By Jeffrey Braithwaite
The tens of billions of dollars spent on unnecessary or inappropriate medical tests and treatments in Australia every year is not just a phenomenal waste of tight healthcare budgets. It shows modern healthcare systems needs more than just a spring clean to ensure we can meet future demands and keep up with advances in biomedical technology.
The challenge is not insurmountable. We can reset the way our system works. Much of the research we need to sort this out is already under way.
One in every 10 patients in our hospitals is actually harmed by our healthcare system through errors, omissions or miscommunication.Credit: Nicolas Walker
First, the negative headlines. Australians receive care in line with the latest evidence in only 57 per cent of cases. And delivery of care is uneven. For some conditions, like coronary artery disease, most Australians receive excellent care, but for others such as obesity, antibiotic use and alcohol dependence, more than two-thirds of care isn’t up to scratch. On top of this about a third of spending is wasted on tests and procedures that do little to improve a patient’s condition, as Four Corners detailed this week.
And one in every 10 patients in our hospitals is actually harmed by our healthcare system through errors, omissions or miscommunication. Mostly this is minor, but a significant number of patients are made sicker or can die as a result.
Let’s look at this apparently sorry list from another angle. As a healthcare researcher, I unravel the multitude of interactions that must take place to ensure our teams of doctors, nurses, allied healthcare professionals and administrators deliver the best possible care. What astounds me is that within such complex and constantly changing systems is that nine out of 10 hospital patients do receive good care.
That means not only that every single clinician, computer, medical device and drug works as it should, but also that every person and piece of technology and software within this complex web communicates effectively to deliver the right care at the right time. This, to me, is where the future of healthcare lies.
Key to improving healthcare delivery is a term we bandy around – "evidence-based". Healthcare is constantly evolving in response to often rapid advances in medical knowledge and technology, yet parts of the system can be slow to keep up. For example, of the many tests and procedures listed for Medicare rebates we now know some are ineffective or unhelpful.
The federal government’s current review of all the 5700 items on the Medicare schedule is a step in the right direction. We need Medicare to be based on the latest and best evidence of what treatments and procedures really work.
We also have a national snapshot of the standard of care in Australia to build on, one of the few in the world. The Caretrack Australia study scrutinised 22 common conditions which account for more than 40 per cent of health treatments. It helped identify where our evidence-based healthcare excels, and where it performs poorly so that improvements can be carefully targeted to where they are most needed. We are undertaking a similar study of the standard of care for children, Caretrack Kids.
But I believe research is also beginning to tell us something else important. Over the past 25 years we’ve invested heavily in studies of medical errors that have left us wringing our hands because things still can go decidedly wrong. Meanwhile, we have paid virtually no attention to when everything goes right. Staff largely provide good care but no one stops to ask "How do you manage to do that?", day in and day out, in busy, complex health systems operating under considerable pressure.
We know our doctors, nurses, administrators and support staff are overwhelmingly committed to their patients and to safety and are intuitively nearly always right. Yet we don’t invest in research that could tell us how these millions of encounters work effectively; that is, when the system is performing at its resilient best, flexing and adjusting to accommodate for the unexpected.
It’s clear to me the most remarkable thing about modern healthcare is not what goes wrong or how much money is wasted, but how successful we usually are even with limited resources. The more we understand what it is that helps us get healthcare right, the better the prescription for our health system of the future.
Professor Jeffrey Braithwaite, PhD, is founding director of the Australian Institute of Health Innovation at Macquarie University and co-author of the Caretrack Australia study.