After the Quality in Australian Health Care Study, what happened?

Milestones in Australia's journey to high-quality care

The 1995 Quality in Australian Health Care Study (QAHCS) demonstrated the potential to improve the quality and safety of health care.1-3 Using a modified version of the earlier Harvard Medical Practice Study on medical negligence, the QAHCS focused on the more useful measure of preventability of medical error. The incidence of adverse events was higher than in the Harvard study, and at first the Australian rates were queried by government: 16.6% of hospital admissions were associated with an adverse event, of which 51.2% were judged to have high preventability. Many countries replicated the Australian study, using one medical reviewer rather than two as in the QAHCS, which reduced the estimate by about 3%. Overall, a consistent rate of about 10% of hospital admissions associated with an adverse event was seen in New Zealand, Japan, Singapore, the United Kingdom and Denmark. In 2012, a World Health Organization study on adverse events in developing countries showed a similar result.4

The Australian Government responded with a succession of initiatives: the Australian Council for Safety and Quality in Health Care was established by Australian health ministers in 2000 and operated until 2005; the Australian Commission on Safety and Quality in Health Care (ACSQHC) was created in 2006 and written into legislation with the National Health Reform Act 2011. The ACSQHC promulgated 10 national quality and safety standards as part of national accreditation processes. Health reform has also included the Independent Hospital Pricing Authority, the National Health Funding Body and the National Health Performance Authority. Linking costs to quality outcomes, combined with national comparative performance measures of safety, efficiency, access and patient experience, has to be considered a milestone in Australia's journey to high-quality care.

Have the rates of adverse events declined? A repeat of the same study would be costly, and the changed context of health care would complicate interpretation. However, there have been significant process changes that reflect an increasing attention to quality. Federal and state governments are reporting infection rates and triage times. The Australian Council on Healthcare Standards reports annually on 360 indicators in Australasia and, for the years 2005–2012, more indicators improved (125) than worsened (38), with no significant trend for 62 indicators.5 For example, the proportions of emergency department presentations meeting the triage benchmarks increased by about 6% over the 8-year period.

Quality principles have been introduced into medical and health professional education and expanded as a research theme. Early on, the University of Newcastle introduced a quality-of-care project, winning Australian Council on Healthcare Standards student quality improvement awards.6 Other schools have followed, and national and international curricula have been developed from Australia.

Notwithstanding the good progress, there remains much to do to improve health care systems. There is increasing focus on process re-engineering, applications of reliability science, human factor mitigation strategies, teamwork, communication, patient-based care and greater application of evidence-based medicine.