other interested
stakeholders with relevant expertise may also participate in the expert working groups.
- 33 -
Given the national purview of the new body, the capacity to identify and link with other key
bodies in the safety and quality arena will be important to its future success in transforming
safety and quality. A key initial activity will be to find out what other bodies do and where
strategic links are needed for collaborative action (eg peak bodies for consumers, clinicians,
allied health professionals, private hospitals, private health insurance etc).
The national body will need to utilise appropriate mechanisms to formalise those links in
order to strengthen its role in the national coordination of various elements of work being
undertaken for safety and quality. Organisations with representatives on the Stakeholder
Reference Group may also be undertaking, within their own area of responsibility, work
which is highly relevant to national work on safety and quality (eg NICS, NHIG, PHARM,
etc).
Recommendation 12 – The national body: convening expert working groups and linking with
relevant national bodies.
To ensure that the relevant range of expertise is drawn on in the development of new work in the
agreed priority areas, and that work being undertaken by existing national bodies in the priority areas
is coordinated nationally:
• the body should convene, on a time-limited basis, expert working groups as necessary to
undertake work in AHMC agreed priority areas;
• the expert working groups must include an adequate range of expertise from external sources, and
may also draw on relevant expertise from the Inter-jurisdictional Committee and the Stakeholder
Reference Group; and
• the body should establish formal agreements to embed national collaboration and coordination on
safety and quality with other relevant national bodies.
- 34 -
4.6
Diagram showing the essential features of the national body
The following diagram outlines the proposed composition of the national body and its formal
links with external parties.
AHMC
AHMAC
National Body
Reports to
•
•
Consults with
•
•
8-10 people
High-profile Chair (nongovernment / expert)
AHMAC member
6-8 experts in health
services improvement (1-2
other AHMAC members
or their nominees)
Office
CEO
•
•
•
Staff
•
Expert Working
Groups around
core functions
Profile, credibility, proven track
record
Reports to body
Observer status at AHMC/AHMAC
Project management, policy analysis
and committee support skills.
Interjurisdictional
committee
Chaired by
AHMAC member
of body
Stakeholder
Reference
Group
Chaired by a
member of
body
Expert Working
Groups around
core functions
- 35 -
4.7
Resources and timeframe
The new body must be sufficiently resourced to fulfil its functions. Its office must have the
capacity and expertise to take the policy work forward. In addition, each of the linkages
between the national body and other parties requires the attention of the CEO, and a level of
support from the office. It will be critical to ensure sufficient resources to do this effectively.
To a certain extent the level of costs will ultimately depend on the agreed legal form/structure
of the body. A thorough assessment of resource needs will be required as part of the
arrangements to establish the body (refer to Chapter 5).
It will also be necessary to allow sufficient time to allow the new body to fulfil its mandate.
In the health context a period of 5 years is commonly allowed for an assessment of outputs,
and system change outcomes. This period also enables the funding cycle of the body to be
linked into review mechanisms for budget cycle purposes.
Recommendation 13 – Resourcing of the national body
To ensure that the national body has adequate time and resources to fulfil and measure its outputs
and outcomes, it should be:
• established for an initial term of 5 years; and
• provided with sufficient resources to fulfil its purpose over this period.
4.8
Conclusions
There are no ready-made models for safety and quality governance in comparable countries,
and it is necessary to design a model best suited to Australia’s federal system of government
and mixed public/private health system.
The model recommended by the Review Team is intended to ensure that:
•
•
•
Health Ministers as a group are the final decision point so that there are clear lines of
accountability in the broader governance arrangements for the health system;
the purpose and functions of the new national body are clear and realistic;
the design of the body is consistent with the principles of good governance. In particular:
- it should be a small body, comprising members with the best mix of skills to fulfil its
purpose;
- its responsibility for identified functions and accountability for achieving outcomes
should be clear;
- it should have formal links to AHMAC and health departments, to ensure its work is
well flagged, and all parties understand their roles and accountabilities in delivering
on the work plan;
- it should have formal links with other key bodies, including state-based councils,
relevant national bodies, professional and sector based peak bodies, to inform its
priority setting process, and adequately flag policy directions so that these
stakeholders can implement national policies in their area of responsibility; and
- mechanisms should be in place to ensure adequate input to national policy
development by external experts, through expert working groups.
- 36 -
5.
Legal form of the national body and transition arrangements
Key points
•
•
•
•
5.1
A range of legal forms are consistent with the essential features of the new national body
outlined in Chapter 4.
A number of options are presented for Ministers’ consideration.
The transition process from the current Council to the new arrangements will need
careful management to ensure that the momentum to complete critical pieces of work is
not lost in the transition between the two bodies.
The new national body should be established as soon as practicable.
Legal forms/structures considered by the Review Team
Chapter 3 identified the core elements of national governance arrangements to transform
safety and quality, including the role and functions of a new national body.
Chapter 4 described the essential design features of the national body to ensure capacity and
accountability for fulfilling its purpose.
In considering future governance options for the national body, the Review Team has closely
considered which legal form/structure would best:
•
•
•
enable the body to fulfil its purpose;
accommodate the essential design features described in Chapter 4; and
provide sufficient independence and accountability for the body.
The Review Team has identified four options which are consistent with the essential features
for a new body and which will ensure accountability:
•
•
•
•
5.2
a Committee reporting to Health Ministers;
a not-for-profit company limited by guarantee, established jointly by Health Ministers;
a statutory body established under new legislation; and
a body established under existing legislation.
Structural options
5.2.1 Committee reporting to Ministers – an enhancement of current Council
arrangements
A national safety and quality committee should have the following essential features:
•
•
be established jointly and report to all Health Ministers, as a non-statute based
committee;
enable all Ministers to jointly approve the following – the terms of reference, budget,
work plan, appointment of the Chair, committee membership and CEO; and
- 37 -
•
be dependent on a host department to hold and manage funds and to enter into any
legally binding agreements on its behalf, as it would not be a separate legal entity.
A committee could not employ its own staff or be independently accountable for financial
management. Staffing and procurement options include:
•
the traditional arrangement whereby one jurisdiction provides staffing support for the
entity on behalf of all jurisdictions. Accountability for financial management and staffing
arrangements are determined under the regulations of the host jurisdiction ie the
department head in the host jurisdiction is accountable to the Minister and parliament of
that jurisdiction. Staff may be seconded to the office from one or more jurisdictions; or
staff may be employed under a shared (inter-jurisdictional) accountability arrangement;
OR
•
outsourcing of the entire CEO and office function through a tender process. This would
enable the office to be badged as an independent unit, the CEO and staff to be employed
under the conditions of an entity specific workplace agreement, and the budget for
staffing and procurement to be managed under the terms of the contract between the host
department and the successful tenderer. The tenderer would be accountable to the host
department/s for expenditure and meeting work plan outcomes, and host department/s
would be accountable for the total expenditure under the financial management
regulations in the host jurisdiction/s.
5.2.2 Not-for-profit company limited by guarantee
A national safety and quality company should have the following essential features:
•
•
•
•
be owned by all jurisdictions (and would report to all Ministers);
be established by agreement of all Health Ministers under the Corporations Act 2001;
make provision for all Ministers to jointly approve any of the following – the
constitution, budget, work plan and appointment of the Chair, Board and CEO; and
be legally and financially independent and publicly accountable.
The company structure provides legal and financial separation from bureaucracies. The
governing board would be independently and publicly accountable for financial and work
plan management, have the autonomy to employ its own staff, and would not be tied to the
procurement and staffing requirements of public service bureaucracies.
An example of this legal form is the National E-Health Transition Authority (NEHTA).37
NEHTA is a not-for-profit company owned by all jurisdictions. NEHTA manages a
significant procurement budget contributed by all jurisdictions and its board is entirely
comprised of AHMAC members.
