Make sure you need that surgery

Alarm bells are ringing over the safety of Australia’s hospitals following the release of a report that finds one in every nine patients – or about 900,000 patients every year – suffers a complication that is solely attributable to the hospital. If the surgery requires an overnight stay, the complication rate jumps to one in four.

A Grattan Institute report, released this week, documents the key reasons behind the disturbing figures, and names the culprits responsible for a lack of progress in improving safety.

The report, All complications should count: Using our data to make hospitals safer, states that the public has a right to know which are the best and worst performing hospitals in order to make informed decisions on where to undergo specific procedures. One facility may be better for heart operations, another for knee replacements.

The report says a “veil of secrecy” protects the poor performers, hinders patients’ decision-making and obstructs motivation for hospitals to lift their performance. The hospital safety statistics are collected, but bewilderingly are kept secret from patients, doctors and hospitals.

Media reports in the past 18 months have focused on a cluster of baby deaths at Bacchus Marsh Hospital in Victoria, the death of a boy in Frankston Hospital after he was given food despite staff being told he had allergies, and a sponge left inside a patient at Poplars Private Hospital in Sydney. Mistakes that could have been prevented.

“The additional risk of a complication at the worst-performing hospitals can be four

times higher than at the best performers,” the report finds. “If all hospitals lifted their

safety performance to the level of the best 10 per cent of Australian hospitals, the complication rate across the nation would fall by more than a quarter.”

“This has to change,” the report says. “Patients have a right to know the data on complication

rates in different hospitals and for different procedures, so they – and their GPs – can make better-informed decisions about how and where they are treated. Doctors and hospitals need to know how they are performing compared to their peers, so that they can learn from the best-performing hospitals and clinicians.”

Key recommendations include:

  • State and territory governments should set goals for reducing complication rates in public and private hospitals. They need to ensure the data is published widely so that patients and taxpayers can see which hospitals are improving and which are not.
  • Government should release detailed data on the performance of all hospitals, detailing the catastrophic to less harmful complications.
  • Private health insurers should release the information they gather on private hospitals; lower complication rates would mean quicker recoveries and lower premiums for their members.

Grattan Institute Health Program Director Stephen Duckett says: “Australians expect all hospitals to provide high-quality and safe care, but this report reveals that some hospitals achieve much better results than others.

“The reforms we recommend could cut the complication rate in Australian hospitals by more than a quarter.”

Opinion: We have a right to know which hospitals are safest

I can shop around on assorted websites for the best energy deals and interest rates. I can check the star ratings and reviews on AirBnB apartments before I book. I can go to TripAdvisor to find good restaurants and tours. I can leave feedback about Uber drivers.

But if I want to find a good doctor or the best hospital, I’m totally in the dark.

Information on which hospitals have the best records in terms of patient complication rates is collected but I can’t access it; hospitals can’t access it.

It’s extremely valuable, but it is not shared with the key parties.

Patients can’t ‘keep the bastards honest’, so to speak, by taking their business to the best performers; hospitals cannot learn best practice policies from their high rating peers.

A Grattan Institute report, All complications should count: Using our data to make hospitals safer, has found that one in nine patients who go into hospital in Australia suffers a complication, with that figure rising to one in four if an overnight stay is involved.

If all hospitals could duplicate the safety records of the top 10 per cent of hospitals, then an extra 250,000 patients would head home each year free of complications, the report says.

Hospitals and doctors must be permitted to access the Australia-wide complication rates data so they can learn from the best and improve in areas that need attention.

Patients must be permitted to shop around for the best care, to vote with their feet and head to the hospital they believe is most likely to send them home complication free. If there is one motivator that really works, it is the dearth of customers. Publish the figures annually and it would be easy to see who has lifted their game and who hasn’t.

Data is also collected, though again is not available to the general public, on which hospitals are best in specific areas of surgery. For instance, hospital A might be at the top of the heap in terms of hip replacements, while hospital B might be the jewel in the crown for heart bypass procedures. We deserve to know this information.

Private health insurers collect data on private hospitals but they, too, do not share with the public or between hospitals. As the report states: “Reducing complication rates would mean quicker recoveries and lower premiums for their members.” Lower premiums – another win for the consumer.

The report recommends a series of reforms – from more transparency to sharing data to learning from the best. It is up to state and territory governments to take heed.

We accept that any surgery involves risk, but when that risk is magnified by poor hospital procedure, we need to know. It could be a matter of life and death.

Do you have confidence in our hospital system?

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Written by Janelle Ward

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