Stephen Duckett recently did a presentation on safer health care system using data and the idea of preventability.
He drew his insights from three key reports that his colleagues and him have been working on:
Report 1: Strengthening safety and statistics report: which looks at different ways of measuring and improving hospital care and improving hospital statistics that is used.
Report 2: All complications should count, all complications should matter report
Report 3: Safe Care Report
His Main focus was on the key questions below:
What to do about financial incentives?
- financial incentives: Lots of activity, little evidence they work.
- Australia’s Messy Incentives
- The business case for quality
- Best practice incentives
- Can financial Incentives work?
What about Governance aka Accreditation
- Accreditation is a major part of hospital regulation in Australia
- The effectiveness of the current hospital accreditation system is unreliable
- What might a new approach to accreditation look like?
The Strengthening safety and statistics report conducted by Duckett and his colleagues in Victoria, Melbourne posed the question, ‘what hospitals thought was the quality in of their healthcare compared to other hospitals in Victoria’ and the insights he gained were that,good 70% thought the quality in their hospitals was better or much better and about 20% thought it was the same. So about 90% of board members thought the quality in their hospitals was about the same, more better or much better.
So why did the board members think that?
‘I think the board members thought that because they had not a clue about how their hospital compared to any other hospital in Victoria.’
Board reports would typically tell you trend information about your own hospital because you control that data, you have that data and you can use that data. But it does not tell you very much about the other hospitals and how they compare to yours.
So in Duckett’s all complications should count report his colleagues and him looked at different ways of measuring complications, sometimes complications are called central events, sometimes never events or sometimes they do re occur so they are not never events. The last one happens very frequently. The Commonwealth Government counts never events is that there’s about a 100 of them every year across Australia. In terms of the way hospitals actually count them and before the routine checks, there are about 400 of them across Australia every year. But the incidents are very small.
The second way of counting complications is the hospital acquired designated complications or the HACS. These occur in 2% of admissions and 5% of multi day admissions. when the list of HAC’s was developed by the Commission of Safety and Quality of Healthcare they said these don’t necessarily represent preventable admissions at all, they are just a list that have designated possible complications where its endorsed by the health ministers
‘They said these are preventable so we are going to penalize states to have them’.
The third way of measuring, is measure everything and not claim whether or not they are preventable.
‘The term preventable is a fraught one when we are looking at safety and quality, because something or example that is preventable, at Royal Prince Alfred Hospital in Sydney may not be preventable the Bunbury Hospital in the South West of Australia. Something that is preventable and is known to be preventable today, like bloodstream infections for example was not thought to be preventable 20 years ago, something that is preventable with a person with a My health record, may not be preventable for a person without it. and the list goes on. The concept of prevent ability is time bound, is geography bound there is all sorts of problems with it. Doesn’t stop people using the concept but it’s something to think about.’
Don’t miss Stephen Duckett’s presentation on Improving quality & reducing expenditure
through outcomes measurement at the Measuring Health Outcomes Conference, 5th & 6th of December 2018, Melbourne.