The governance arrangements for a national safety and quality body would not be the same as
for NEHTA. Although all jurisdictions would be the owners of a safety and quality company,
given that the body would have an expert advisory function and a considerably smaller
procurement budget than NEHTA, broad AHMAC membership at the board level would not
be warranted.
37
National E-Health Transition Authority [NEHTA] website at http://www.nehta.gov.au
- 38 -
An alternative model is a not-for-profit company limited by guarantee owned by one
jurisdiction (such as the NICS38). This option shares many of the above features, except that
it would be owned solely by one Minister, and that Minister would be the ultimate source of
approval for appointments.
5.2.3 A new statutory body
A national safety and quality statutory body should have the following essential features:
•
•
•
•
•
be established in legislation;
report to all Ministers;
enable all Ministers to jointly control the appointments, and establish powers to direct the
body to perform its functions (as set up in the legislation);
be both financially and legally separate (ie independently accountable); and
impose legal obligations on office holders.
The statutory body structure would provide the authority of statute, and depending
how it is set up, could provide the same benefits as either the committee structure or
company structure. The body could be both financially and legally separate from portfolio
departments and able to employ staff independently under the conditions of enterprisespecific workplace agreements.
An example of a Commonwealth statutory body which reports to COAG as well as an
Australian Government Minister is the National Water Commission (NWC).39,40 The Chair
and the six commissioners are appointed on the basis of their individual expertise and
capacity to act in the best interests of the NWC. Its functions are similar to those proposed in
this Review for the national safety and quality body.41
The AIHW is an example of a Commonwealth statutory body which reports to the Australian
Government Minister. The Minister can direct the Institute, but is legally obliged to consult
each State/Territory Health Minister before doing so. 42
5.2.4 A new body under existing statute
It would also be possible to establish the national body under an existing statute. At the
federal level, one vehicle might be the Commonwealth’s National Health and Medical
Research Council Act 1992, under which the body could be established as a principal
committee of the NHMRC. The Act specifies the following functions of the NHMRC:
“(a) to inquire into, issue guidelines on, and advise the community on, matters relating to:
38
National Institute for Clinical Studies [NICS] website at http://www.nicsl.com.au/about.aspx
National Water Commission website at http://www.nwc.gov.au/#about.
40
The NWC can second staff under the APS Act 1999, or independently employ contractors or consultants
under agency determined conditions. Funding is administered under a special account of the Commonwealth
Financial Management and Accountability Act 1997.
41
Ibid., Part 2 – Establishment of the National Water Commission (NWC), Section 7 Functions of the NWC.
42
Australian Institute of Health and Welfare Act 1987, Section 5 Functions of the Institute, Clause (1) (k) and
Section 7 Clause (1B). The AIHW is legally and financially independent, has its own appropriation, and can
employ staff independently under an enterprise agreement.
39
- 39 -
-
the improvement of health;
the prevention, diagnosis and treatment of disease;
the provision of health care;
public health research and medical research;
ethical issues relating to health;
(b) to advise, and make recommendations to, the Commonwealth, the States and Territories
on the matters referred to in paragraph (a); and
(c) to make recommendations to the Commonwealth on expenditure:
(i) on public health research and training; and
(ii) on medical research and training.” 43
The essential features of the NHMRC governance arrangements are that:
•
•
•
•
•
the NHMRC Act 1992 enables the establishment of new principal committees by the
Australian Government Minister (after taking advice from the NHMRC, which includes
representation from all jurisdictions);
committees report to the NHMRC, which in turn reports to the Australian Government
Minister;
committees can be directed by the NHMRC on the manner in which committee work is
undertaken;
the Act sets out the functions of committees, so they have the authority of statute; and
the NHMRC is financially part of the Australian government (ie the CEO is accountable
to the Secretary of the Australian Government Department of Health and Ageing).
The Australian Government is currently considering governance arrangements for the
NHMRC in light of a number of recent reviews and reports which addressed governance
issues for the NHMRC and public sector organisations more generally. As a result the above
features may change.
5.2.5 Comparison of the options
A committee has the advantages of clearly being accountable to all Health Ministers and
being the simplest arrangement to establish. Jurisdictions are adept at establishing national
committees and provide cost-effective infrastructure support.
While a committee may be seen as a minor variation on the current Council arrangements, it
could be argued that the Council has produced good work with inadequate governance and
accountability arrangements and that by fixing these problems a new committee could
function more effectively.
A company could be jointly owned by all governments – independent of any one government
but accountable to all. It would also be independently accountable for financial management
and reporting, and able to appoint its own staff. It would have greater independence and focus
than a committee structure, whether a specific purpose committee or one established under
the NHMRC.
43
National Health and Medical Research Council Act 1992, Part 2 Establishment and Functions of the Council,
Section 7 Functions of the Council.
- 40 -
However, the investment required to establish and manage a company may not be warranted
given that there is no commercial or market focus, and the policy functions of the body are
advisory in nature and can be delivered through a less formal mechanism.
A company owned solely by the Commonwealth would limit the influence of other Ministers.
A new statutory body would be created under the statute of only one jurisdiction, but could
be required to provide advice to all Ministers at the same time as providing advice to the lead
jurisdiction.
It would have the authority of statute, but would be time consuming to establish and more
difficult to change or disband. Statutory bodies are limited by the confines of the statute and
are not always adaptable or responsive. Such a structure may not be necessary as the same
functions could be established under a less formal committee structure.
The NHMRC provides an existing statutory basis and authority, but is essentially similar to
the committee model. Under the current terms of the Act, however, it would be difficult for
Health Ministers collectively to directly influence a new safety and quality body principal
committee as it would have to report to the Australian Government Minister through a large
Council whose interests are not primarily in safety and quality. There are also some limits to
the NHMRC’s capacity to act quickly given the public consultation requirements set out in
the Act.
Nevertheless, this option has the advantage of building on the existing NHMRC legislation
and infrastructure and may warrant further investigation, particularly if the functions of the
NHMRC are reconsidered.
5.3
Implementation of the Review: transition arrangements to new national body
Decisions on the form of the new national body and transition arrangements need to be made
as soon as practicable. This is important, both to maintain momentum, and to speed the
implementation of national safety and quality initiatives.
The development of a National Strategic Framework and public report are important, need to
commence quickly and must be done by the new national body.
Ministers will need to determine as quickly as possible:
•
•
•
the legal structure of the new body;
the identification and appointment of new members; and
the appropriate level of funding to enable the new body to fulfil its purpose.
Decisions about the structure will affect how quickly the new body can be established. For
example, setting up a statutory body will take longer than establishing a committee. Once
decisions are made, a timeframe for Council to cease and the new body to commence should
also be announced.
- 41 -
Whatever legal form/structure is chosen, it will be important to maintain continuity of the
current work plan in the transition between Council and the new body. It is critical that the
expertise and momentum in the current Council and the Office is not lost in the transition to
new arrangements. Council should be given clear directions on the outstanding work to be
completed prior to ceasing operation. Council should not, however, commence any new work
as this may inappropriately commit the new national body.
Recommendation 14 – Legal form and transition arrangements
Health Ministers should determine the appropriate legal form/structure and agree that the new body
be established as soon as practicable. Transition arrangements should ensure a seamless
changeover from the current Council.
5.4
Conclusions
The Review Team believes that any of the legal forms outlined above are consistent with the
essential functions, processes and relationships for the new body outlined in Chapter 4.
The development of a National Strategic Framework and public report are important, need to
commence quickly and must be done by the new national body.
It is important to minimise the loss of Council expertise and momentum in the transition to
new arrangements. If there is a delay in the establishment of the new body, Council should be
given clear direction on the work it is to finalise prior to ceasing operation.
- 42 -
6.
Priorities for future national action
Key Points
The Review Team believes that the priorities for national action should both build on the
valuable work of Council and allow a refocusing of the agenda on measurable improvement
in safety and quality across the continuum of care.
