Engaging frontline clinicians in effective quality and safety improvement is essential for improving patient outcomes
Health care in Australia faces many challenges. Research suggests, for example, that effective care is underused in 40% of clinical encounters,1 up to 60% of tests and treatments are not justified by evidence,2 and misuse or errors affect up to 20% of hospital admissions.3 These observations call for significant investment in systematised quality and safety improvement (QSI) activities which can improve patient outcomes across a variety of clinical settings. These include reducing surgical site infections in joint replacement surgery,4 reducing mishaps, complications and mortality during and after non‐cardiac surgery,5 or improving survival and optimising care processes of patients with acute cardiac disease.6
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Runciman WB, Hunt TD, Hannaford NA, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 2012; 197: 100–105. https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia
- 2. Scott IA. Audit‐based measures of overuse of medical care in Australian hospital practice. Intern Med J 2019; 49: 893–904.
- 3. Wilson RM, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458–471. https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1995.tb124691.x?sid=nlm%3Apubmed
- 4. Calderwood MS, Yokoe DS, Murphy MV, et al. Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty. BMJ Qual Saf 2019; 28: 374–381.
- 5. de Vries EN, Prins HA, Crolla RM, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010; 363: 1928–1937.
- 6. Scott IA, Denaro CP, Bennett CJ, et al. Achieving better in‐hospital and post‐hospital care of patients recently admitted with acute cardiac disease. Med J Aust 2004; 180: S83–S88. https://www.mja.com.au/journal/2004/180/10/achieving-better-hospital-and-after-hospital-care-patients-acute-cardiac
- 7. Wachter RM. Patient safety at ten: unmistakable progress, troubling gaps. Health Aff (Millwood) 2010; 29: 165–173.
- 8. West M, Dawson J. Employee engagement and NHS performance. London: The King's Fund, 2012. https://www.kingsfund.org.uk/sites/default/files/employee-engagement-nhs-performance-west-dawson-leadership-review2012-paper.pdf (viewed Sept 2018).
- 9. Salyers MP, Bonfils KA, Luther L, et al. The relationship between professional burnout and quality and safety in healthcare: a meta‐analysis. J Gen Intern Med 2017; 32: 475–482.
- 10. Braithwaite J, Herkes J, Ludlow K, et al. Association between organisational and workplace cultures and patient outcomes: systematic review. BMJ Open 2017; 7: e017708.
- 11. Spurgeon P, Mazelan PM, Barwell F. Medical engagement: a crucial underpinning to organisational performance. Health Serv Manage Res 2011; 24: 114–120.
- 12. Pannick S, Sevdalis N, Athanasiou T. Beyond clinical engagement: A pragmatic model for quality improvement interventions, aligning clinical and managerial priorities. BMJ Qual Saf 2016; 25: 716–725.
- 13. Mannion R, Davies H. Cultures in healthcare. In: Ferlie E, Montgomery K, Reff Pedersen A, editors. Oxford handbook of healthcare management. Oxford, UK: Oxford University Press, 2016.
- 14. Heifetz RA. Leadership without easy answers. Boston: Harvard University Press, 1994.
- 15. Berwick D. Diffusion of innovations in health care. JAMA 2003; 289: 1969–1975.
- 16. Scott IA, Phelps G, Dalton S. Arise the systems physician. Intern Med J 2014; 44: 1251–1256.
- 17. Ham C, Berwick D, Dixon J. Improving quality in the English NHS. A strategy for action. London: The King's Fund, 2016.
- 18. Vaughn VM, Saint S, Krein SL, et al. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Saf 2019; 28: 74–84.
- 19. Strifler L, Cardoso R, McGowan J, et al. Scoping review identifies significant number of knowledge translation theories, models, and frameworks with limited use. J Clin Epidemiol 2018; 100: 92–102.
- 20. Braithwaite J, Churruca K, Long JC, et al. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med 2018; 16: 63.
- 21. Barac R, Stein S, Bruce B, Barwick M. Scoping review of toolkits as a knowledge translation strategy in health. BMC Med Inform Decis Mak 2014; 14: 121.
- 22. Reed JE, Howe C, Doyle C, Bell D. Simple rules for evidence translation in complex systems: a qualitative study. BMC Med 2018; 16: 92.
- 23. Scott IA, Wakefield J. Deciding when quality and safety improvement interventions warrant widespread adoption. Med J Aust 2013; 198: 408–410. https://www.mja.com.au/journal/2013/198/8/deciding-when-quality-and-safety-improvement-interventions-warrant-widespread.
- 24. Dixon‐Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature. BMJ Qual Saf 2012; 21: 876–884.
- 25. Churruca K, Ludlow K, Taylor N, et al. The time has come: embedded implementation research for health care improvement. J Eval Clin Pract 2019; 25: 373–380.
- 26. Hewett DG, Watson BM, Gallois C, et al. Intergroup communication between hospital doctors: implications for quality of patient care. Soc Sci Med 2009; 69: 1732–1740.
- 27. Scott IA, Coory M, Wills R, et al. Impact of hospital‐wide clinical process redesign on clinical outcomes: a comparative study of internally versus externally led intervention. BMJ Qual Saf 2011; 20: 539–548.
- 28. Fleischut PM, Faggiani SL, Evans AS, et al. 2011 John M. Eisenberg Patient Safety and Quality Awards. The effect of a novel Housestaff Quality Council on quality and patient safety. Innovation in patient safety and quality at the local level. Jt Comm J Qual Patient Saf 2012; 38 (7): 311–7.
- 29. Wells S, Tamir O, Gray J, et al. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf 2018; 27: 226–240.
- 30. Wiltsey Stirman S, Kimberly J, Cook N, et al. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012; 7: 17.
Online responses are no longer available. Please refer to our instructions for authors page for more information.
We acknowledge the following members of the Australian Health Research Alliance (AHRA) Health Systems Improvement and Sustainability working group who reviewed and provided comments on earlier drafts: Michael Barton, Patricia Bradd, Jane Gray, Leonard Gray, Edward Janus, Michael Kalloniatis, Christopher Levi and Tracy Robinson. The paper arose from their discussions on clinical improvement practices and unwarranted clinical variation. We also thank Dr Haida Luke from Brisbane Diamantina Health Partners (BDHP) and executive members of the AHRA. The Australian Government Medical Research Future Fund enabled BDHP and the AHRA to undertake this work. The funding source played no role in the planning, writing or publication of the work or in data collection, analysis and interpretation.
No relevant disclosures.