The National Health Performance Authority

Serious efforts to make meaningful comparisons of performance among local health care organisations go back at least 150 years, to the days of nursing pioneer Florence Nightingale. Yet only in the past 25 years has this idea gained traction in a handful of advanced economies, and it has taken until now for Australia to fully participate in this international movement.

In December 2012, the National Health Performance Authority launched its first report to support clinicians in efforts to improve care.1 It detailed the percentages of patients presenting to emergency departments at 134 hospitals nationally who were seen within the 4-hour National Emergency Access Target (NEAT) adopted by state and territory governments.

The Authority, which began operations last year, will soon publish its first report on primary health care services, drawing on a subset of the 48 indicators that the Council of Australian Governments agreed should guide the Authority’s work. The report will detail the health status and service usage of Australians living in the geographical areas served by the new network of Medicare Locals. Like the NEAT report before it,1 and others to follow later this year, this report will allow fair comparisons to be made between similar hospitals and community-based health organisations nationwide. Doing this allows patients to judge how effectively their health services are performing, and gives clinicians important feedback on the effectiveness of their peers’ practices as well as their own.

For those unfamiliar with health performance reporting, three questions are likely to arise at this point. Why is performance reporting necessary, when Australia’s health system is acknowledged to be among the world’s best? What evidence exists as to the benefits of such reporting? And, perhaps most relevantly, how can performance reporting help busy doctors, nurses and allied health clinicians?

The question of necessity is linked to the evolution of health care driven by shifting patterns of disease. For the past decade or more, Australian public hospitals have faced unprecedented pressures associated with rising costs, soaring demand and workforce strain, leading to a succession of highly publicised incidents that have risked damaging the public’s faith that standards are being upheld. At the same time, Australians’ ratings of the quality of medical care they receive are among the highest in the world; but they also have among the lowest levels of confidence they will receive the most effective treatment, and the highest levels of support for health reform.2

Various expert individuals and organisations have urged new models of care based on enhanced clinical engagement and teamwork, yet independent silos remain common in clinical practice. The truth is that the complexity of 21st century health care makes a focus on single practitioners an outdated concept for the purposes of improving system performance, and the National Health Performance Authority will not be reporting on performance at the level of individual clinicians. But unless we establish baseline performance measures for local organisations and health systems, we will struggle to understand the markers of poor performance and will be unable to identify exemplars and use their innovative practice to drive improvements elsewhere.

Other countries are already seeing the benefits that public health performance reporting can bring, particularly when linked to health systems improvement as part of an overall quality framework. The Canadian Institute for Health Information reported in 2010 that between 2004–2005 (when reporting began) and 2008–2009, the age-adjusted rate of hospitalisation for heart attack fell from 239 to 217 per 100 000 people, even though cardiovascular risk factors were becoming more common.3 The story is similar in Sweden, where dramatic improvements have been seen in the quality of care for patients who have had a heart attack.4 An analysis by the Society for Cardiothoracic Surgery in Great Britain and Ireland found public reporting has resulted in a 50% improvement in risk-adjusted mortality rates for cardiac surgery, and that collecting the data cost £1.5 million per year — just 0.6% of the total spending on cardiac surgery, and much less than the £5 million saved in reduced bed-days for coronary artery bypass operations.5

How can clinicians benefit from performance reporting? Review the data to benchmark with your peer groups. Be open to learning from colleagues on how to achieve best performance, and be generous in sharing your innovations with the system. Be aware that it is no longer enough to be personally excellent. To achieve consistent and reliable care across a range of indicators will require good systems and processes, and clinical teams who can work effectively across professional groups and continuums of care.