The immediate priorities for the future should be to:
•
•
•
•
establish new national governance arrangements for safety and quality improvement by
June 2006 (AHMC and individual jurisdictions);
take action to deliver on the functions of the new national safety and quality body (the
new national body);
fully implement Council recommendations previously agreed to by Ministers (all
jurisdictions collaboratively, and with other stakeholders); and
finalise key elements of Council’s work (new national body and Council in the interim).
The national body should conduct a regular, transparent consultation process for setting
priorities in the future, involving all key stakeholders and particularly members of the
Stakeholder Reference Group.
6.1
Stakeholder views
Individual stakeholder suggested a range of priority areas and actions. Some of these were
specific topics (eg medication safety, blood and workforce), some were tools or activities (eg
a common discharge summary; guidelines and standardised products for intrathecal and IV
injections to prevent wrong administration and reduce risks associated with interstate
transfers caused by variances in practice) and others were strategies (eg better communication
and dissemination).
The focus of stakeholder attention, however, was on the overall national requirements for
transforming safety and quality and in that context there was a high degree of consensus, as
outlined in Chapters 3 and 4, that the national priorities are:
•
•
•
6.2
effective national governance arrangements to lead and coordinate the safety and quality
agenda;
a national strategic framework to promote coordinated and complementary action at all
levels of the health system; and
successful implementation of national policies and standards already agreed to by Health
Ministers.
Review Team’s view
The Review Team believes it is imperative that the focus on systems improvement begun by
the Council is continued, and this involves following through and implementing key aspects
of the Council’s current work-plan. Further, this systems approach needs to be given a
broader focus on quality improvement across the continuum of care and needs to be made
- 43 -
operational at all levels of the health system. Most importantly, the progress of safety and
quality improvement needs to be measured in a meaningful way and publicly reported.
In line with the above, the Review Team believes the immediate priorities for future action
should be the following:
Priority 1: Establish new national governance arrangements for safety and quality
improvement by June 2006
In order to establish truly national governance arrangements for safety and quality in health
care, as described in Chapter 3, Ministers need to ensure the following actions:
Priority 1.1
Establish new national safety and quality body
AHMC to establish a new safety and quality body to lead and coordinate improvements in
the safety and quality of health care in Australia, as soon as practicable.
As described in Chapters 4 and 5, the decisions on the form of the new national body and
transition arrangements need to be made quickly in order to maintain momentum.
Priority 1.2
Review jurisdictional safety and quality arrangements
Jurisdictions to review their own safety and quality arrangements, in light of the
jurisdictional functions recommended in Chapter 3, to ensure:
•
•
•
•
•
•
an effective working relationship with the new body;
development of principles and mechanisms for advancing safety and quality in their own
jurisdiction (eg through the establishment of a safety and quality body and mechanisms
for consumer involvement);
appropriate governance and accountability arrangements to provide public assurance of
quality and safety;
implementation of agreed national standards within their jurisdiction;
development of coordinated mechanisms to ensure implementation is effective; and
participation in national data collections on safety and quality.
Priority 2: Take action to deliver on the functions of the national body
The following priorities are essential for the new body to deliver on its functions.
Priority 2.1
Develop a National Strategic Framework for Improving the Safety and
Quality of Health Care, for endorsement by Health Ministers, within the
first six months of the new national body’s operation
A National Strategic Framework for Improving the Safety and Quality of Health Care is
necessary to ensure a comprehensive range of action is undertaken in a nationally coordinated
way by leaders, decision makers and providers operating at different levels in the health
system. The national body should develop the National Strategic Framework for
endorsement by Health Ministers. It should be developed in consultation with jurisdictions
and stakeholders as an immediate priority (ie within the first six months of operation).
- 44 -
Priority 2.2
Prepare a National Report on the State of Safety and Quality by June 2007
The view of the Review Team, confirmed by stakeholders during the consultation process, is
that the time is now overdue for a regular authoritative national report to the public on the
safety and quality of patient care in Australia. This should be a priority for the new national
body. The purpose of such a report (and for subsequent reports) would be to (a) inform the
public about the current state of health care safety and quality and progress in quality
improvement; and (b) promote quality improvement by engaging clinicians, health care
organisations, funders, and consumers to learn from successful delivery systems and
practices. The national report should also advise Ministers and the public on the progress
made in implementing policies and standards endorsed by Ministers.
Priority 3: Fully implement previous AHMC decisions
Priority 3.1
Fully implement the eight uniform national actions to improve patient
safety within the timeframe previously agreed to by Ministers
Jurisdictions should fully implement the eight uniform national actions to improve patient
safety within the timeframe previously agreed to by Ministers.
The Review Team was repeatedly advised by stakeholders that implementation of the eight
Council recommendations already agreed to by Ministers has been patchy. In addition, while
many of these standards can and should be implemented across the health care system, there
is currently only a commitment for implementation in public hospitals.
A priority for jurisdictions should be to fully implement these recommendations. In doing so
they should work collaboratively, and involve other stakeholders to ensure implementation
across the health system, unless inapplicable for the care setting. As Ministers have
previously only agreed to implement recommendations in the public hospital system, it may
be necessary to go back to Health Ministers with implementation plans for other sectors.
Priority 3.2
Create a National Minimum Data Set for Safety and Quality by June 2006
In January 2005, Health Ministers agreed to the development of a national minimum data set
for safety and quality. The development of the national minimum data set will allow for a
comprehensive assessment of the state of safety and quality of health care in Australia, filling
a notable gap in what is known about the current extent of safety and quality problems, the
impact of recent initiatives, and the capacity that exists for improvement.
The Review Team notes that the process for developing a national minimum data set is
already being undertaken by the National Health Information Group (NHIG) with Council
involvement. As outlined in Chapter 3, the Review Team envisages an ongoing role for the
new national body working with NHIG to ensure that minimum data sets for safety and
quality are created and maintained.
AHMC agreed that participation in the collection of data for a national minimum data set
should be required of public hospitals and that States and Territories should consider
requiring the same for private hospitals. The Review Team is of the view that a national
minimum data set should also include primary care data, as a first step towards a whole of
system approach to collecting a national minimum data set for safety and quality. It should
- 45 -
also include a broad range of performance data, reflecting the broader quality focus envisaged
for future national action on safety and quality. AHMAC should bring these matters to
NHIG’s attention.
Priority 4: Finalise key elements of Council’s work
Priority 4.1
Provide advice on the reform and streamlining of accreditation by June
2006
Accreditation is an important component of national efforts to improve safety and quality in
health care, both because it is a quality improvement tool in its own right and because it is an
important mechanism for implementing agreed national standards. The Review Team is
aware that the Council, and others, have undertaken significant work on options for
reforming and streamlining current accreditation arrangements to increase their effectiveness
in improving safety and quality. Building on this work, a priority for the new national body
(and Council in the interim) should be to prepare advice to Health Ministers by June 2006 to
transform current accreditation arrangements.
These issues are discussed in more detail in Chapter 7.
Priority 4.2
Provide advice on the implementation of the Open Disclosure Standard by
December 2006
The Open Disclosure Standard44 was first endorsed by Ministers in July 2003. The Standard
provides a framework for an open, consistent approach to communicating with patients when
things go wrong in health care, and provides guidance on what to say and what not to say in
such situations. In January 2005, Ministers agreed to an implementation plan developed by
AHMAC for the Standard, involving a pilot implementation process, external evaluation and
a report to AHMC in December 2006. This process is to be overseen by jurisdictions. At the
completion of the pilot Ministers will consider national implementation.
The Review Team believes the Open Disclosure Standard is a crucial piece of work that
needs to be vigorously followed through. The new national body (and Council in the
interim) should provide ongoing advice to Health Ministers on the progress of the pilots and
their evaluation.
