Call to tie hospital bosses’ pay packets to patient safety

One of the most effective ways to improve the safety in hospitals is, ironically, keeping people out of hospital as much as possible, health safety experts say.

Australia's ageing population and the growing number of people now living with chronic conditions such as diabetes are going to strain the nation's healthcare system like never before in the coming decade.

At Macquarie University, the Australian Institute of Health Innovation is running world-class research into how we cope with such pressures.

Professor Peter Hibbert from Macquarie University has researched the surgical instruments left inside patients during operations.
Professor Peter Hibbert from Macquarie University has researched the surgical instruments left inside patients during operations.

The institute's Associate Professor Peter Hibbert said an important step was making sure the top brass in hospitals value safety.

"If we want to improve safety culture, it needs to start from the top," he said.

"Chief executives and boards of hospitals are judged primarily on their financial management.

"Did they meet budget? Was that new building completed on time? I would argue that safety of staff and patients, and quality of service, is equally important and hospital management should be held accountable to these as well as finances."

He also says research shows one of the most effective ways to raise safety is to actually for people to avoid hospital in the first place, and running more preventive health programs and offering more high quality care in the community.

"We need to recognise that most people would prefer to stay at home for as long as possible when sick or frail," he said.

"Getting high quality healthcare services into the community, near to where people need them, is critical."

More focus also needs to be spent on reducing operations and care that doesn't help patients, Professor Hibbert said.

"For instance, research has shown that 40 per cent of prostate cancers diagnosed and treated each year would not have caused the person any harm in their lifetime," he said.

A laser being used in prostate surgery.
A laser being used in prostate surgery.

"That cost to the health system and the patient, financial and emotional, that could have been avoided."

And within the hospitals system itself, transparency and public reporting will improve outcomes enormously.

"Making performance data available does improve the performance of hospitals," Professor Hibbert said.

In 2017, 48 deaths were recorded in NSW as being "wholly or partly related to anaesthetic factors", a specialist anaesthetic review committee found.

These deaths included inappropriate drug dosage in five cases, poor planning in four cases, inadequate pre-ops in five cases and two cases each of inadequate ventilation and monitoring.

They also reported on 14 "futile" cases - patients subjected to unnecessary surgery where there could have been no favourable outcomes.

Another measures to help improve safety include sharing common insights when things go wrong.

Associate Professor Hibbert's research team recently recommended to a Victorian safety agency that all the individual root cause analysis investigations carried out at hospitals could be aggregated across the state and the findings shared.

He also said there needed to be independent review processes for serious events in hospitals, not just an investigation conducted by the same health service where the problem occurred.

Other areas for improvement included wrong diagnosis.

"Less obvious is the risk to people who experience delay in receiving a diagnosis or receive the wrong diagnosis.

"In the case of people with drug-resistant epilepsy, they can wait years for a diagnosis and then access to surgery with the potential to alleviate their symptoms. In Australia the delay to receiving surgery is around 17 years."

Medication errors alone cost $1.4 billion in Australia, but progress is being made.

Associate Professor Hibbert said the growing use of electronic medication management was making a difference.

In aged care, the software can pick up potentially harmful cocktails of drugs, particularly in aged care where residents might be given anti-inflammatory drugs such as Ibuprofen alongside ACE inhibitors and diuretics, causing acute kidney injuries.

His recent research at The Children's Hospital at Westmead found the introduction of an electronic medical management system slashed mistakes, including a 38 per cent cut in high risk drug prescribing errors.

"Specifically, there was a 23 per cent reduction in all prescribing errors and a 20 per cent reduction in potentially severe prescribing errors.

"While eMM systems can introduce their own errors - such as if drop down menus are poorly designed - they have the potential to greatly improve patient safety."

 

 

Originally published as Call to tie hospital bosses' pay packets to patient safety

But not all surgeries are necessary.
But not all surgeries are necessary.

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