Introducing Health System Change Strategies to Policy Makers: Some Australian Experiences

Introducing Health System Change Strategies to Policy Makers: Some Australian Experiences

Brian T. Collopy (Director CQM Consultants and Clinical Advisor ACHS Clinical Indicator Program, Australia)
Copyright: © 2014 |Pages: 14
DOI: 10.4018/ijrqeh.2014040101
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Abstract

In a world first, for accreditation programs, Clinical Indicators (clinical performance measures) were introduced into the Australian Council on Healthcare Standards (ACHS) accreditation process 21 years ago. The resulting national clinical database now receives data from over 740 health care organisations (HCOs) on 22 indicator sets, for different medical disciplines, containing almost 400 separate indicators. HCOs receive aggregate and peer comparative feedback and the types of action by HCOs in response to their results include further data reviews, policy/procedure changes, education programs, new appointments and equipment changes. Favourable data trends in patient care are evident and, with some indicators, cost avoidance can be demonstrated. Revision of the indicator sets is an essential task to ensure continued relevance to clinicians. The Federal Government response to a study in which patient care in Australian hospitals was, prematurely, judged to compare poorly with care in the USA (and later the UK) resulted in the establishment of The Australian Commission on Safety and Quality in Health Care which has now embarked upon a separate program of hospital-based outcome indicators, as have other health care providers. Advice is provided from the literature and personal experience on issues of presentation of material to health care policy makers.
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Hospital Performance

Accreditation and Quality Assessment

In 1974 a voluntary national hospital accreditation program was introduced, modelled on the US Joint Commission and the Canadian programs, by an organisation widely representative of health care peak bodies and Government, initially titled the Australian Council on Hospital Standards (ACHS), but subsequently called the Australian Council on Healthcare Standards (same acronym) as the program was extended to other health care facilities as well as hospitals. Accreditation can now be obtained through other organisations in this country but the ACHS remains the major organisation involved, and currently over 90% of Australian public and private hospitals are accredited (Australian Hospital Statistics, 2011-12). The acronym HCOs (Health Care Organisations) may be used from hereon as an alternative to hospitals for it encompasses other facilities such as Day Procedure Centres.

In the early 1980s the presence of a quality assurance process within a hospital became a requirement for ACHS accreditation. However at that time the clinicians’ view of the accreditation program was that it did not reflect patient outcomes and its concentration was on administrative processes. It was also evident that in some circumstances a hospital could be fully accredited and yet on-site surveys had failed to identify poor clinical outcomes, as there were no accessible documented measures of clinical care.

The purpose of a hospital is to treat compromised people i.e. patients, not clients. A client can make a decision to purchase or not purchase a service or item depending on price etc., but a compromised person has to “purchase” the service which should, hopefully, correct or reduce their compromised state. Compromised people can, for many disorders, be treated in primary care or in the specialist’s office, but other disorders may require multidisciplinary management in a facility which provides access to complex investigative and treatment pathways. The ACHS accreditation program, as such programs did, was ensuring that the environment, i.e. the processes and management in the facility, were appropriate. However, it had no system in place by which to determine the success, or otherwise, of the management of a compromised person.

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