Through close collaboration with our stakeholders and partners, we have made great strides in enriching our products and services, while providing trusted, timely, accurate and relevant information. Continuous improvement to our suite of reporting products and services is central to delivering on the goals articulated in Targeting zero.
Enhancing incident monitoring, reporting and action
The Victorian Health Incident Management System (VHIMS) is a standardised dataset designed to collect clinical and occupational health and safety (OH&S) incidents, non-clinical/non-OH&S incidents (hazards) and feedback in Victorian public health services. The information collected in VHIMS will enhance the information available for health services to support improvements in the quality, safety and experience of health care.
In 2017, VAHI announced a series of reforms to VHIMS. This was in response to feedback from health services, who found the current system confusing and time-consuming from a data entry and analysis perspective.
In 2019–20, we have progressed the VHIMS reform process with significant developments.
A highlight was the successful implementation of the VHIMS Central Solution for 39 smaller Victorian public and community health services that have their incident reporting arrangements subsidised by the Victorian Government. These health services can now quickly log and action their incidents with ease, and create reports to assess their performance.
In close collaboration with the Department and an advisory group comprising Victorian public health service representatives, we have made excellent progress in creating a statewide tender to allow the remaining health services to select a preferred VHIMS platform. The two platforms available through the tender are the VHIMS Central Solution and the VHIMS Local Solution. All Victorian public health services are required to have their preferred VHIMS arrangements in place by 1 July 2021 to ensure they can fulfil their VHIMS minimum dataset requirements. The new VHIMS minimum dataset will improve statewide reporting to drive quality and safety improvements as, for the first time, Victorian public health services will be able to benchmark their performance against their peers.
In response to the COVID-19 pandemic, the VHIMS program saw an opportunity to allow health services to capture pandemic-related incidents. Working with representatives from the Victorian Directors of Clinical Governance, we implemented a new field in all VHIMS arrangements to allow health services to log and monitor incidents, and action improvements in this area. These data will also contribute to statewide reporting.
This year also saw an important milestone with the release of the first VHIMS statewide report in the program’s 12-year history. The VHIMS reported incidents: Inaugural statewide report, July 2017–December 2018 report was released in November 2019 with positive feedback from our partners and stakeholders. A second incident report with 2018–19 data will be delivered early in 2020–21.
In 2020–21, the VHIMS program will continue to support public health services to implement their preferred VHIMS arrangements, and improve the quality of incident and feedback reporting.
Improving patient experience data in Victoria
The Victorian Healthcare Experience Survey (VHES) program collects feedback from recent users of Victorian public health services about their experience of care. This feedback is reported to public health services to inform local quality improvement initiatives and support a patient-centred approach to healthcare delivery.
The VHES program plays a key role in supporting our commitment to improve the experience of patients who use Victorian public health services. This year alone, more than 83,000 Victorians completed a VHES questionnaire. Understanding the aspects of care that are most important to patients allows public health services, the Department and SCV to focus on improvements in areas where they are likely to have the greatest positive impact.
While VHES data is integral to delivering patient-centred care, it was identified that improvements need to be made to the timeliness and actionability of patient feedback collected by the program. Work in this area has progressed well in 2019–20 in consultation with end users of the program, the Department and SCV.
This year, VAHI made changes to the way patient comments collected through the VHES program are reported to public health services, enabling near–real time access to improve service response. We also launched interim reporting on the VHES results portal. This allows Victorian public health services to track their progress monthly as opposed to quarterly under the previous approach and implement evidence-based changes in a more timely way.
In response to feedback regarding the length and utility of the current survey, and to ensure the program is collecting meaningful data, we have commenced work with stakeholders to redesign our VHES questionnaires. The redesign will ensure that questions align with areas of care that are not only most important to patients, but also provide actionable insights to health services. Improving the ease of use of questionnaires for culturally and linguistically diverse populations is another driver of our reform program.
Significant work is under way to contract a survey administrator, informed by the VHES tender advisory group. We have completed the first expression of interest phase of the approach to market, and this process identified potential innovations to move closer to real-time reporting of patient experience data. Some of these innovations include continuous patient sampling and a transition to electronic data collection. We look forward to implementing these features as part of the new program.
The final stage of the approach to market for the next survey administrator is due to commence in early 2020–21. Following this, the new program will be implemented, bringing together recent improvements including the redesigned questionnaires and new data collection and reporting methodologies. These changes will help Victorian public health services action patient experience feedback sooner and more effectively inform patient-centred care.
Monitoring the quality of health care with clinical quality registries
The primary function of clinical quality registries (CQRs) is to monitor the quality of health care, within specific clinical domains and settings, by routinely collecting and analysing clinical performance data.
VAHI’S CQR program aims to create and share meaningful information to identify benchmarks and variation in clinical outcomes, inform clinical practice and decision-making, and ultimately improve the quality and safety of care provided in Victoria’s health system.
