Australia Case Study

6.1.2 Australia’s patient safety journey

Supporting healthcare organisations to develop effective systems of clinical governance has been integral to Australia’s efforts to improve patient safety. Since 2011, the Australian Commission has set National Safety and Quality Health Service (NSQHS) Standards, outlining the level of care consumers can expect.

The Clinical Governance Standard provides a basis “for the effective implementation of all other standards”.

In the Australian context, clinical governance refers to the combination of culture, structures and systems that enables everyone in a health service to deliver care that is consistently high quality and improving.

It is the system by which boards, executives, clinical leaders and the workforce are accountable to patients and the community for providing high-quality care.

The NSQHS Standards are reviewed regularly and were updated in 2017 and 2021. The Commission is currently undertaking a major revision of the standards (to be published in 2028) to ensure they remain relevant in the context of emerging technologies, new models of care and ongoing challenges since the Covid-19 pandemic.

The new standards will also stretch beyond hospital care for the first time. Clinical governance will remain the cornerstone of the standards, and there will be a greater focus on the desired outcomes of care, not just the processes of care:

Improving safety and quality at the state level: the example of Safer Care Victoria

The importance of clinical governance is also recognised as critical at the state and territory level. Established in 2017, Safer Care Victoria is the quality and safety body for the state of Victoria. It was born out of the Targeting Zero report – a review into hospital safety and quality assurance across the state – triggered by a cluster of perinatal deaths in 2013 and 2014. The report found an inconsistent approach to safety and quality across the health services, and insufficient oversight of safety and quality from the department.

Safer Care Victoria partners with clinicians and consumers to improve safety through three broad activities: knowing what matters (proactively monitoring data and intelligence for risk areas); enabling what matters (building system-wide improvement culture and capability); and delivering what matters (scaling evidence-based improvement interventions). Around 85 per cent of the 78 healthcare organisations in the state are engaged in work with them, with the aspiration to involve all organisations.

Safer Care Victoria has iterated its approach since its inception in 2017. It began with a strong reactive focus, responding to safety events and overseeing system responses to episodes of harm in light of the Targeting Zero findings. This reactive component (which includes sentinel event reviews and oversight of the Duty of Candour remains a core part of its work, but there has been “a deliberate shift in our evolution over time”.

Today, their work is broadly divided as 70 per cent improvement work, 20 per cent capability building and 10 per cent reactive work. Safer Together is the flagship programme to shift thinking from reactive, localised improvement efforts to proactive, state-wide learning in areas such as safer medication management.

Safer Care Victoria talks to the Government about the impact of its work, particularly how a focus on “front-end engineering around quality and safety will avoid unnecessary harm and costs down the track”.

6.1.3 What has been learnt?

Focusing on the outcomes

The focus on clinical governance has supported organisations to have foundational structures and systems in place to deliver safe care. There is a recognition that, while this remains an important pillar, it should be built upon and evidenced to continuously improve patient safety: “[…] we've got the systems, but are they working? And how do we measure whether they're working, what’s the outcome?”. This progression also means that the right balance needs to be found between accountability and outcomes:

This shift can also be seen at the regional level through the implementation of key patient safety policies. For example, in the state of Victoria, there is an ongoing evaluation of the implementation of the new Duty of Candour. However, initial feedback has suggested an excessive focus on ensuring compliance with process measures at the expense of the intended outcomes:

Fostering improvement

At the national level, the importance of developing the more adaptive features of the healthcare system is recognised. For example, the Australian Commission on Safety and Quality in Health Care is in the process of developing guidance for boards on how to strengthen the role of consumer representatives for inclusive and representative governance.

This is reflected at the state level too, recognising the need to place greater emphasis on the quality of leadership, and on what is required to foster a positive safety culture. For example, Safer Care Victoria has recently updated its clinical governance framework to bring in the concept of adaptive leadership:

6.1.4 What next?

Focusing on what matters

The Australian Commission is currently developing the next edition of the national standards. In addition to the increased focus on outcomes for patients and consumers, there will be increased attention paid to leadership and culture, patient experience and partnerships, workforce, culture, effective clinical practice, data-driven improvement, and environmental sustainability.

At the regional level, Safer Care Victoria is also strengthening its focus on outcomes for patients as part of a strategic shift to ensure it addresses a smaller number of high-priority, high-value areas to achieve greater scale and impact. Part of this work will see Safer Care Victoria explore how the concept of values-based healthcare – delivering care that matters most and adds the most value to people – can be applied in its work.

Making better use of data

Safer Care Victoria experiences challenges in its collection and use of data, in part due to the devolved nature of its healthcare system. They monitor administrative and activity data for trends and insights, such as unplanned readmissions to surgery and mortality rates, “but these are pretty blunt measures”.

Instead, they are exploring how to make better use of patient experience and outcome measures, and of staff experience measures, as signals in the system to identify risk areas. They are also working with the Health Complaints Commissioner on how to use data to better understand what their communities are telling them:

The Australian Commission is focussing on better use of data in the next edition of the NSQHS Standards and in its future work on national standards, generally. Collecting and analysing data about health-service systems and performance, patient outcomes and experience – and publishing and acting on the findings – is fundamental to providing high-quality and continuously improving care. At a health-service level, responsive governance is needed to use findings across the health service to inform learning, improvement and accountability.