Priority 4.3
Develop an implementation plan for the Credentialling Standard by June
2006
In July 2004, the Australian Health Ministers Conference agreed to the public release of the
Council’s Credentialling Standard.45 This work followed on from the National Guidelines for
Credentials and Clinical Privileges which Council presented to AHMC in July 2002.
The aim of the Standard is to increase the consistency and improve the effectiveness of
processes used by health care organisations to ensure clinicians have the knowledge, skills
and resources needed to deliver safe care.
44
Australian Council for Safety and Quality in Health Care (2003), Open Disclosure Standard: A national
standard for open communication in public and private hospitals.
45
Australian Council for Safety and Quality in Health Care (2003), Standard for Credentialling and Defining
the Scope of Clinical Practice: A national standard of credentialling and defining the scope of clinical practice
of medical practitioners, for use in public and private hospitals.
- 46 -
In January 2005, Health Ministers endorsed an implementation plan developed by AHMAC
for a Council recommendation regarding performance agreements with clinicians. However,
there is still no nationally agreed plan for implementation of the credentialling standard
across the health care system.
In suggesting a more gradual approach to performance agreements, AHMAC noted that
jurisdictions have various approaches to performance management and are at different stages
in adopting and evaluating credentialling policies. AHMAC proposed, and Ministers agreed,
to a phased approach with the initial focus on supporting jurisdictions in the implementation
of the agreed credentialling approach.
The Review Team notes that despite credentialling being a key issue for Council for the
majority of its term, the implementation of a national approach is yet to occur. A key priority
for the new national body (and Council in the interim) will be to work with jurisdictions and
other stakeholders to develop an implementation plan. This should be developed for
consideration by Health Ministers by June 2006 to enable implementation of the
Credentialling Standard across all health care settings.
6.3
Process for identifying future national priorities
Two of the core functions recommended for the new national body are to provide strategic
advice on safety and quality improvement across the continuum of care and to recommend
key national policy standards. To inform the delivery of this function, the national body will
need to conduct a regular, transparent consultation process for setting priorities. Wide
engagement will be facilitated by the involvement of a range of stakeholders, in particular the
Stakeholder Reference Group, in the priority setting process.
The first such priority setting process should be conducted within the first 12 months of the
new body’s operation. It should focus on identifying the key activities which will fulfil the
body’s mandate to advise on improving the safety and quality of health care across the
continuum of care.
Broadly speaking, stakeholders desired priorities that focused on the following:
•
•
•
•
efficiency – the development of safety and quality interventions should be integrated
across jurisdictions and sectors of the health system;
effectiveness – interventions that will make a real difference to the safety and quality of
health care;
sharpened focus – making a difference in a few areas rather than dissipating energy
more broadly across a wide range of issues;
relevance – meeting the needs of jurisdictions, stakeholders and the service delivery
level, while also focusing on areas of concern to consumers and where most gains can be
made.
Some stakeholders suggested a ‘horizon scanning’ exercise to map the safety and quality
activities that are in place, identify what is and is not working well, and to inform the setting
of future priorities.
- 47 -
One notable example from submissions suggested the following principles be used to identify
initiatives or issues for action at the national level.
1.
2.
3.
4.
5.
6.
Can only be addressed by a national body (eg harmonisation of legislation).
Are not being addressed elsewhere by other groups.
Have a significant impact on patients or the health care system, through safety, quality or
cost.
Are amenable to intervention or there are means of determining if they are amenable to
intervention.
Can be integrated into routine health care delivery (are sustainable).
Represent value for money.46
The Review Team believes that following the above principles will help ensure that priorities
for the future are kept tightly focused. This is especially important given the broad scope of
action (safety and quality across the continuum of care) that is envisaged under the new
national arrangements.
Recommendation 15 – Priorities for future national action
The Review Team believes the priorities for future action should be the following:
Priority 1
Establish new national governance arrangements for safety and quality
improvement as a matter of urgency
1.1 AHMC to establish a new safety and quality body to lead and coordinate the safety and quality
agenda in Australia.
1.2 Jurisdictions to review their own safety and quality arrangements to ensure:
•
•
•
•
•
•
an effective working relationship with the new body;
development of principles and mechanisms for advancing safety and quality in their own
jurisdiction (eg through the establishment of a safety and quality body and mechanisms for
consumer involvement);
appropriate governance and accountability arrangements to provide public assurance of quality
and safety;
implementation of agreed national standards within their jurisdiction;
development of coordinated mechanisms to ensure implementation is effective; and
participation in national data collections on safety and quality.
Priority 2
Take action to deliver on the functions of the new body (the new national body)
2.1 Develop a National Strategic Framework for Improving the Safety and Quality of Health Care
within the first six months of operation.
2.2 Prepare a National Report on the State of Safety and Quality by June 2007.
Priority 3
Fully implement previous AHMC decisions
3.1 Jurisdictions to fully implement the eight uniform national actions to improve safety and quality
previously agreed to by Ministers.
3.2 NHIG and the new national body/Council to create a National Minimum Data Set for Safety and
Quality by June 2006.
46
Submission No. 33, Western Australian Council for Safety and Quality in Health Care and the Office of
Safety and Quality in Health Care (Department of Health), pp. 8-9.
- 48 -
Priority 4
Finalise key elements of Council’s work (the new national body and Council in the
interim)
4.1 Provide advice on reforming and streamlining accreditation by June 2006.
4.2 Provide advice on implementation of Open Disclosure Standard, including evaluation of pilots, by
December 2006.
4.3 Develop an implementation plan for the Credentialling Standard by June 2006.
Process for identifying future national priorities
Within the first 12 months of its operation, the new national body should conduct the first of a series of
regular priority setting processes involving all members of the Stakeholder Reference Group.
6.4
Conclusions
The Review Team believes that the priorities for national action should both build on the
valuable work of Council and allow a refocusing of the agenda on measurable improvement
in safety and quality across the continuum of care.
The first step would be to establish a new national body to lead and coordinate the safety and
quality agenda. Its priorities will be to:
•
•
develop a National Strategic Framework for Improving the Safety and Quality of Health
Care to guide and coordinate national action; and
prepare a national report on the state of safety and quality.
Critical pieces of work from the current safety and quality agenda need to be brought to
fruition:
•
•
•
•
•
National Minimum Data Set for Safety and Quality;
accreditation;
Open Disclosure;
credentialling; and
full implementation of all Council recommendations agreed to by Health Ministers.
Recognising that the national safety and quality body is just a part of broader governance
arrangements, the Review Team believes that jurisdictions should, as a priority, review their
own safety and quality arrangements. In doing so, jurisdictions need to ensure that they have
appropriate mechanisms for safety and quality governance and that they have the capacity to
work with and implement agreed recommendations from the national body.
It is this concerted action across the health system which has the potential to transform health
care safety and quality in Australia.
- 49 -
7.
Enhancing the role of accreditation
Key Points
•
•
•
•
Accreditation is an important driver for safety and quality improvement.
Translating nationally agreed safety and quality improvement policies and standards into
accreditation standards is an important mechanism for implementation of those policies
and standards.
Stakeholders have legitimate concerns regarding the current processes of accreditation of
health care services.
A priority for the new national body should be to provide Ministers with a plan to
transform accreditation arrangements.
7.1
Context
At the request of AHMAC, the Review Team considered the current processes of
accreditation of health care services (for the health system as a whole) and their impact on the
safety and quality of health care provision.
The Review Team was assisted by a background paper prepared by the Council which
outlined the key issues identified through Council’s extensive work on accreditation.47 This
work included a literature review,48 consultation paper,49 and a report on stakeholder
consultation,50 all of which were provided to the Review. Other useful information was
gathered through the consultation process and from information provided by a number of
jurisdictions.