One of VAHI’s priorities for 2019–20 was to increase access and use of CQR data, and we made progress with this important work during the year.
In collaboration with the Centre for Victorian Data Linkage, VAHI continued its CQR linkage project. The project aims to enable better use of CQR and administrative data to monitor and drive improvements in the safety and quality of health care. The project will serve the interests of Victorian consumers, clinicians, health services and government.
This year, four registries provided complete datasets for the CQR linkage project: the Australian and New Zealand Intensive Care Society (ANZICS), Victorian Cardiac Outcomes Registry, Victorian State Trauma Registry (VSTRM) and the Cardiac Surgery Database (ANZSCTS).
VSTRM data helped to influence a change in clinical practice leading to a reduction in length of stay. ANZICS data led to a review of out-of-hours discharge from ICUs, resulting in improved process support. It is also currently informing the public health unit’s understanding of Victoria’s ICU capacity in response to COVID-19. In the near future, ANZICS data will also be used for service planning, and to gain a better understanding of patient outcomes over time.
In addition to the CQR linkage project, VAHI’s work in increasing access to and use of CQR data improved our routine reporting. In May 2020, several measures reported by our CQRs were included in the Board safety and quality report for the first time. These measures included risk-adjusted mortality, timeliness of access to critical clinical treatment, transfer to appropriate care, and patient-reported outcomes. The inclusion of CQR data in this report means that Victorian public health service board members now have a more comprehensive picture of quality and safety within their health service.
To inform planned quality improvement initiatives at a statewide level, VAHI also provides its CQR data to SCV’s clinical network insight groups and clinical leadership expert group. Access to these data supports targeted improvement initiatives in Victorian public health services.
Our CQR work will continue into 2020–21, with more VAHI reporting products, including those aimed at private hospitals, set to include more CQR measures. Additionally, we will continue our work with SCV to better use CQR data to inform clinical practice and decision-making. At a national level, we will continue to work closely with the Australian Government Department of Health and the Australian Commission on Safety and Quality in Health Care to develop and implement the national CQR strategy, and revise the framework for Australian CQRs.
In the coming year, we will also use CQR data to gain an understanding of any unintended impacts on the Victorian health system due to the COVID-19 response.
Measuring patient quality of life after treatment
Patient-reported outcomes (PROs) data come from questionnaires completed by patients about their health-related quality of life. PROs can measure changes in quality of life associated with treatment or management of a disease. They can be benchmarked to identify variation in clinical practice, as well as lead to improvements in appropriateness of care and potentially reduce unplanned readmissions through improved patient outcomes.
VAHI’s PROs program consists of three components for investigation:
- individual level component – interested in enhancing interactions between patients and clinicians
- health service level component – focused on understanding, evaluating and monitoring factors that influence variation in health outcomes
- system level component – aims to establish and evaluate policies to benefit whole populations.
This year at an individual level, VAHI worked closely with the Florey Institute of Neuroscience and Mental Health and SCV to investigate the most effective formats to present PROs data to support patient-centred clinical decision-making. A literature review and final report were completed in December 2019, and findings from this review are currently being used to inform how clinicians can better access and use PROs data in their practice. This work has allowed for greater understanding of the enablers and barriers that affect clinicians’ acceptance and uptake of PROs data, and how effective feedback formats may be implemented to allow for greater usage of PROs data.
At a health service level, we continued work on the Utility of Patient-Reported Outcomes in Cancer Care project. This project will trial the collection of PROs for approximately 2,800 cancer patients through the VHES platform. Benchmarked, health service level reports will be available via the VHES portal in 2020–21. Data collected through this project will allow for a stronger understanding of the relationship between patients’ experiences and PROs data, and the data used to identify opportunities for quality and safety improvements within relevant public health services. The Department will use these data to evaluate cancer program improvement initiatives.
At a system level, we partnered with the Australian Orthopaedic Association in 2019–20 to implement a pilot of PROs collection through the National Joint Replacement Registry. Within this partnership, PROs are collected pre and postoperatively for patients receiving elective hip, knee and shoulder arthroplasty. In the initial pilot, 1,335 Victorian patients participated across five public hospitals. The pilot is now being extended to all relevant Victorian public health services. This work will inform how to improve PROs data usage in supporting patient self-management of symptoms. The data has also been requested by the Department to inform discussions around value-based care.
Our work during the year demonstrates the benefits of PROs data analysis. As a result, VAHI will continue to invest in new PROs collections, including in the areas of hip fractures and burns. In the future, we will leverage PROs data as it becomes available for our routine reporting program. This will improve understanding of the appropriateness of care and how public health services can best support patients to self-manage.
Enhancing capability in coding and classification
VAHI’s classification and coding unit supports and enhances the quality of coded health data in Victoria. This work ensures that data is accurate and is actioned appropriately to improve quality and safety in Victoria’s health system.
