Integrating Care

Australian Healthcare and Hospitals Association

Better integration of the various services that make up Australia’s healthcare system would enable more efficient service delivery and improve accessibility for patients. That’s the view of Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA). She has been in the position as head of the country’s top independent membership organisation and advocate for the Australian healthcare system since July, having previously held senior posts in the government sector.

AHHA describes itself as the national voice for universally accessible, high quality healthcare in Australia. Despite a common preconception that healthcare is shifting away from public to private operations, Alison reminds us that there are some 760 public hospitals nationwide – compared with around 570 private hospitals – and that in some sectors of medicine, notably emergency care, public hospitals dominate. The same is essentially true of medical care provision in rural and remote areas – public healthcare and hospital services are the major providers.

The association, originally formed in 1946 as the AHA, is well regarded in Canberra as a respectable lobbying organisation with solid expertise, experience and research to back up its policies. To support its evidence-based work, the organisation established the Deeble Institute for Health Policy Research, an initiative in partnership with seven universities across Australia. Through its partnerships with health practitioners, researchers and policymakers, the Deeble Institute aims to support evidence-based health care practices and policy development.

An issue currently occupying the minds at Deeble is the future shape of Medicare. The healthcare sector, like the broader economy, is under increasing financial pressures. It is generally agreed that some reform of Medicare may be needed to ensure its sustainability. Policymakers, says Alison, “need to work with clinicians and researchers to develop evidence-informed reform options that will continue to foster a comprehensive, accessible, high quality health system that uses resources wisely and delivers the best health outcomes for all Australians.” This universality of healthcare remains the core tenet of the AHHA.

The AHHA is also concerned with service efficiency and recently signed a deal with an Ireland-based company, LEI Group, to deliver its ‘Lean’ training programmes to Australian healthcare organisations. The ‘Lean’ system is designed to remove waste elements from processes to improve the flow of tasks. In the health care field, for example, the system is currently set up around departments, each of which has its own set of processes through which a patient must pass before being sent to the next rather than the flow of tasks being centred on the needs of the patient. Lean processes can assist in improving efficiency of service delivery – integrating services better and cutting out overlaps and duplication.

While health reform has been a work in progress over the past few years, the change in government at federal level raises the question, “Where to next?” Alison says the AHHA is reasonably confident of the intentions of the new federal administration, but there is a need for constant vigilance. “It will be important for the Government to balance two values: equity of access to a safe, responsive and high quality healthcare system, against a national policy that is socially, economically and environmentally sustainable. Duplicated activity, particularly in the national bureaucracy, should be addressed,” she explains.

“Over the past few years, significant national health reforms have been progressively rolled out, including the introduction of activity-based funding and local governance through Local Hospital Networks and Medicare Locals. Radical systemic changes should not be contemplated before the current reforms are evaluated and, in any case, should be evidence-based rather than ideologically driven,” says Alison.

The association believes that privatising the governance of public healthcare, as proposed in a recent report from the Centre for Independent Studies (CIS), is not an optimal solution to address rising health expenditure as it, “overlooks the gains that could be made by better integration between the public and private sectors. Increased attention to prevention and improved access to primary care would also decrease demand for acute care and associated hospital costs.”

The AHHA challenges numerous assumptions made in the review, ‘Overcoming Governance and Cost Challenges for Australia’s Public Hospitals’. “First, the report suggests a direct relationship between increased public health expenditure and inefficient delivery of services in the public healthcare sector. While private hospitals in Australia make a significant contribution, particularly in the provision of elective surgery, most emergency services, intensive care and non-elective surgery (by their nature, largely more costly and resource-intensive) are provided by public hospitals.

“There is no robust evidence to suggest that private hospitals would deliver these services any more efficiently or cost-effectively than public hospitals, despite this being the basis of the CIS report’s proposals. The focus on cost efficiency also overlooks considerations regarding clinical safety and quality – a fundamental omission in any debate on hospital funding.”

The report suggests that competition between hospitals for state funding would provide superior hospital management and performance. The AHHA does not support this argument, noting the varied conditions that create different service needs across rural and metropolitan areas and the important need to ensure service accessibility in the former (Alison says AHHA works closely with the National Rural Health Alliance in this regard – please see Healthcare in Focus, February 2013). In any case, although the competition model has been tried in the UK, its success is yet to be demonstrated.

In particular, AHHA regards as inappropriate the implication that individual hospitals might end up competing for staff via offers of improved pay. “We already experience significant recruitment and retention issues in the health workforce. If each hospital was responsible for its own employment negotiations, these challenges would be compounded; labour costs would escalate, and rural and regional Australia in particular would suffer,” explains Alison.

“While the AHHA supports local control and decision making through autonomous boards for Local Hospital Networks, it recognises the importance of some central planning and coordination to support workforce planning; to minimise duplication or omission of services; to leverage benefits that can be gained from centralised procurement and economies of scale; and to underpin the broader requirements of disease surveillance and population health policy.

“The skills and competence of those responsible for local governance arrangements must be enhanced, and further work is required to ensure activity-based funding is focused on quality improvement and not only cost saving.

“While the steps being undertaken are in the right direction, they would be enhanced by better integration between primary health care and hospitals and between the private and public sectors. Simply handing public healthcare over to the private sector will not ensure change for the better.”

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

November 21, 2018, 9:46 AM AEDT