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Improving quality and safety in health services requires strong oversight across the health system. VAHI strives to provide public and private health service CEOs and boards with trusted, timely and accurate information to help them fulfil their governance responsibilities. Our aim is that CEOs and boards find the information meaningful and use it to improve the effectiveness, efficiency and sustainability of health services.

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Improving information for boards

VAHI has produced the Board safety and quality report since March 2017. The report provides board members of public health services with information about the quality and safety performance of their service, to support their role in clinical governance. It aims to help boards answer the question, ‘Is my health service safe?’ and identify any areas of declining performance that have the potential to impact future patient safety.

VAHI released four issues of the report during 2018–19. Three versions of each issue are produced, containing information that is targeted at:

  • metropolitan and large regional health services
  • regional health services
  • rural health services.

Based on feedback from stakeholders that indicated a need for greater interpretation of the information and results, VAHI introduced new features into the report.

In November 2018, we introduced a statewide average or benchmark for most measures to make it easier for boards to see how their health service is performing. We also added an ‘In focus’ section to provide further interpretation and analysis of measures in the report. So far, this section has looked at safety culture and patient experience measures, exploring their relevance to quality and safety and advising board members on how to interpret results and support improvement.

In early 2019, in partnership with SCV, we started work on improving the Board safety and quality report. Changes to the report will improve the way we communicate information to board audiences to better reflect their role in clinical governance and their associated information and data needs. The revamped report is scheduled for release in November 2019.

Reporting to private hospitals

In November 2018, VAHI produced Victoria’s first private hospital quality and safety report. The report was a result of a successful collaboration between VAHI, the private hospital sector, the Department and SCV.

The report aims to improve the quality and safety of care in private hospitals by improving access to high quality information, including the ability to compare performance with peers. Reporting to private hospitals is consistent with recommendations in Targeting zero (2016), published following a review of hospital quality and safety assurance in Victoria.

The private hospital report included innovative work to capture unplanned readmissions to any Victorian hospital by using hospital linked data. This new method gives a more accurate picture of readmissions than only reporting readmissions to the same hospital. The methodology will be applied in VAHI’s public hospital reporting in 2019–20.

The report also presented us with an opportunity to increase health services’ knowledge about reporting sentinel events and readiness to report healthcare-associated infections, which became mandatory for private hospitals in July 2018 and July 2019 respectively.

Following positive feedback from private hospital executives, VAHI will now produce the Quality and safety in Victorian private hospitals report twice a year. Clinical leaders from private hospitals explained how the report prompted them to take a closer look at their data. Health service data managers have used the data to understand variation across the different facilities in their service.

The second issue was distributed to private hospitals in May 2019.

VAHI is excited to expand our reporting to include private hospitals and will continue to develop this relationship with a view of improving information for private hospitals in the coming years.

Developing new quality and safety measures

In 2018, VAHI undertook a consultation process seeking feedback from Victorian public health services, clinicians, consumers, the Department and SCV on its reports and the quality and safety measures within them. We have made changes to our reports based on feedback received, with a focus on improving the Board safety and quality report.

As part of our consultation process, VAHI received feedback on suggestions for 100 new or amended quality and safety measures. In June 2019, we held a forum with the Victorian Clinical Council to prioritise these suggested measures. Discussion at the forum focused on prioritising the suggestions for new measure development in relation to measures that currently exist and gaps in measurement according to the Australian Health Performance Framework, for example equity measures.

Stakeholders at the forum identified four areas of high priority for measurement development: child and youth, mental health, Aboriginal and Torres Strait Islander people and palliative care. Within each area of priority, stakeholders defined where measurement gaps existed and where development efforts might be best placed.

Focus on Aboriginal and Torres Strait Islander people

The stakeholders discussed how development of new measures should be considered through an equity lens, including considering the different experiences and outcomes of care of Aboriginal and Torres Strait Islander people in our analyses. Equity influences all elements within the Australian Health Performance Framework and VAHI will consider how it can be applied across existing and future measures.

We are already progressing measures of care in relation to Aboriginal and Torres Strait Islander health, including emergency department visits. The new measures will be tested with the Aboriginal and Torres Strait Islander community as well as health services over 12 months before being incorporated into VAHI’s reporting suite.

Refining existing measures

Death in low mortality DRG measure

In response to feedback from clinicians, we removed the death in low mortality diagnosis-related groups (DRGs) measure from VAHI reports in June 2018 so that the methodology could be reviewed. The review was carried out by an expert advisory group including clinicians, measurement experts from Australian Commission on Safety and Quality in Health Care (ACSQHC) and the NSW Bureau of Health Information.

Having adopted the group’s recommendations, the measure now better captures deaths that are genuinely unexpected. We reintroduced the measure into the Inspire report in February 2019.

Hospital mortality: acute myocardial infarction

VAHI is developing a new mortality measure for heart attack (acute myocardial infarction) that includes both in-hospital and out-of-hospital deaths 30 days post hospitalisation. VAHI currently reports only in-hospital mortality following hospitalisation for heart attack; the new measure will capture potential variations in discharge practices and post-discharge care. We expect to include it in the Inspire report in 2019–20. This work has been informed by consultations with the Cardiac Clinical Network and an expert advisory group.

Page last updated: 13 Nov 2019

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