Belief is such an interesting thing – central to who we are, what we do, and how others see us. What does this have to do with quality of care? Well, quite a lot as it turns out. In the various health, community, and aged care organisations I visit, I see a lot of “belief-based quality”. What does that mean? Boards and executives are generally very optimistic about the quality of care their organisation provides. They all think their care is above average (hmmmmm) and that in general their staff are out there every day doing a great job. Sometimes they have valid and reliable information to support this view, sometimes they do not. Many of you will have heard my theory on this: we have a deep belief, embedded in our healthcare DNA, that high quality care is created by smart, well trained, well intentioned people coming to work and doing their best. Even in the face of copious evidence to the contrary, in the shape of adverse event studies and public inquiries into poor care, many boards and executives cling steadfastly to the view that all is well – until it’s not. Their mantra is: “We’re accredited and we have great staff. What else is there?”
One of the biggest challenges facing the health information management workforce in the healthcare system in Australia is the tyranny of distance. The National Rural Health Alliance (2016) lists workforce shortages as one of the key issues in rural and regional health. Shepheard (2015) identified the issues facing regional and rural Health Information Managers (HIMs), including isolation, communication, workforce retention, and technological opportunities and challenges. Over the last few years Australian regional and rural HIMs have been working with their state branches and the Health Information Management Association of Australia (HIMAA)on ways to support the rural and regional health information management workforce, including the dissemination of information, implementing ways to provide professional development, and support of each other in overcoming the obstacle of distance.
The release of “Targeting Zero: Report of the Review of Hospital Safety and Quality Assurance in Victoria”1 in October 2016 seemed a long time coming – but it was well worth the wait. From my perspective, it’s a racy page turner: a good hard look at Victoria’s clinical governance gaps and how to close them, which will be useful for anyone seeking to provide safer, better care. It is fantastic to see authentic safety and quality issues being named and explored, with associated recommendations for real change; exciting to see leadership and culture recognised as key to that change, at both state and health service levels; a relief that out of such tragedy at the Djerriwarrh Health Services comes an honest appraisal of system gaps and clear direction for improvement.
Professions Australia aims to be the unifying voice of associations representing the professions in Australia. Formed in 1971 by Councils for Professions in New South Wales, Victoria, Queensland and South Australia, the federal Council for Professions today represents more than 20 professional associations which in turn serve more than 420,000 professionals. Incorporated as a public company in 1994, the state councils became branches – by that time including the Australian Capital Territory and Tasmania – and in 2002 registered a business name in every state and territory to officially become the Australian Council of Professions Limited, trading as Professions Australia.
In 2013, Health Workforce Australia recognised the need to delineate the health information workforce (HIW), and improve data collection processes for this workforce. Existing workforce estimates from sources such as the Australian Bureau of Statistics (ABS) census data and the Australian Institute of Health and Welfare (AIHW) are unreliable and do not examine all occupations within this workforce. A focus group was held at the 2015 Health Information Workforce Summit to examine the need for a minimum dataset to allow data collection and monitoring on this workforce. Nine participants unanimously agreed upon the need to formally monitor and evaluate the HIW by collecting current workforce data. A national census of the HIW would capture the data to provide evidence for increased funding and support for workforce supply and configuration.
Sitting in on a quality committee meeting recently, I wondered if all of us working in aged, community and acute care are sometimes a little too smart for our own good. Of course, “communication” was the number one problem for consumers – as it had been for the past year, and probably way before that. And it’s not only consumers who raise these issues; staff also consistently complain that they are not adequately informed about changes affecting them, often scuttling changes out of frustration at not being in the loop.
THE FAMILIAR PHRASE “think globally, act locally” urges people to consider the health of the entire planet and to take action in their own communities and cities. The rapid spread of epidemics such as Avian flu, Ebola, HIV, and the latest threat of Zika to pregnant women and their unborn children remind us how small the world is. This also underscores the importance of embracing global standards to facilitate information collection and data sharing to advance health and wellness.
In the last Quality Conversation, I discussed the clinical governance issues that arose from the Djerriwarrh Health Services clinical governance failure case in Victoria in 2015. In this Conversation I ask: If that’s what clinical governance failure looks like, what are high performing boards and executives doing differently?
October 2015 brought sombre news for Australian healthcare – another health service inquiry into poor care, this one concerning the deaths and stillbirths of a number of babies in a Victorian regional hospital. It’s caused me to reflect again about what is at the heart of our failure to guarantee safe, quality care for our consumers. An extract from the 16/10/15 Djerriwarrh Health Services (DjHS) media release1 stated: ‘A comprehensive, independent investigation of 11 cases at DjHS between 2013 and early this year found a series of failures and deficiencies may have contributed to the deaths of up to seven babies...Djerriwarrh has, in consultation with the Victorian Department of Health and Human Services, initiated all possible measures to reinforce the safety of its maternity and newborn services.’