The safety and quality of the care provided in Australia’s health system is of utmost importance to all patients, their families and carers. A safe and high-quality health system provides the most appropriate and best-value care, while keeping patients safe from preventable harm.
Definitions
Safety: the avoidance or reduction to acceptable limits of actual or potential harm from health care management or the environment in which health care is delivered (NHIPPC 2017).
Quality: the degree to which health services for individuals and populations increase the likelihood of desired health outcomes, and are consistent with current professional knowledge (ACSQHC 2019a).
Informally, the term ‘safety and quality’ is often summarised as: the right care, in the right place, at the right time and cost. Safety and quality is important in all areas of the health system (see the Health system snapshots in Australia’s health snapshots) and across all population groups (see Culturally safe health care for Indigenous Australians).
It is estimated that around 15% of total health expenditure in OECD countries is spent on treating patient safety failures, many of which could have been avoided (Slawomirski et al. 2018).
A range of organisations act to improve safety and quality of health care. They may focus their efforts nationally, at the state or territory level (for example, health departments), at the service level (for example, individual hospitals), at the clinical level or for specific areas of health care (health professional associations). At a national level, the Australian Commission on Safety and Quality in Health Care (the Commission) provides leadership to improve the safety and quality of health care in Australia.
The Australian Commission on Safety and Quality in Health Care
The Commission leads and coordinates national improvements in health care safety and quality. It works in partnership with patients, carers, clinicians, the Australian and state and territory health systems, the private sector, managers and health care organisations to achieve a safe, high-quality and sustainable health system.
Key functions of the Commission include: developing national safety and quality standards, developing clinical care standards to improve the implementation of evidence-based health care, providing guidance on how to establish and develop clinical quality registries, coordinating work in specific areas to improve outcomes for patients, and providing information, publications and resources about safety and quality. The Commission works in 4 priority areas (ACSQHC 2019a):
- patient safety
- partnering with patients, consumers and communities
- quality, cost and value
- suppo rting health professionals to provide care that is informed, supported and organised to deliver safe and high-quality care.
Safety and quality standards are a set of statements which describe the level of care consumers can expect from a health service. They aim to protect the public from harm and improve the quality of care provided (ACSQHC 2019b). The second edition of the National Safety and Quality Health Service (NSQHS) Standards has 8 standards. Figure 1 lists the 8 standards.
Health services (such as public and private hospitals, day procedure hospitals, private dental practices, transport and community health services) are assessed and must comply with these standards to become accredited (ACSQHC 2019b). State and territory health departments determine which health service organisations must be assessed against the NSQHS Standards.
There are a number of other sector-specific standards, some of which are still being developed, that apply in health service organisations. These include:
- the National Safety and Quality Primary Health Care Standards
- National Safety and Quality Standards for Digital Mental Health Services
- Clinical Care Standards.
The Australian Health Practitioner Regulation Agency (AHPRA) is another key national agency which ensures only qualified and trained health professionals deliver health care. Along with national boards (such as the Medical Board of Australia), they support the National Registration and Accreditation Scheme (see Health workforce) which applies to accreditation and compliance programs for health service practitioners. Complaints or concerns about health practitioners and students are addressed through AHPRA. AHPRA also supports the auditing of health professionals against standards and policies to ensure public safety (AHPRA 2019).
Indicators of safety and quality in the Australian health care system are reported through the Australian Health Performance Framework (AHPF) (AIHW 2019a), MyHospitals (AIHW 2019b) and at a variety of other national, state and territory and local levels, including within individual services and clinical teams.
One measure of safety is the rate of Staphylococcus aureus bloodstream (SABSI) infections (AIHW 2021). In 2019–20 all jurisdictions had public hospital SABSI rates below the national benchmark of 2.0 cases per 10,000 patient days (Figure 2).
The Australian Health Ministers’ Advisory Council (AHMAC) has endorsed a new national benchmark for healthcare-associated SABSI of 1.0 per 10,000 patient days for public hospitals. The revised benchmark will be implemented from 1 July 2020.