20 August 2018

Urgent call to overhaul hospital accreditation system

Accreditation Government Hospitals

Medical colleges would refuse to place trainees in clinical units with poor patient-safety records in a proposed overhaul of Australia’s hospital accreditation.

A new Grattan Institute report says the hospital accreditation system, adopted in 1974 on a voluntary basis, is not supported by clinicians and does not encourage better safety.

“It does not improve patient outcomes; doctors dismiss it as irrelevant, or worse, a waste of their time; it provides no incentives for excellent safety performance; and accreditation reports are kept secret,” the report says.

“Practically every significant safety failure in Australian hospitals in recent decades – from Bundaberg in Queensland to Camden and Campbelltown in NSW, Bacchus Marsh in Victoria and, most recently, a gas mix-up at Bankstown-Lidcombe Hospital in NSW – has occurred in a hospital that had passed accreditation with flying colours.”

The report, by Professor Stephen Duckett, the institute’s health program director, and Christine Jorm, comes as a new accreditation system is due to be introduced in January next year.

However, the Grattan report says the modifications mapped out by the states and health service heads do not go far enough, saying the process should move from an event in a hospital’s calendar to a driver of ongoing improvement.

Currently, in Australia accreditors “mostly assess work ‘as imagined’; they do not assess management of actual high-risk situations”, it says.

“Australia’s standards represent a floor; there are neither incentives nor models for excellence that indicate where the ‘ceiling’ might be.”

The report describes as “archaic” the notion of an entire hospital “passing” accreditation when performance in one clinical unit may be quite different from another unit in the organisation.

Moreover, accreditation data and reports are not made public.

“This must change. Some public and private institutions choose to make accreditation and other safety information available.  But public reporting should be required of all hospitals.”

The report, titled Safer Care Saves Money, says each hospital and clinical unit should develop an improvement plan based on its own contemporary data, with progress checked once a year.

Private health insurers should also increase pressure on hospitals and surgeons to improve safety, by making information on complication rates available to members, either directly or through their GPs.

Instead of inspectors making scheduled checks on spruced-up facilities, inspectors would conduct safety tests to address specific issues without warning, the report says.

Medical colleges should not send trainees to hospital units with poor safety records, and clinical units would be warned when their performance was lagging.

“Under our proposed model, medical colleges would remove accreditation for training from units with poor performance (that is, consistently in the bottom 10% of performance) and where there is material difference on any of three measures: patient outcomes; patient experience; or staff experience.

“College training standards would also require evidence of specialist participation in the hospital’s improvement plan.

“The experiences of medical students and junior doctors affects their later clinical practice. Therefore, consideration should be given to reducing their exposure to poor-performing units.”

The Grattan report says clinicians would be more likely to buy into its proposed model because improvement plans would be based on their local data.

“They would see it as a valuable contributor to improving the safety and quality of care, rather than merely extra paperwork.”

The safety overhaul should be backed by the provision of more data on the costs of complications to hospitals, making internal financial incentives to improve care far more evident, the report says.

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