RegHealth Projects

Governance of health safety and quality – an ideas paper

The Safety and Quality Branch, Australian Department of Health and Ageing, commissioned an ideas paper titled ‘The governance of health safety and quality’ (Braithwaite, Healy and Dwan November 2004). The paper discusses, among other ideas, networked governance, responsive regulation and restorative justice: theories that have been tested in other areas. The paper considers how these theories and associated mechanisms might improve safety and quality in the delivery of health care in Australia. It draws together research and experience from health and other sectors and begins to formulate an evidence base for choosing between regulatory strategies.

ARC Linkages Project: ‘Regulatory strategies for improving health sector performance’

A research partnership has begun between RegNet at the Australian National University and two industry partners: the Australian Commission on Safety and Quality in Health Care, and the Australian Capital Territory (ACT Health).

This project, running for four years from 2005-2008, was funded by the Australian Research Council (ARC) Linkages Program, and by cash and in-kind contributions from our two industry partners. The project examines the mix of ‘hard’ and ‘soft’ regulation and proposes productive pathways towards future ‘responsive regulation’ in the health sector. The project will begin by ‘mapping’ the terrain of regulation in the Australian health sector, and then armed with this knowledge, will undertake evaluative case studies of regulation/quality assurance strategies intended to improve clinical performance in three areas: nursing homes, hospitals and primary health care. This project is expected to produce a better understanding of the regulatory strategies likely to improve the safety and quality of health care and thus save the lives and improve the health of Australians.

Safety First: Regulating Patient Health Care

This book, edited by Judith Healy & Paul Dugdale, assembles leading patient safety experts to evaluate promising regulatory approaches for making health care safer for patients. A continuing spate of medical scandals has prompted more external scrutiny as well as more pressure to ensure that the health professions and the health care industry strengthen their own internal regulation. The nine chapters in the book cover strategies ranging from persuasion, such as the promotion of patient safety clinical protocols, to information strategies, such as public reporting of adverse incidents involving patients, as well as sterner sanctions, such as revoking hospital accreditation or suing doctors. The book will be published by Allen & Unwin in mid 2009.

The Governance of Health Care: Reluctant Regulators

This book, authored by Judith Healy, applies a “responsive regulation” framework in mapping the scope and scale of regulatory actors and regulatory strategies, in Australia and internationally, which are intended to improve the performance of health care. The book surveys promising paths across the rapidly expanding terrain of health sector regulation, and identifies and analyses the assumptions/values underlying the various approaches. The health sector traditionally has relied upon ‘softer’ forms of regulation by the professions but increasingly in many countries is being subjected to greater external regulation. The book explores what is known about the impact of regulation upon the safety and quality of health care for patients. The book will be published by Ashgate Publishers in late 2009.

Regulating Aged Care: Ritualism and the New Pyramid

This analysis of the nursing home industry, by John Braithwaite, Toni Makkai and Valerie Braithwaite analyses trends in the regulation of aged care in Australia, the US and UK over the last 20 years. It proposes a strengths-based pyramid of regulatory strategies that complements the earlier sanctions-based pyramid of the responsive regulation approach. (See Recent Publications link to Braithwaite, Makkai & Braithwaite (2007) Regulating Aged Care: Ritualism and the New Pyramid.

Correct patient, correct site and correct procedure: the implementation of the 3Cs protocol

Misidentification errors in hospital operating theatres are described as “never events”, that is, preventable and inexcusable adverse events. These errors can have a devastating impact upon patients and their families and are also very distressing to the staff involved. Surveys are finding that such incidents are not as unusual as originally assumed; for example, 53 such incidents were reported in Australian public hospitals in 2004-05. This study reviewed the promulgation of the national 3Cs protocol by the Australian States, and undertook interviews with hospital managers and health professionals on their experiences in embedding the protocol as “the way we work around here”. The study examines why an apparently simple patient solution to the problem of wrong patient/site/procedure surgery proved less simple than expected to implement.

European Observatory on Health Care Systems: reporting on Australia

review of the Australian health care system that profile its policies, funding, organisation and regulation was published in 2006: Healy, Sharman & Lokuge Health Care Systems in Transition: Australia (See link below under Recent Publications). This report is part of a series on European and OECD countries published by the European Observatory on Health Care Systems and Policies, a research partnership convened by the European Regional Office of the World Health Organization.

International Healthcare Comparisons Network

This research network comprises experts in 13 countries (including Judith Healy from the ANU) is funded by the UK Department of Health. Managed through the London School of Hygiene and Tropical Medicine, the network provides policy briefings to the UK Department of Health. Some briefings are published by the European Observatory on Health Systems and Policies. The International Health Care Comparisons Network provides both in-depth analyses and rapid-response-type briefings. It responds to specific requests for information on international experience in areas ranging from health sector capacity planning to activity-based financing of hospitals. These themes are selected in close consultation with the Department of Health, the focus being comparative analysis to facilitate learning from the experience of other health systems as an input to policy development by the Department of Health.

A Knowledge Network on Health Systems for Policy Makers in Asia

This study, by Judith Healy (ANU), John Maxwell (ANU), Vivian Lin (La Trobe) and Phua Kai Hong (National University of Singapore) was funded by the Alliance for Health Policy and Systems Research based in the World Health Organization, Geneva. The study explored views on the need for an information mechanism in the Asian region, through which policy makers could pose questions on health system issues and receive timely responses. The purposes of such an entity would be to promote the take-up of research evidence in participating countries, and expand the capacity of researchers in the region, in order to help strengthen Asian health systems and thereby improve the health of their populations. Over 20 information mechanisms around the world were reviewed, and over 90 informants from health ministries and research institutes were interviewed by collaborators in seven countries: China, Indonesia, Laos, Malaysia, Philippines, Singapore, and Vietnam. The survey found strong support for a regional mechanism able to provide information relevant to Asian health systems (See below Recent Publications link to Health et al 2007).

NHMRC/ARC Research Network 'Ageing Well'

The NHMRC and ARC jointly funded the 'Ageing Well' Network for five years from 2005-09 to support interdisciplinary, high quality research on the National Research Priority Goal of Ageing Well, Ageing Productively. The Network links researchers from many disciplines, nurtures developing researchers, strengthens international collaboration and involves end-point users. Administered by Sydney University (Professor Hal Kendig) and by four main university hubs, the Australian National University group (convened by Dr Judith Healy), informs and supports population research strategies across Australia in the area of 'ageing well, ageing productively'. The Network also sponsored the Archive on Ageing that is located in the Australian Social Science Data Archive at the Australian National University.