Major reforms are planned for Victoria’s health services, in response to a Review led by the Grattan Institute’s Professor Stephen Duckett, that was prompted by a concerning cluster of avoidable newborn and stillborn deaths at Djerriwarrh Health Services (Bacchus Marsh hospital).
The Report of the Review of Hospital Safety and Quality Assurance in Victoria, aspirationally entitled Targeting Zero, identified major deficiencies in the oversight of quality and safety by the Victorian Department of Health and Human Services, and made detailed recommendations for reform, which the Victorian State Government quickly announced it accepted in principle and would adopt.
The planned reforms include:
- The establishment of a new overarching quality and safety monitoring body, Safer Care Victoria.
- A new health information agency to share information about areas of concern, as well as about services and strategies that are performing well.
- The creation of the Victorian Clinical Council so that clinicians have a pathway to advise the Department on strategic issues.
- Public and private hospitals being held to the same quality and safety standards and reporting requirements.
- Upskilling and improved accountability of hospital boards.
- A strengthened focus on obtaining and responding to patient experiences.
The report and the reforms have been welcomed in Victoria, for the reasons articulated by Professor of surgery and surgical safety expert, David Watters, below.
Professor David Watters writes:
The Report of the Review of Hospital Safety and Quality Assurance in Victoria (the Duckett Report) recognises that although many Victorian hospitals are leading the way in quality and safety, we can make the whole system safer. This will ensure a consistent standard in all health services, minimising the risk of avoidable harm, and focusing on the patients’ experience of healthcare and its outcome.
Improving governance; clinicians’ vital role
The report addresses the need for improved overarching governance and oversight of safety particularly by the Victorian Department of Health and Human Services.
How this will happen has at its core a repositioning of how our health services and hospitals are managed, and will see system managers working in conjunction with clinical leaders across all levels. This report will be welcomed by Victorian clinicians as it will offer new opportunities for them to engage and contribute. A clinician-led path of continuous improvement means more decision-making and oversight by those on the front-line of health care.
The patient experience
The recommendations are also good news for patients as there will be a stronger focus on improving the patient experience, and the need to include patient reported outcomes (PROMS) in the reporting framework. Underpinning this is greater recognition of the importance of the patient’s voice in the decisions we make about health services and how they are provided.
Adequate, efficient resourcing
The Governance framework of our hospitals and health services will be reinforced with better training for members of Hospital Boards.
The Report recognises that funding cuts have compromised the ability of the Department to provide the oversight and governance it would like. The Department will therefore be encouraged that it will be strengthened and resourced to implement the recommendations. Its safety and quality advisory and oversight committees will be streamlined, with better integration and more use of clinical networks that will assume a regional responsibility.
Data and communication
The Report makes recommendations on the use of data, much of which is already available to the system, but can be better used to provide more consistent reports on performance and outcomes across the system. The Victorian Admitted Episodes Dataset (VAED) offers great potential to inform the public, clinicians and the Department, particularly about the care of patients who are readmitted to a different facility to the one in which they had their initial procedure. Better tracking of patient journeys and outcomes through the health system between services will be beneficial to those responsible for clinical governance.
Building on strengths
The Report commends the Victorian Audit of Surgical Mortality (VASM) as a ‘state of the art’ peer review of the management of patients who have died during an admission that involves surgical or gynaecological care.
One mark of the effectiveness of surgical care in Victoria is that, to meet demand, the number of operations being performed in Victoria has increased steadily over the past 5-10 years. This increase has been achieved with lower mortality rates despite an increase in age, comorbidity and emergency presentations.
The Report also recommends expanding the role of VASM to ensure greater learning from complications of clinical care.
A focus on consumers
The Report should reassure patients and consumers that the system is focused on them – that they can have the right treatment at the right time in the right facility. Wherever treatment is undertaken, that facility will have the necessary resources, skills and backup in place, and that a patient’s journey through the system will be as seamless as possible. Rather than numerous hospitals duplicating services, there will be clear roles delineated as to which hospitals offer specialist programs for treatment of conditions such as heart disease, obesity surgery and cancer. Rural hospitals will do what they do well – providing an appropriate level of care for less complex conditions closer to home.
There is also a welcome shift in recommendations for how hospitals and health services might be accredited, with more reliance on ongoing monitoring of safety and quality through standard reporting of health care outcomes rather than a focus on scheduled accreditation inspections. This will build a more robust and ultimately safer system than what we have in place.
Consistency and transparency
In the reorganisation and rearrangement of the current advisory committees greater oversight and monitoring of safety and quality will be secured. There will be, for the first time, a common set of broader safety and quality performance indicators across both the public and private health sectors, giving patients the ability to make informed decisions about care. Transparency and probity in investigations of events will be secured with all health services being able to recruit independent experts to assist their review.
Targeting zero: the journey to safer care
All jurisdictions are on similar journeys toward safer care and the Report ensures that Victoria learns from some of the successes elsewhere and from the pockets of excellence throughout the State, ensuring best practice is shared and learned from.
This will be represented by a more collegiate response to sharing of knowledge and will see greater support for smaller health services and hospitals in Victoria through networks and partnerships.
Victorians should have confidence in the fact that they have access to one of the best and safest health systems in the world; implementing the recommendations of the Duckett Report across the State will further reduce adverse events and avoidable harm.
Professor David Watters OBE is Alfred Deakin Professor of surgery at Deakin University and Barwon Health, and a member of the Victorian Surgical Services Advisory Committee.