7.2
Stakeholder views and concerns about current accreditation processes
In its background paper, the Council identified the following stakeholder concerns with
current accreditation arrangements. These concerns were reiterated in the Review
consultation process:
Development of defined standards
•
Standards are developed independently by the various organisations that also assess
against them. This has resulted in considerable duplication of, and potential gaps in,
standards and requires many organisations to demonstrate compliance against multiple
sets of standards that are directed at the same outcome.
47
The Council background paper was prepared at the request of the Review Team and is available on the
Review website at www.health.gov.au/safetyandqualityreview
48
Australian Council for Safety and Quality in Health Care. Standards Setting and Accreditation Literature
Review and Report, July 2003.
49
Australian Council for Safety and Quality in Health Care. Standard Setting and Accreditation Systems in
Health: Consultation Paper, July 2003.
50
Australian Council for Safety and Quality in Health Care. Standard Setting and Accreditation Systems in
Health Consultation, August 2004.
- 50 -
•
•
Standards are usually only accessible to organisations that are members of the standardsetting body. Standards should be accessible to all stakeholders, including the general
public.
The process for developing standards is not always transparent.
Assessment of compliance with standards
•
Accreditation survey processes vary in their rigour and reliability.
•
Many health care organisations are required to undergo repeated accreditation surveys by
different organisations, where an organisation-wide approach would be more efficient
and appropriate.
The outcome of accreditation surveys is not always transparent to stakeholders and, in
particular, there is no robust and/or consistent method of responding to organisations
which are found through accreditation surveys to pose an unacceptable safety and quality
risk. This concern also pertains to the appropriate management of the results of
assessment.
•
Appropriate management of results of assessment
•
7.3
Accreditation data is a potentially rich source of information about safety and quality
issues in the health care system and, if used optimally, will inevitably drive system-wide
improvement. The optimal effects of accreditation can only be achieved if processes are
applied across all systems, rather than by the piecemeal adoption of ideas and/or
standards.
Current status of Council’s work on accreditation reform
The Council’s 2003 Consultation Paper, outlining a set of principles for accreditation reform,
was endorsed by Health Ministers in July 2003. These principles, which aimed to address the
stakeholder concerns listed above, are:
Development of defined standards
•
•
•
Standards against which compliance is assessed are capable of adaptation to varying
health environments – but are firm and credible.
Effective consumer engagement occurs throughout the accreditation system.
Standard setting and accreditation processes are externally validated.
Assessment of compliance with standards
•
•
•
Surveying against standards is credible, robust, and consistent.
Assessment options are flexible.
Stakeholder confidence in the rigour of accreditation systems is enhanced, and the
reliability of responses to significant non-compliance is increased. Accreditation
processes encompass both assessment of compliance with minimum standards, and
encouragement of continuous improvement.
- 51 -
Appropriate management of results of assessment
•
•
•
Responsibility for taking action on accreditation outcomes is clearly defined.
Information learned from accreditation is used for system-wide improvement.
Accreditation processes and outcomes are transparent.
Resource allocation and/or research
•
Accreditation of health care services is supported. Varying regulatory and funding
options for achieving greater national consistency are utilised to encourage the
accreditation of health care services.
The administration of accreditation is efficient.
The direct and indirect relationship between accreditation and safety and quality in health
care is evaluated through research.
•
•
Council’s Consultation Paper also proposed the creation of a national body, the National
Health Accreditation Advisory Council, to advise governments and coordinate national
efforts on accreditation issues. This had some support from stakeholders, although concerns
were raised that a national framework would create another layer of bureaucracy and lead to
less adaptable standards.51
Council has yet to advise Ministers on its proposed way forward regarding the
recommendations in the consultation paper. It did, however, recommend to AHMC in July
2004 that all hospitals be required to participate in a process of assessment, including
periodic external review, of their systems that support the delivery of safe, high quality health
care and report the outcomes of these processes to the relevant authority.
Ministers subsequently agreed to an implementation plan developed by AHMAC for the
above Council recommendation. The plan proposed ongoing consultation between
jurisdictions, accreditation bodies and industry to identify ways of ensuring the robustness of
accreditation and review systems and opportunities for integration and streamlining. It also
stated the need to develop processes whereby the outcomes of accreditation/review for public
hospitals can be made available to jurisdictions.
7.4
Review Team’s view
7.4.1 Impact of accreditation
The Review Team is of the view that accreditation is an important driver for safety and
quality improvement, which is widely used internationally in the health sector and in other
industries, and notes that Australia’s health accreditation processes are highly regarded
internationally.
The Review Team also supports the view of many stakeholders that accreditation is an
important implementation tool for policies and standards developed by the national safety and
quality body and endorsed by Health Ministers. Currently there is no direct mechanism to
support the incorporation of such policies and standards (eg credentialling) into relevant
accreditation standards. A recent study in the United States concluded that the main driver of
51
Ibid.
- 52 -
safety and quality initiatives in US hospitals was accreditation (specifically the Joint
Commission on Accreditation of Healthcare Organizations – JCAHO).52
7.4.2 Reform of current accreditation processes
The Review Team notes that there are different accreditation/standard setting bodies (and
processes) for different parts of the health care system. Examples include:
•
•
•
•
ACHS/QIC/ISO for general hospital and organisation accreditation;
RACGP/AGPAL/QPA for general practice;
Aged Care Standards and Accreditation Agency for residential aged care; and
National Pathology Accreditation Council/National Association of Testing Authorities
(NATA) for laboratories.
The above are mostly separate bodies working in separate domains – closely aligned in some
settings, but not in others. For example, most residential aged care is provided by the private
or not-for-profit sector and is not associated with hospitals. However, as cited by
stakeholders, there are examples of duplication where facilities are required to be assessed by
multiple accreditation bodies and/or meet the additional requirements of regulators/funders.
Any attempt to address this issue needs to recognise that the approaches of accreditation
agencies are also backed by different statutes, incentives and self-regulatory measures.
Examples include:
•
•
•
•
residential aged care and pathology laboratories through Commonwealth legislation;
hospitals through State/Territory legislation/regulation;
health purchaser-provider agreements between private hospitals and health funds; and
the Practice Incentive Program for general practice.
Reform of accreditation arrangements would thus require the coordinated action of multiple
levels of government and other stakeholders. It may also lead to there being a smaller number
of accreditation agencies which can accredit across the health system according to robust
standards.
The Review Team believes the new national safety and quality body should advise Ministers,
by June 2006, on the best way to reform and streamline accreditation arrangements. The
Review Team is not convinced that the model of a National Health Accreditation Advisory
Council, as recommended in Council’s Consultation Paper, is the best way forward.
However, Ministers do need advice on the best ways to reduce the burden for health services
in meeting the accreditation requirements of multiple agencies and address the other concerns
identified above.
The new national safety and quality body should identify alternative models and notes that
there is an international exemplar (JCAHO in the United States), where all accreditation can
be conducted by one entity in a streamlined manner, with sanctions imposed by relevant
funders/purchasers at their discretion.
52
Devers K, Pham H & Liu G (2004), ‘What is Driving Hospitals’ Patient-Safety Efforts?’ Health Affairs,
23(2), pp. 103-115.
- 53 -
A mechanism is also needed for jurisdictions to consider, as a group and with other relevant
peak bodies, how polices and standards (eg credentialling) can be translated into accreditation
standards.
Until such time as the new body is established, the Council should progress this work.
7.5
Conclusions
The Review Team proposes that Ministers be provided with a plan to transform accreditation
arrangements, to enhance the role of accreditation in both quality improvement and in the
implementation of agreed national standards. In developing this plan, the national body (and
Council in the interim) should engage with multiple stakeholders, including jurisdictions,
accreditation bodies and the wider health industry. The plan should be consistent with the
principles outlined in this Chapter and the AHMAC implementation plan, and should
recommend:
•
•
•
•
•
whether a national accreditation body is necessary and, if so, what its role and function
should be;
the best mechanism to review existing standards that apply to the health sector, to
determine opportunities for streamlining and reducing duplication;
the best way to translate nationally agreed safety and quality improvement policies and
standards into accreditation standards as a mechanism for implementation;
ways to address issues relating to the rigour and robustness of survey processes; and
the development of a mechanism to ensure appropriate action is taken in the event that an
unacceptable threat to the safety and quality of care is identified by an accreditation
agency.
