Fix the sickest hospital wards first

by Stephen Duckett

Published by The Australian, Tuesday 6 February

Australia needs to set a big target for improving hospital safety.

About one in every nine patients who go into hospital in Australia — public or private — suffers a complication. That’s about 900,000 patients each year. At least one in every 100 patients contracts a hospital-acquired infection, one in every 75 endures a complication with their procedure, and the list goes on.

Of course, hospitals care for the sick and the vulnerable, so even with the best treatment and the newest technology, there will always be some complications. But in Australia, the rate of complications varies markedly between hospitals: in some cases, the additional risk of a complication at the worst-performing hospitals can be four times higher than at the best performers.

This points to a problem that can and should be fixed.

A new Grattan Institute report, All Complications Should Count: Using Our Data to Make Hospitals Safer, argues that the veil of secrecy over which hospitals have higher rates of complications and which are better performers needs to be lifted. For too long, hospital safety statistics have been held secret, with doctors, patients and the public kept in the dark about the good, the bad and the deadly.

State and territory governments need to take the lead and release comprehensive data on hospital performance, highlighting those areas where there is a big difference between the best and worst performers. This data needs to show the whole gamut of hospital performance, from catastrophic errors (which thankfully are very rare in Australia) through to less dramatic but nonetheless harmful (and much more prevalent) complications.

Hospital quality and safety policies in Australia emphasise only a small proportion of total complications — those officially classified as being “preventable”. But these affect just 2 per cent of patients, compared to the 11 per cent who suffer any complication. Even worse, the narrow reporting focus excludes whole classes of patients — for example, people admitted to hospital for mental health conditions — as if those patients and their complications don’t count.

The data produced in our report on differences between hospitals reveals room for improvement across the gamut of complications.

Private health insurers have a critical role, too, in exposing the truth about hospital performance in Australia. They can see in their claims data which private hospitals have higher and which have lower rates of complications. Reducing complication rates would have a dual benefit for their members: their recovery would be quicker and their premiums lower. Insurers should publish the information they hold to put more pressure on private hospitals to improve their performance.

The most detailed, specific information must be given to hospitals, both private and public. Hospital managers and clinicians must be told how their performance stacks up against their peers, so they can start the hard slog of reviewing their methods and priorities, and learning from Australia’s best-performing hospitals and clinicians.

The size of the prize is enormous. If Australia could reduce the average rate of complications across all hospitals to the rate achieved in the best 10 per cent of hospitals, then the rate of complications would fall by more than a quarter.

Australia has an enviable hospital system, but it can and should be better.