The quality of healthcare and patient safety is an issue that concerns us all and one that has come to the forefront of government and media attention internationally in recent years in light of the increasing public awareness of adverse events in our hospitals and healthcare facilities. ‘Adverse event’ is a broad term used to refer to a situation in which a person endures an unintended negative outcome in association with the healthcare they receive. Governments at federal and state levels have responded to public concerns regarding increasing numbers of adverse events with a range of initiatives designed to identify and begin addressing the cause of such incidents. The Australian Commission on Quality and Safety in Healthcare, The Garling Report, the Clinical Excellence Commission and a commitment to Clinical Governance strategies are but a few of the measures that have been implemented to date.
The Australian Commission on Quality and Safety in Healthcare
The Australian Commission on Quality and Safety in Health Care (‘the Commission’) was commenced in 2006 and is funded by the Federal, State and Territory governments. The Commission is aimed at developing a cohesive national strategy to guide improvements in safety and quality in healthcare. The Commission reports publicly on the state of quality and safety in healthcare, identifying issues and recommending policy directions and priorities for action.
The Garling Report
At the instigation of the NSW government, a comprehensive inquiry into acute care services in NSW hospitals was undertaken in 2008. The inquiry was headed by Peter Garling SC and the final report, which included 139 recommendations, is often referred to as the Garling Report. The NSW government responded to the report with a document entitled Caring Together: The Health Action Plan for NSW in which 134 of the Garling Report’s recommendations are accepted.
Clinical Excellence Commission
The Clinical Excellence Commission (CEC) is a statutory health corporation that is part of the NSW Health System, reporting directly to the NSW Minister for Health. Established in 2004, the CEC has as its mission ‘to build confidence in healthcare in NSW, by making it demonstrably better and safer for patients and a more rewarding workplace.’ The main function of the CEC is to promote improvement in quality and safety in health services and monitor the performance of public health organisations in this regard. This function is largely achieved through the development of programs designed to improve safety and quality of health care including programs designed to address fall prevention, hand hygiene and early identification and management of deteriorating patients.
Clinical governance and patient safety
At the level of local health networks, perhaps the most significant initiative concerning patient safety is clinical governance. Clinical governance is the framework by which accountability for quality patient care and standards of care delivery is ensured and demonstrated. There are many components of clinical governance frameworks including ethics, risk management, complaints handling, and policy development.
One aspect of clinical governance that frequently arises in relation to situations where people have suffered an adverse outcome from healthcare is incident reporting.
In New South Wales there is a state-wide incident management system which collects de-identified data from an electronic reporting system known as Incident Information Management System (IIMS). All serious clinical incidents must be reported and are investigated in detail using root cause analysis methodologies. In the period January-June 2009 therate of serious incidents was reported by NSW Health as 0.11 per 1,000 bed days, or 0.04 per cent of all admissions. At the conclusion of an investigation into a serious clinical incident feedback should be given to the patient or their support person.
An important aspect of clinical governance is communication and open disclosure. In ideal circumstances, open disclosure provides for patients affected by an adverse outcome to be provided with information regarding the results of the investigation into an event and what measures have been put in place to prevent a recurrence of that type of incident.
Persons affected by adverse events or serious clinical incidents often express a desire to know what went wrong and why and incident reports and investigations often potentially hold many of the answers to these pertinent questions. However, the extent of the information actually made available to the affected person following such inquiries is often minimal, presumably for fear (perhaps legitimately) of negative repercussions such as litigation. Whilst it may be possible to apply for copies of a hospital’s documents concerning an adverse event under legislation designed to provide easier access to documents held by government agencies, such as public hospitals, access is often denied on grounds of legal professional privilege or that the documents are excluded from the operation of legislation.