This year, the classification and coding unit provided expertise at an organisation, state and national level through representation on many working groups and committees, including the Victorian International Classification of Diseases (ICD) Coding Committee, Health Classifications Advisory Group, national ICD Technical Group, and the Department’s Coding for COVID-19 working group.
Through VAHI’s representation on the national ICD Technical Group, we contributed to the refinement of an adjustment regarding additional diagnoses to the Australian Coding Standards. This refinement led to an amendment being issued by the Independent Hospital Pricing Authority (IHPA) in January 2020.
More recently, VAHI has contributed to IHPA’s work to provide advice on consistent national coding for COVID-19. IHPA has published this work as supplementary guidelines for classifying COVID-19 scenarios in admitted patient care. The use of these guidelines in Victoria will present an accurate view of COVID-19’s impact on the state’s health system, and VAHI will continue to promote the use of these guidelines through our coding support function.
Driving health data integrity improvements
Through the health data integrity (HDI) program, VAHI is responsible for ensuring the integrity of performance and activity data reported by health services to the Department. The HDI program ensures that health data collections accurately reflect the care provided to patients. The collections are used to inform decisions around funding requirements of health services, increase transparency, and present an accurate picture of Victoria’s health system to the community.
The Victorian Admitted Episodes Dataset (VAED) audit continued in 2019–20, with 28 hospitals and 4,984 medical records audited. This audit examined the quality of data provided by health services to the VAED, including whether hospital-acquired complications were over or under-reported by health services. Each health service was issued with its own report including an impact assessment rating, and recommendations have been made to each health service that are monitored on an ongoing basis.
The COVID-19 pandemic presented unique challenges for the VAED audit process, mainly because it is typically conducted on site at health services. Given this was not possible, for the first time in the VAED audit’s 25-year history, we successfully conducted remote audits for Western Health and St Arnaud Health Service. The process was well received by both health services, and plans are in place for more remote audits to be conducted throughout the pandemic.
Our program of monitoring corrective actions continued to review the progress of health services implementing recommendations from previous health data integrity audits. To inform this program, we sought feedback from 23 health services on their implementation of recommendations from previous audits.
We also undertook an analytical review of the delay between clinical registration date and administrative registration date for elective surgery. Discrepancies between these dates contribute to inaccuracies of elective surgery wait times. Using data from the Elective Surgery Information System, the review provided health services with advice on efficient booking processes and improved electronic medical record functionality.
In 2020–21, we will continue to oversee health data integrity in Victoria as the VAED audit cycle enters its final year. Plans are also in place to test whether the remote audit process can be more broadly applied beyond the COVID-19 pandemic.
Engaging with experts to identify priority reporting needs
Since their establishment, VAHI and SCV have focused on partnering to develop new reporting products and priority measures. Collaboration has been key, with engagement across SCV’s clinical networks and our expert advisory groups being two key drivers.
Formerly known as ‘clinical networks’, SCV this year transitioned to four Centres of Clinical Excellence that cover 11 different specialities including cardiac, palliative care, mental health, emergency care and maternity, to name a few. These centres continue to provide clinical leadership, expertise and advice towards improving outcomes and patient experiences.
VAHI engages with these centres to gain input from clinicians and health services about new reporting products and measures. This input is critical to ensure new measures are clinically relevant and able to support meaningful improvements to quality and safety. This year, VAHI has developed new measures or refined existing measures relating to acute myocardial infarction (AMI) mortality, unplanned readmissions for hip and knee replacements, heart failure, AMI, paediatric tonsillectomy, as well as new measures for critical care and palliative care.
Many of these measures were developed in line with expert advice from VAHI’s Mortality Indicators Expert Advisory Group, comprising representatives from VAHI, SCV, Victorian health services, The University of Melbourne, the NSW Bureau of Health Information and the Australian Commission on Safety and Quality in Health Care. By working in consultation with clinicians and health services, we can ensure that the measures contained in our reports are relevant, able to inform decision-making, and aligned with clinical needs.
In 2020–21, VAHI will continue its work with Centres of Clinical Excellence to make improvements to our reporting products and measures across more specialities and areas, including COVID-19.
Improving consumer literacy for health quality and safety
VAHI’s public reporting team has commenced work to improve consumer literacy within the context of health service quality and safety. This work is aimed at engaging and collaborating with consumers to better understand their challenges with accessing and understanding quality and safety information.
In 2019–20, VAHI established a public engagement strategy as a roadmap to enlisting consumer input and feedback as a step in the product development process across VAHI.
A partnership agreement has been established with Consumer Health Forum, a peak health consumer body, to facilitate consumer involvement and input across VAHI’s community-focused work, ensuring consumer voices are heard and addressed in the implementation.
In 2020–21, we will continue our partnership with consumers to co-design a consumer charter, value-based care reporting, our public reporting strategy and the digital redesign of the VHES.
Page last updated: 26 Oct 2020