To the Editor: I am surprised that your recent editorial1 failed to recognise the quite dramatic changes for the better occurring in our health system and the way these changes have come about.

In July, the Australian Health Ministers agreed that there had been widespread acceptance of the National Safety and Quality agenda developed by the Australian Council for Safety and Quality in Health Care, and agreed to build on the Council’s extensive platform of reforms by establishing the Australian Commission on Safety and Quality in Health Care to continue this work.2

They noted change and progress in key areas, including the development of incident management systems in all jurisdictions to fix problems in a timely way. All public hospitals are developing integrated patient safety risk management plans, a common protocol for correct site procedures has been accepted, and across the system the booklet 10 Tips for safer health care3 is being given to patients on admission to hospital to enhance their ability to ask the right questions and better control their care.

The Australian Council for Safety and Quality in Health Care has commissioned preparation of the first national sentinel events report. Each state is teaching health care staff “root cause analysis” methodology and, on the back of this, there has been a massive increase in reporting across the country — 30-fold in New South Wales — because people realise that systems issues will be fixed without inappropriate blame. This supports openness about mistakes and the reporting of problems.

Other national initiatives under way include an education framework for safety and quality, a single common medication chart in all public hospitals, agreed national approaches to infection control, as well as a national open disclosure standard and a national standard for credentialling and defining the scope of clinical practice. Ministers have endorsed this standard, which, if applied appropriately, could be expected to help prevent situations like that in Bundaberg. The Bundaberg scandal, however, appears to have been caused initially by a fraudulent application for registration. The safety and quality agenda does not address criminal behaviour, but puts in place opportunities for improvement.

These are only some of the reforms being implemented using levers for change, which include leadership, advice, persuasion, example, and the development of tools, standards and guidelines. Commonwealth, state and territory health and human services departments, as well as organisations in the private sector, continue to be responsible and accountable for implementing these activities.

Internationally, the Council’s work is held in high regard by authorities from the United Kingdom, the United States, Canada and Ireland, who are seeking advice about how coordination of these activities across the health and human services departments of nine sovereign governments has been achieved.

The new Commission will continue the difficult task of taking the health system from “very good” to “even better”.