Recommendation 16 – Accreditation
A priority for the new safety and quality body (and Council in the interim) should be to provide Health
Ministers with a plan to transform accreditation arrangements, by June 2006.
- 54 -
Appendix 1
Australian Council for Safety and Quality in Health Care
membership as at May 2005
NAME
ROLE
PROFESSIONAL CAPACITY
Members
Professor
Bruce Barraclough AO
Chair of Council Chair – Institute for Clinical Excellence; Past
President, Royal Australasian College of Surgeons,
Chair of
Professor and Director of Cancer Services for the
Executive
Northern Sydney Area Health Service
Professor Chris Baggoley
Member
Chair, National Institute of Clinical Studies
Professor Lesley Barclay AO
Member
School for Social and Policy Research, Institute of
Advanced Studies, Charles Darwin University, NT
Dr Jenny Bartlett
Executive
Member
Chief Clinical Adviser, Department of Human
Services, Victoria
Dr Beverley Anne Brand
Member
Deputy Secretary
Department of Health and Human Services
Tasmania
Dr David Brand
Member
Client Solutions
Dr Heather Buchan
Member
Chief Executive Officer,
National Institute of Clinical Studies
Mr Dermot Casey
Executive
Member
Executive Director
Office of the Safety and Quality Council
Associate Professor
Kaye Challinger
Executive
Member
Director, Acute Services, Central Northern Adelaide
Health Services
Ms Marie Colwell
Member
Director, Asoka Systems Pty Ltd
Dr Paul Dugdale
Member
Chief Health Officer, ACT Health
Ms Christine Gee
Member
Chief Executive Officer, Toowong Private Hospital
Professor John Horvath AO
Member
Chief Medical Officer, Australian Government
- 55 -
Professor Clifford Hughes
AO
Member
Head, Cardio-Thoracic Surgical Unit,
Royal Prince Alfred Hospital
Ms Betty Johnson AO
Executive
Member
National Secretary,
Older Women’s Network Australia
Dr Dorothy Jones
Member
Director, Office of the Safety and Quality of Health
Care, Health Department of Western Australia
Professor Brendon Kearney
AM
Member
Director, Institute of Medical and Veterinary Science
Dr Len Notaras AM
Member
Director, Clinical and Medical Services
Royal Darwin Hospital
Ms Jane Phelan
Member
Consumer, with an extensive background in
journalism
Professor Paddy Phillips
Executive
Member
Department of Medicine, Flinders Medical Centre
Ms Maureen Robinson
Member
Executive Manager, Development
Australian Council on Healthcare Standards
Professor Bill Runciman
Member
Head, Department of Anaesthesia and Intensive
Care, Royal Adelaide Hospital
Clinical Associate Professor
Bryant Stokes AM
Member
Department of Neurosurgery
Saint John of God Hospital
Dr Mark Waters
Executive
Member
Senior Executive Director, Innovation and Workforce
Reform Directorate, Department of Health,
Queensland
Dr Heather Wellington
Executive
Member
Phillips Fox
Principal Consultant, HPA Consulting Pty Ltd
Dr Ross Wilson
Member
Director, NSH Centre for Healthcare
Royal North Shore Hospital
Dr John Youngman
Member
Safety and Quality expert
- 56 -
Appendix 2
List of Council achievements
The following is taken from Council’s submission to the Review.53
Some highlights
Supporting health care practitioners
• Conducted a national workshop and gained endorsement by Health Ministers of a
National Strategy to Reduce Health Care Associated Infection (HCAI), one of the leading
causes of adverse events. There is national agreement to key HCAI definitions and
production of clinical guides for health professionals to reduce health care associated
infection.
•
Funded over 120 local projects to improve patient safety across Australia in two rounds of
the Safety Innovations in Practice Program (SIIP). Another 50 being funded in SIIP Mark
III, as Council continues to foster innovation in safety and quality improvement at the
local level.
•
Produced the National Report on Qualified Privilege, consulted with jurisdictions and
developed guidelines for improved administration of qualified privilege schemes, to help
achieve a balance between clinician participation in quality assurance activities and
public access to health information.
•
Conducted national workshops to instruct Australian trainers on root cause analysis
methodology, which identifies factors contributing to adverse incidents.
•
Produced the Ensuring Correct Site, Correct Site, Correct Procedure Protocol to help
prevent procedures being carried out on the wrong patient or body part, an event that can
cause serious harm and distress to patients.
•
National Framework for Education on Patient Safety is being developed to build the
required skills, knowledge and behaviour in respect to patient safety. It recognises
education as a foundation element for redesigning systems and facilitating a sustainable
culture of safety and quality in health care.
System redesign
• Medication Safety Innovations Awards Program provided funding for 16 local level
projects testing innovative interventions to reduce harm from medication use. The
program aims to ensure sustainable improvement that can be applied more widely.
•
In the Medication Safety Breakthrough Collaborative, 100 clinical teams from across
Australia participating in two waves of collaborative action to reduce harm from
medication use by 50% in participating facilities.
•
The first High-Risk Medication Alert on Intravenous Potassium Chloride released in
October 2003 with another alert on Vincristine in development. This gives the Council
the capacity for prompt action to publicise information on known hazards that can lead to
catastrophic patient outcomes.
53
Submission No. 53, ACSQHC, pp. 7-9
- 57 -
•
A National Common Inpatient Medication Chart is being trialled in 30 sites across
Australia, to reduce medication error, one of the most common causes of unintended
harm to patients.
Awareness and understanding
• Helped spread the safety and quality message by sponsoring the Australasian Conference
on Safety and Quality in Perth in 2003 and Canberra in 2004, including support for
international patient safety experts to speak at the Conferences and 19 scholarships for
health workers and consumers to attend.
•
Organised the world class 1st Asia Pacific Forum on Quality Improvement in Health
Care and provided scholarships for the 2nd and 3rd Asia Pacific Forums in Singapore and
New Zealand.
•
Council members delivered hundreds of patient safety presentations to thousands of
people throughout Australia, contributing to wider safety and quality knowledge.
•
Charting the Safety and Quality of Health Care in Australia, based on that developed by
the US Commonwealth Fund, assembled data to provide health care providers, policy
makers and consumers with a comprehensive overview of what is known about the safety
and quality of the Australian health care system.
Consumer participation
• Produced, launched and distributed more than 60,000 copies of ’10 tips for safer health
care’ to help consumers understand health care safety and become more actively involved
in their health care. It has been translated into 15 languages, and agreed by Health
Ministers that all public patients will receive a copy of the booklet at or before the time of
admission.
•
The Open Disclosure Standard: A National Standard for open communication in public
and private hospitals was endorsed by Health Ministers as a national standard in July
2003. It aims to encourage greater openness about adverse events through acknowledging
when things go wrong and providing reassurance to patients and their carers that lessons
will be learned. A national trial is underway.
•
The Consumer Adverse Medicine Events (AME) Line, a national system for consumers to
report adverse events, was launched nationally in October 2003 as an initial 18-month
trial. This is an important way of identifying common adverse drug events enabling
learning and preventative action.
Data and information
•
A national core set of sentinel events has been agreed with jurisdictions and a national
report is being developed to measure and learn from events that cause death or serious
harm to patients.
Research
•
Forged a partnership with the National Health and Medical Research Centre resulting in a
Centre of Research Excellence (CRE) in Patient Safety. Council will invest $2 million
over 5 years into this Centre to build a body of knowledge on what works in health care.
- 58 -
Appendix 3
Public submissions to the Review
No.
