Error in health care remains a significant problem in Australia, despite more than a decade of efforts to remedy it. Since the landmark 1994 Quality in Australian Health Care Study (QAHCS),2 Australian governments, both state and federal, have introduced various clinical governance, health policy and structural reforms to improve the quality of patient care and reduce preventable harm to patients. However, adverse events have not been measurably reduced. Many acknowledge that barriers to change are embedded in the culture and norms of health care. So, 15 years after the QAHCS and 5 years after a follow-up editorial in the Journal by Wilson and Van Der Weyden3 noting that health care was no safer and calling for a more imaginative strategy to improve patient safety, it is necessary to consider new approaches — not just more of the same. One such approach is to enable patients, carers and families who have experienced poor-quality care and preventable health care harm to develop solutions in partnership with clinicians, health providers and policymakers.

In July 2009, 40 people who identified themselves as agents of change met in Perth, Western Australia, to take part in the 3-day inaugural Australian Patients for Patient Safety (PFPS) workshop, convened by the Health Consumers Council of WA, the WA Department of Health, Perth’s Curtin University of Technology and the United States organisation, Partnership for Patient Safety.

The workshop was the 12th in a series of global workshops supported by the World Health Organization’s PFPS program,4 which was launched in London in November 2005. The workshop adapted an organisational change strategy known as appreciative inquiry (AI). AI builds on meaningful personal experiences that reflect the most positive core of human systems — values, visions, achievements and best practices.5 Participants in an AI process mine their stories to give voice to their most desired future.5

Half the workshop attendees were patients who had suffered preventable harm in health care or lay carers of people who had been harmed. The other half were health care professionals, health system researchers, government officials and non-governmental organisation leaders interested in hearing from and working with patients to bring about change. Participants came from a variety of backgrounds and cultures (fulfilling a workshop planning goal). In an atmosphere of deep mutual respect, they shared their experiences of health system failure and the profound impact this had had, and continues to have, on their lives.

Sharing personal experiences, lessons learned and possible ways to make health care safer, participants developed the Perth Declaration for Patient Safety (Box).1 This passionate call to action seeks to ensure that the impact of health care harm is recognised and that patients’ unique experiences inform change. It calls on all who work in and shape the Australian health system to strive, in partnership with patients and their families, to improve health care safety.

Participants emerged from the workshop appreciative of one another’s experience and contributions, and dedicated to working collaboratively to advance patient safety in Australia. Through the WHO, they join an international network of PFPS “champions”, whose mission is to help patients be active partners in health care, not passive recipients.6-8

The Australian PFPS workshop and its recommendations are timely indeed, given the current push for reform of the Australian health care system. Authors of recent reports, including the proposed National Safety and Quality Framework of the Australian Commission on Safety and Quality in Health Care9 and the final report of the National Health and Hospitals Reform Commission (NHHRC),10 encouraged conversation with consumers about future directions. Both reports call for action more than words, a call now underscored by the Perth Declaration. The NHHRC final report specifically argues that, to create a self-improving health system, a necessary first lever is to strengthen the engagement and voice of consumers.

The PFPS workshop showed that a partnership is readily achievable when stakeholders reach through the invisible walls that separate them. Cooperation among people who are moved to attain what is possible brings new life and confidence to reform efforts.

The vision of a safer future embodied in the Perth Declaration and reflected in the workshop participants’ commitment to openness, appreciation for one another’s experiences and learning from patients’ wisdom, must be supported. The opportunity to co-create that future — to stop harm and save lives — is now here.