Safety and Quality Review Report Recommendations

Recommendation Implementation Watch.

In 2016 the Director General of the Department of Health in WA commissioned the Report into the Safety and Quality in the WA health system. This was not in response to a crisis, but instead was a proactive project to address the changes in the WA Health system with the introduction of the new Health Act. You can find out more about all the changes here. In simple terms, the responsibility for safety and quality in our public health systems sits with the new Health Service Providers or HSPs – North, South and East Metropolitan, Child and Adolescent and WA Country Health Services. This report sets out a strategy for the continuous improvement of safety and quality and has 28 Recommendations. HCC is posting this up to provide a place to see the progress of the Recommendations. Number 1 is implemented. Transparency is a key feature of this report’s recommendations and a central plank to HCC’s systemic advocacy priorities.

  1. Report publication. The DoH should place this report in the public domain to support its S&Q improvement agenda.
  2. The attendance and scope of current formal performance meetings between the DoH and Health Service Providers (i.e. the area health services) should be reviewed to ensure that HSP boards or board representatives are directly held to account for S&Q performance. DoH assurance requirements should be aligned with HSP Board assurance requirements and all S&Q performance reports to the DoH should be signed off at HSP Board level.
  3. Regular meetings should be established between the DoH and all HSP Safety & Quality (S&Q) sub committee/working group representatives to allow for collective review of statewide S&Q issues.
  4. The DoH and HSPs should collectively ensure that appropriate behaviours, aligned with new roles, responsibilities and accountabilities are promulgated across the system. To this end a time-limited DoH and HSP leadership group should be established, comprising the Director General and nominated DoH deputies, and representatives from each HSP including at least two Chief Executives and two Board Chairs, as well as consumer representation.
  5. Further communications are required to embed understanding of the new WA health system. Organisational development strategies/initiatives at DoH and HSP level should take account of the need to support staff as they transition into new roles.
  6. The responsibility of HSP Boards to provide S&Q assurance in regard to all of their services, hospitals and facilities should be monitored by the DoH and HSP leadership group as a priority action for the system.
  7. The HSPs should construct a development programme for the new HSP Boards and S&Q sub-committees/working groups, drawing on international health service governance best practice. Responsibility for board development should reside with each Board, however the proposed DoH and leadership group should be responsible for ensuring this happens in each organisation for a time-limited period.
  8. HSPs should ensure that their governance structures allow for integrated risk management and adequate consideration of the quality impact of non clinical changes. It is the responsibility of HSP Boards to balance quality of care with the availability of resource, both human and financial, and Board Members should expect to be held to account for this.
  9. Roles and responsibilities of clinical leaders in the WA health system should be clearly defined including expectations around managerial responsibilities and the performance management of all clinicians to ensure that the patient need is met and contractual obligations are fulfilled.
  10. The DoH should focus on the development of strategic policy frameworks with HSPs responsible for the development of local operational policies. In many instances we would expect HSPs to collaborate to develop consistent, system wide policies in the interests of efficiency, patient safety (particularly at the points of transfer between services) and to facilitate joint working across clinical networks.
  11. The WA health system should move towards greater transparency and publish, at a minimum, hospital-level S&Q performance data. There should be a presumption in favour of publication at all times. Consideration should be given to holding part-meetings of HSP Boards in public.
  12. HSP Boards should engage with consumers on their expectations for S&Q. Boards should receive training/advice on undertaking effective consumer engagement activities.
  13. The WA health system should make clear that participation in clinical audit is a requirement for all health practitioners. Job and activity plans should take into account this requirements and there should be system wide commitment to ensuring results are transparent.
  14. There should be transparency as to where HSPs are not achieving the standards to which private providers are held through the licensing process. Although HSPs are not subject to licensing, efforts should be made to improve compliance with these standards in order to ensure equity of treatment for all publicly-funded care.
  15. All assurance requirements outside of the DoH’s regulatory activities should be purposeful, effective and determined by the Director General in consultation with DoH and HSP leadership group. A minimum data set should be collected to support this.
  16. S&Q assurance reporting should cover clinically-reported and patient-report outcomes, patient safety, workforce, staff and patient experience and provider governance metrics. These should be consistent across all providers of publicly-funded care.
  17. The DoH should give consideration to the robustness of processes and metrics for routinely obtaining assurance on providers’ capability and capacity in respect of S&Q.
  18. The HSPs should explore their requirements for S&Q facilitation and support with the DoH in order to establish an appropriate model. The alternative model – the establishment of a new, independent body – may warrant consideration in the future.
  19. The DoH should expand its intervention strategy to cover how it will specifically respond to clinical performance concerns, outlining the non-statutory and statutory responses that all providers of publicly-funded care should expect should they fail to meet required standards. This should set out how and when providers will be supported to access independent clinical expertise to address particular concerns.
  20. All providers should benchmark clinical outcomes at individual clinician, service/specialty and organisation level. This should be done across WA, at a national level and internationally in appropriate specialties.
  21. Data sharing agreements between HSP should be strengthened where barriers exist to effective benchmarking of performance, clinical audit and other quality improvement activities. If necessary the DoH could facilitate collaborative working across HSPs to support coordinated activity.
  22. Clinical support agreements between HSPs should be strengthened to support high quality and equitable service delivery across the WA geography.
  23. HSP Boards should be held to account for their management of S&Q of Public Private Partnership (PPP) hospitals (i.e. Joondalup, Peel, Midland) in the same way as for their public hospitals. Performance management and assurance requirements for S&Q should be set out in robust and comprehensive contracts and aligned with standards for other parts of the publicly-funded system. In the public interest, where PPP contracts do not have robust or contemporary performance management and assurance requirements, these contracts should be modernised at the earliest opportunity.
  24. There is an urgent need to simplify and clarify the organisational arrangements supporting effective clinical governance of mental health services in order to provide direction, consistency and facilitation across service providers. To this end an external review of the overall governance of the mental health system in WA should be initiated as a system priority.
  25. The DoH should seek assurance of individual clinicians’ and service level capabilities to provide high quality care where volumes are low for some treatments and procedures and/or where treatments and procedures are highly specialised or resource intensive. Beyond existing consolidated arrangements for specialised services, the DoH and HSPs should consider further networked delivery and/or centralisation of services where there is a known relationship between volume and quality or where case numbers mean it is not statistically possible to demonstrate safety.
  26. The DoH should work collaboratively with the HSPs to identify SMART S&Q improvement goals for incorporation into a new WA Health S&Q Strategy from 2018 onwards.
  27. Compliance with mandated timescales for implementing learning from clinical incidents should be integrated into the HSPR.
  28. Subject to consultation with the HSPs, the DoH should facilitate a systemwide, coordinated response to learning, not only from clinical incidents but also from consumer feedback including complaints, clinical audit and other internal and external reviews.