Organisation
Author
1
Individual
Dr Kerry Breen
2
Monash University
Dept of Epidemiology & Preventive Medicine
Professors John McNeil and Just
Stoelwinder
3
The Voluntary Euthanasia Society of Victoria
Dr Rodney Syme
4
Individual
Dr John Youngman
5
Northern Yorke Peninsula Health Service
6
Lyell McEwin Health Service
Dr Claire Hale
8
Pharmaceutical Society of Australia
Kerry Deans
9
The Royal Australasian College of Physicians
10
Individual
Margaret Ryan
11
Pharmaceutical Health & Rational Use of Medicines
Professor Ric Day
12
University of WA
Faculty of Medicines & Dentistry
Professor Louis Landau
13
Joint Accreditation System of Australia & New Zealand
Tony Craven
14
Risk Management Working Party
(incorporating AMA/CPMC/MIIAA/MIPS)
Dr Christopher Cain
16
Neurosurgical Society of Australasia
Glenn McCulloch
17
Individual
Diana Aspinall
19
Monash University
Faculty of Medicine, Nursing & Health Sciences
Dr Brendan Flanagan
20
Australian Society of Cardio-Vascular Perfusionists
Darryl McMillan
21
Monash University
Monash Institute of Health Services Research
Professor Don Campbell
22
RWM Consultancy
Rollo Manning
23
National Institute of Clinical Studies
Dr Heather Buchan
24
Australian Association of Occupational Therapists
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25
Australian Private Hospitals Association
26
Private Hospitals Association of Queensland Inc
27
The Health Information Management Association of
Australia
28
Victorian Medication Safety Committee/Victorian
Therapeutics Advisory Group/Victorian Drug Usage
Advisory Committee
29
NSW Therapeutic Advisory Group
Karen Kaye
30
The Australian Council on Healthcare Standards
BW Johnston
32
Individuals
Martin Fletcher & Dr Vin McLoughlin
33
WA Council for Safety & Quality in Health Care and Office
of Safety & Quality in Health Care (Dept of Health WA)
34
Australasian Association for Quality in Health Care
Sandy Thomson
35
Riverland Health Authority
Nino DiSisto
36
Australian Society for Geriatric Medicine
Professor Leon Flicker
37
Royal College of Nursing, Australia
38
Australian and New Zealand College of Anaesthetists
40
Australian Red Cross Blood Service
41
Queensland Health
42
The Royal College of Pathologists of Australasia
Dr Debra Graves
43
Australian Pharmaceutical Advisory Council
Dr John Aloizos
46
Department of Health and Human Services Tasmania
47
Australian Institute of Health and Welfare
Richard Madden
48
General Practice & Primary Health Care NT
Kathy Bell
49
National Health and Medical Research Council
50
Faculty of Medicine, Dentistry & Health Science, Uni of
Melbourne
Assoc Prof Geoff McColl
52
Centre for Health Service Development, Uni of Wollongong
Assoc Prof Roy Harvey
53
Australian Council for Safety & Quality in Health Care
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Dr Robert Hetzel
54
The Health Care Consumers’ Association of the ACT Inc
55
Department of Health & Community Services NT
56
Statistical Information Management Committee
57
Royal Australasian College of Surgeons
58
Australasian College of Physical Scientists & Engineers in
Medicine
Assoc Prof Lyn Oliver
59
Australian Bureau of Statistics
Susan Linacre
60
Australian Association of Pathology Practices Inc
Dr Michael Guerin
61
Breast Cancer Network Australia
62
Office of Health Review (WA)
63
Australian Medical Association
64
Consumers’ Health Forum of Australia
65
The Royal Australian College of General Practitioners
66
Australian Nursing Federation
67
Medical Industry Association of Australia
69
Policy & Planning (Health)
Australian National University
70
Department of Health & Ageing
73
Australian Nursing and Midwifery Council
74
Individuals
76
Department of Health SA
77
The Royal College of Pathologists of Australasia
(addendum to Submission 42)
Dr Debra Graves
78
Australian Healthcare Association
Prue Power
79
NSW Department of Health
80
National Blood Authority
Dr Ric Marshall
Eamon Ryan
Professor Michael Kidd
Brian Vale
Betty Johnson and Jane Phelan
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Appendix 4 List of workshop attendees
Name
Organisation
Professor Bruce Barraclough
Chair, ACSQHC
Dr David Brand
ACSQHC
Dr Heather Wellington
ACSQHC
Ms Betty Johnson
ACSQHC
Ms Christine Gee
ACSQHC
Professor Bryant Stokes
ACSQHC
Ms Maureen Robinson
ACSQHC
Professor Lesley Barclay
ACSQHC
Dr Len Notaras
ACSQHC
Dr Anne Brand
ACSQHC
Dr Jenny Bartlett
ACSQHC
Professor Paddy Phillips
ACSQHC
Professor Clifford Hughes
ACSQHC
Mr Dermot Casey
ACSQHC
Dr Mark Waters
ACSQHC
Dr Wayne Ramsey
ACT Health
Associate Professor Angela Magarry
ACT Health
Dr Glen Power
Affinity Health
Ms Marisa Vecchio
AGPAL/QIP
Ms Amanda Adrian
Amanda Adrian and Associates
Mrs Dianna Aspinall
Arthritis NSW
Dr Sally McCarthy
Australasian College of Emergency Medicine
Dr Christine Jorm
Australian and New Zealand College of Anaesthetists
Ms Christine Dennis
Australian Association for Quality in Health Care
Ms Janet Angel
Australian Association of Gerontology
Dr Susan Ogle
Australian Association of Gerontology
Ms Nicola Ballenden
Australian Consumers’ Association
Mr Brian Johnston
Australian Council on Healthcare Standards
Ms Heather McDonald
Australian Council on Healthcare Standards
Ms Prue Power
Australian Healthcare Association
Ms Jenny Hargreaves
Australian Institute of Health and Welfare
Ms Carmel McQuellin
Australian Nursing and Midwifery Council
Ms Ged Cowin
Australian Nursing Federation
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Name
Organisation
Dr John Aloizos
Chair, Australian Pharmaceutical Advisory Council
Dr Leon Clark
Australian Private Hospitals Association
Mr Paul Mackey
Australian Private Hospitals Association
Associate Professor Neil Boyce
Australian Red Cross Blood Service
Dr Amanda Thomson
Australian Red Cross Blood Service
Dr Catherine Yelland
Australian Society for Geriatric Medicine
Professor Allan Carmichael
Committee of Deans of Australian Medical Schools
Dr Andrew Child
Committee of Presidents of Medical Colleges
Ms Helen Hopkins
Consumers’ Health Forum of Australia
Mr Ian Yates
COTA National Seniors
Mrs Penny Parker
Department of Health and Community Services NT
Professor Brendon Kearney
Executive Director of Statewide Services
Department of Human Services SA
Professor John McNeil
Department of Epidemiology and Preventive Medicine, Monash
University
Dr Joanne Ramadge
Aged Care Clinical Adviser
Australian Government Department of Health and Ageing
Dr Peter McIsaac
Medical Adviser, Information and Communications Division
Australian Government Department of Health and Ageing
Mr Peter Callanan
Australian Government Department of Health and Ageing
Ms Lisa McGlynn
Assistant Secretary, Budget and Performance Branch
Australian Government Department of Health and Ageing
Ms Margaret Lyons
First Assistant Secretary, Health Services Improvement Division
Australian Government Department of Health and Ageing
Dr Cathy Balding
Department of Human Services Vic
Ms Megan Baratta
Department of Human Services Vic
Ms Jennifer Blyton
Australian Government Department of Veterans’ Affairs
Dr Claire Hale
Lyell McEwin Health Service
Mr Glenn Street
Medical Industry Association of Australia
Ms Denise Hutchins
Ministry of Health NZ
Ms Gillian Bohm
Ministry of Health NZ
Mr Rollo Manning
Mirrijini Consultancy
Professor Donald Campbell
Monash Institute of Health Services Research
Professor Dick Smallwood
Chair, National Blood Authority
Ms Nicole Fields
National Blood Authority
Professor Allan Pettigrew
CEO, National Health and Medical Research Council
Adjunct Professor Belinda Moyes
National Nursing and Nursing Education Taskforce
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Name
Organisation
Professor Katherine McGrath
Deputy Director General, Health System Performance
NSW Health
Ms Karen Kaye
NSW Therapeutic Advisory Group
Ms Kirsty Cheyne-Macpherson
Office of the Safety and Quality Council
Mr David Duncan
OT Australia National
Ms Jan Erven
OT Australia National
Ms Roberta Lauchlan
Pharmaceutical Health and Rational Use of Medicines Committee
Ms Jenny Bergin
Pharmacy Guild of Australia
Ms Lucy Fisher
Private Hospitals Association of Queensland
Dr John Holmes
Professional Services Review
Dr Roger Boyd
Royal Australasian College of Medical Administrators
Dr Pam Montgomery
Royal Australasian College of Surgeons
Mr Ian Watts
Royal Australian College of General Practitioners
Mrs Elizabeth Foley
Royal College of Nursing, Australia
Ms Rosemary Bryant
Royal College of Nursing, Australia
Dr Tamsin Waterhouse
Royal College of Pathologists of Australasia
Dr Sue Page
Rural Doctors Association of Australia
Ms Deniza Mazevska
Statistical Information Management Committee
Mr Mark Brandon
The Aged Care Standards and Accreditation Agency Ltd
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Appendix 5
Consultation meeting participants
Figures in brackets indicate the number of individuals who attended.
