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).

Improving safety and quality

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
  • supporting health professionals to provide care that is informed, supported and organised to deliver safe and high-quality care.

Standards and accreditation

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.

Figure 1: National Safety and Quality Health Service (NSQHS) Standards

This infographic shows the eight NSQHS Standards and their icons 1. Clinical Governance Standard, 2. Partnering with Consumers Standard, 3. Preventing and Controlling Health care-Associated Infection Standard, 4. Medication Safety Standard, 5. Comprehensive Care Standard, 6. Communicating for Safety Standard, 7. Blood Management Standard and 8. Recognising and Responding to Acute Deterioration Standard.

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).

Performance and safety reporting

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 (SAB) infections (AIHW 2020). In 2018–19 all jurisdictions had public hospital SAB 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 SAB of 1.0 per 10,000 patient days for public hospitals. The revised benchmark will be implemented from 1 July 2020.

This chart shows that there were 1,573 cases of SAB in 2018–19 in Australian public hospitals. New South Wales had the most SAB cases, 551, and Northern Territory had the least, 18 cases. 

Another key measure of safety and quality under the AHPF is the rate of potentially avoidable deaths. Potentially avoidable deaths are deaths below the age of 75 from conditions that are potentially preventable through primary or hospital care (AIHW 2019c). This includes events such as surgical complications as well as preventable deaths that could have been addressed through screening, good nutrition and healthy habits such as exercise.

The rate of potentially avoidable deaths is higher in regional areas than in metropolitan areas (Figure 3). This could be explained by a higher proportion of people with health risk factors in regional areas, or differences in the quality of care. Differences in the quality of care highlight the importance of nationally consistent standards and transparent performance reporting.
 

This chart shows that the number of potentially avoidable deaths differs by PHN area with regional PHNs having generally higher rates than metropolitan areas. The PHN with the highest rate of potentially avoidable deaths was the Northern Territory, with 213 deaths per 100,000 persons. The PHN with the lowest rate of potentially avoidable deaths was Northern Sydney, with 59 deaths per 100,000 persons.

An emerging area of safety and quality reporting relates to Patient Reported Experience Measures (PREMs) and Patient Reported Outcome Measures (PROMs) (see Patient experience of health care). One example is the Your Experience of Service survey, developed by the Palliative Care Outcomes Collaboration and reported in AIHW’s Mental health services in Australia. A range of other PROMs and PREMs development work is occurring, including a project by the Australian Commission on Safety and Quality in Health Care.

Variation in practice

The Australian Atlas of Health Care Variation maps differences in health care use according to where people live. Health care variation is clearly appropriate where it reflects difference in patients’ needs or preferences. However, when a difference in use does not reflect these differences, it is considered unwarranted variation and represents an opportunity for the health system to improve.

Since 2015, 3 atlases have been published, each identifying variations in the use of many treatments (for example, antibiotics), diagnostic procedures (for example, endoscopy) and surgical procedures (for example, knee arthroscopy). The most recent Atlas (ACSQHC & AIHW 2018) found, for example, that antibiotic dispensing for children differed across regions in Australia, with the rate of prescriptions in Queensland (102,339 per 100,000 children) higher than that in Tasmania (71,472 per 100,000 children) (Figure 4). 

Overuse of antibiotics can contribute to bacterial resistance, meaning the medicine is less effective in treating infections in the future (ACSQHC & AIHW 2018). Variation in antibiotic dispensing for children across Australia may be explained by geographical differences in access to care, rates of underlying disease, clinical decision making or socioeconomic status and health literacy (ACSQHC & AIHW 2018).
 

The graph shows the rate of prescriptions dispensed per 100,000 children coloured by Jurisdiction. A single dot on the graph represents a Statistical Area Level 3, which each dot varying in size depending on the number of prescriptions dispensed. The Australian rate is 96,721 per 100,000. NSW has the most prescriptions at 1,023,567 and the highest rate at 101,950 per 100,000 children. 

International comparisons

Australia monitors the safety and quality of its health services relative to other countries through participation in the Organisation for Economic Co-operation and Development (OECD) Health Care Quality Indicators project. The OECD publishes selected data in its Health at a glance series (OECD 2019). Table 1 lists the indicators related to patient safety against which Australian data were reported for the most recent OECD collection—for all indicators Australia had poorer performance outcomes than the OECD average.

See International comparisons of health data.

Table 1: OECD selected patient safety indicators, Australia (2016) and OECD average (2017, or nearest year)

Indicator

Australia

OECD average

Number of OECD countries

Rate per 100,000 surgical hospitalisations

 

Foreign body left in during procedure

8.2

5.2

19

Post-operative deep vein thrombosis in hip and knee surgeries

1,006.3

259.7

21

Post-operative pulmonary embolism in hip and knee surgeries

535.2

267.3

21

Rate per 100,000 vaginal deliveries

 

Obstetric trauma—vaginal delivery with instrument

6.8

5.5

23

Obstetric trauma—vaginal delivery without instrument

2.5

1.4

22

Defined daily dose per 1,000 population, per day

 

Overall volume of antibiotics prescribed (all)

23.5

18.3

31

Overall volume of antibiotics prescribed (2nd line)

4.8

3.4

31

Note: Caution should be taken in interpreting these findings due to differences in data capture and reporting that may influence the reported rates.
Source: OECD 2019.

Where do I go for more information?

For more information on safety and quality of health care, see:

Visit Health care quality & performance for more on this topic.

References

ACSQHC (Australian Commission on Safety and Quality in Health Care) & AIHW (Australian Institute of Health and Welfare) 2018. The third Australian atlas of health care variation. Sydney: ACSQHC.

ACSQHC 2019a. The state of patient safety and quality in Australian hospitals 2019. Sydney: ACSQHC.

ACSQHC 2019b. Standards. Sydney: ACSQHC.

AHPRA (Australian Health Practitioner Regulation Agency) 2019. What we do. Canberra: AHPRA.

AIHW (Australian Institute of Health and Welfare) 2019a. Australia’s Health Performance Framework. Canberra: AIHW.

AIHW 2019b. MyHospitals. Canberra: AIHW.

AIHW 2019c. Life expectancy and potentially avoidable deaths in 2015–2017. Cat. no. HPF 45. Canberra: AIHW.

AIHW 2020. Bloodstream infections associated with hospital care 2018–19. Cat. no. HSE 217. Canberra: AIHW.

NHIPPC (National Health Information and Performance Principal Committee) 2017. The Australian Health Performance Framework.

NHMRC (National Health and Medical Research Council) 2010. Australian Guidelines for the Prevention and Control of Infection in Health Care. Australian Government.

OECD (Organisation for Economic Co-operation and Development) 2019. Health at a glance 2019: OECD indicators. Paris: OECD.

Slawomirski L, Auraaen A & Klazinga N 2018. The economics of patient safety: strengthening a value-based approach to reducing patient harm at a national level. OECD Health Working Papers no. 96. Paris: OECD Publishing.