To the Editor: Van Der Weyden calls for quality and safety for all Australians accessing health care.1 Improving the quality and safety of health care requires clinical leadership and active participation by all staff. This will not occur until quality and safety activities are allocated protected time and considered by governments, hospitals, managers, health departments, health funds, clinicians and all others to be equivalent in value to clinical work.

Airline pilots, to whom doctors are often compared, spend a day a month on safety training. The recently revised consultant contract in the United Kingdom provides a minimum of a half-day per week of protected non-clinical time for audit, quality and safety, governance and similar activities.2 These paid, protected sessions are equivalent to those spent in theatre, outpatients or other clinical work. There is no similar protected, non-clinical time in the Australian health service. Australia’s current trainees, the consultants of tomorrow, will expect such activities to be included within their safe working hours’ allowance.

The clear message is that time allocated to quality and safety is less valuable than that spent maintaining clinical throughput. The shortage of doctors over the medium term means there will be pressure to maintain the clinical service. This will inevitably result in a further reduction in the time spent on quality and safety.

A suitable start would be for every Australian hospital to stop clinical activity for one half-day per month to provide protected time within working hours for quality and safety activities. This need not be expensive. For example, many hospitals close for a prolonged period over the summer and by reducing this closure by 1 week, and spreading the days gained as quality and safety sessions over the year, hospitals will work exactly the same number of days. By rotating this half-day each month, the impact would be spread evenly. If coordinated, this would facilitate multidisciplinary, inter-hospital and even area-wide meetings.

The cost of quality and safety activities is a short-term necessary inefficiency that is an investment for a long-term gain. The government’s failure to provide the paid, protected time for this necessary inefficiency clearly indicates that its interest in quality and safety ceases when a cost is involved.