Sydney - 28 February 2005
NSW Health (5), national bodies (5) and state based stakeholders (10):
NSW Health
NSW Clinical Excellence Commission
Ambulance Service of NSW
Greater Southern Area Health Service
Greater Western Area Health Service
Hunter/New England Area Health Service
Justice Health Service
South Eastern Sydney/Illawarra Area Health Service
Sydney South West Area Health Service
The Children's Hospital at Westmead
Aged Care Standards and Accreditation Agency
Arthritis NSW
Australian Council on Healthcare Standards
Medical Industry Association of Australia
Sydney - Australian Council for Safety & Quality in Health Care - 1 March 2005
20 members and executive of the Council and 2 members of the secretariat attended. Some
individual members also attended state based meetings or met separately with the Review
Team.
Canberra - 3 and 4 March 2005
ACT Health (6), Australian Government (14), national bodies (28) and state based
stakeholders (4):
ACT Health
Australian Association of Pathology Practices
Australian Divisions of General Practice
Australian Healthcare Association (apology)
Australian Health Insurance Association
Australian Institute of Health and Welfare
Australian Medical Association
Australian Nursing and Midwifery Council
Australian Nursing Federation
Australian Pharmaceutical Advisory Council
Australian Private Hospitals Association
Calvary Health Care
Canberra Hospital
Consumers’ Health Forum of Australia
Department of Health & Ageing
Department of Veterans’ Affairs
General Practice Registrars Australia (apology)
National Blood Authority
National Health & Medical Research Council
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Office of the Community & Health Services Complaints Commissioner
Pharmaceutical Health and Rational Use of Medicines Committees
Royal Australasian College of Physicians
Royal College of Nursing, Australia
Women’s and Children’s Hospitals of Australasia
Perth - 8 March 2005
Department of Health WA (24)
WA Council for Safety and Quality in Health Care (12)
Melbourne - 9 March 2005
Department of Human Services (6), national bodies (16) and state based stakeholders (14):
Department of Human Services
Victorian Quality Council
Australian Red Cross Blood Service
Faculty of Medicine, Nursing & Health Sciences, Monash University
Royal Australasian College of General Practitioners
Brian Collopy
Australian Society of Geriatric Medicine
National Nursing and Nursing Education Taskforce
Australian Association of Occupational Therapists
Medibank Private
Affinity Health
National Institute of Clinical Studies
Southern Health
St Vincent’s Health
Royal Children’s Hospital
Northern Health
Victorian Surgical Consultative Committee
Health Services Commissioner, Victoria
Medical Practitioners’ Board, Victoria
Victorian Consultative Committee on Anaesthetic Mortality & Morbidity
Health Issues Centre
Victorian State Committee, Royal Australian College of Physicians
Hobart - 10 March 2005
Department of Health & Human Services (10) and state based stakeholders (10):
Department of Health & Human Services
Australian Health Workforce Officials Committee Secretariat
North West Regional Hospital
Nursing Board of Tasmania
Health Complaints Commission
Royal Hobart Hospital
Medical Council of Tasmania
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Adelaide - 11 March 2005
Department of Health SA (9), state based stakeholders (46), national bodies (1):
Department of Health South Australia
Association of Quality in Health Care (SA) Inc
Australian Healthcare Association
Australian Red Cross Blood Service
Children, Youth and Women’s Health Service
Chiropractors Board
Consumers Association of South Australia
Flinders Medical Centre
Flinders University
Glenside Campus Mental Health Service
Health Consumers Alliance
Hills Mallee Southern
Joanna Briggs Institute
Lyell McEwin Health Service
Medical Board of South Australia
Mid North Regional Health Service Inc
Minter Ellison
Modbury Public Hospital
Noarlunga Health Services
Nurses Board of South Australia
Royal Adelaide Hospital
Royal District Nursing Service
SA Ombudsman
The Queen Elizabeth Hospital
University of Adelaide
University of South Australia
Wakefield Health
Whyalla Hospital & Health Services
Women’s & Children’s Hospital
Brisbane - 17 March 2005
Queensland Health (3)
Queensland Health’s Safety & Quality Council (23)
Darwin - 18 March 2005
Department of Health & Community Services (12) and state based stakeholders (4):
Department of Health & Community Services (including Chair and Secretariat of Acute Care
Quality Committee, Chair of NT Safety and Quality Council and NT State Quality Officials’
Forum representative)
Australasian Association for Quality in Health Care/Professional Development and
Credentialling Committee Representative
General Practice and Primary Health Care NT
Charles Darwin University (also NT Safety and Quality Council representative)
Professional Licensing Board NT
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Acronyms
ACHS
ACSQHC
AGPAL/QIP
AHMAC
AHMC
AIHW
AMA
ANZCA
CEO
COAG
COTA
CPMC
HCAI
ISO
JCAHO
MIIAA
MIPS
NATA
NEHTA
NHIG
NHMRC
NICS
NWC
PHARM
QIC
QPA
RACGP
RACP
RACS
RCNA
SIMC
SQOF
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Australian Council on Healthcare Standards
Australian Council for Safety and Quality in Health Care
Australian General Practice Accreditation Ltd/Quality in Practice
Australian Health Ministers’ Advisory Council
Australian Health Ministers’ Conference
Australian Institute for Health and Welfare
Australian Medical Association
Australian and New Zealand College of Anaesthetists
Chief Executive Officer
Council of Australian Governments
Councils on the Ageing
Committee of Presidents of Medical Colleges
Health Care Associated Infections
International Organization for Standardization
Joint Commission on Accreditation of Healthcare Organizations (USA)
Medical Indemnity Insurers Association of Australia
Medical Indemnity Protection Society
National Association of Testing Authorities, Australia
National E-Health Transition Authority
National Health Information Group
National Health and Medical Research Council
National Institute of Clinical Studies
National Water Commission
Pharmaceutical Health And Rational use of Medicines
Quality Improvement Council
Quality Practice Accreditation
Royal Australian College of General Practitioners
Royal Australasian College of Physicians
Royal Australasian College of Surgeons
Royal College of Nursing, Australia
Statistical Information Management Committee
State Quality Officials’ Forum
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