Beruflich Dokumente
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PUBH1382 Australian Health Care System
Week 5 (Section A): Health promotion, quality and
safety: Working in the Australian health care
system
INSTRUCTORS: Mervyn Jackson & Amy Loughman
Learning objectives
1. Describe health promotion, its major action areas and the principles that guide it.
2. Briefly describe the way different health sector organizations can contribute to
health promotion.
3. Explain the opportunities for multidisciplinary engagement in health promotion
4. Outline different approaches/strategies that attempt to reduce health inequalities
5. From your discipline’s perspective, describe the six components associated with
measuring quality.
6. In terms of quality, safety and errors:
a. What are errors?
b. What is the major source of errors?
c. Distinguish human from systemic errors
d. What common (human) factors increase risk?
e. Describe the role of public inquiries
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Notes
1. Health promotion
Health promotion is a scheme that aims to prevent illness before it occurs and promote
wellness. Health promotion also aims to encourage early detection to ensure chronic
diseases are identified before they get to their later stages. Health promotion decreases
the overall burden of disease and injury on the Australian health care system. Health
promotion has come about through health public policy.
Health promotion allows people to take control over their own health and wellbeing and in
turn, improve it. Health promotion does not only focus on good health, but people’s ability
to participate in the community and to take control of circumstances that affect health.
Most changes in health promotion have come from the World Health Organisation (WHO)
and United Nations Children’s Fund (UNICEF). In 1986, these organisations developed the
Ottawa Charter which is a document used as the framework for all contemporary health
promotion schemes.
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html
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There are five key aspects of health promotion:
1. healthy public policy that is agreed upon across all levels of government (federal,
state/territory and local)
2. the creation of supportive environments for health
3. the development of personal skills
4. strengthening community action and
5. reorienting health services to focus more of improving population health as a whole.
The Ottawa Charter looks at health holistically, meaning it takes into account social,
physical and mental factors that are further shaped by external influences such as
behaviour, cultural, environmental, political, social and economic factors. Social justice and
empowerment of the people is a strong focus throughout the document, highlighting the
benefits this has on population health outcomes.
http://fawziyajournal2013.wordpress.com/the-ottawa-charter-and-the-manda-model/
In the Australian health care system, principles from the Ottawa Charter that are clearly
evident include:
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● community participation
● undertaking action at all levels of government
● creating and working in partnerships and
● involving a wide range of organisations and sectors of government to create policies
and programs that shape development.
2. Contribution of different health sector organisations
There are 9 major health organisations that are major contributors to health promotion in
the Australian health care system.
These are:
1. The Australian Department of Health including via the National Strategic Framework
for Chronic Conditions
2. State and territory health departments
3. Health promotion foundations
4. Issue-specific non-government organisations (NGOs)
5. Regional health authorities
6. Community health services and hospitals
7. Aboriginal health services
8. General Practitioners
9. Private health companies (including Medibank Private)
Below are descriptions of the responsibilities and contributions of each.
The Australian (Federal) Department of Health established a National Strategic Framework for
Chronic Conditions to provide a national approach to guide planning, design and delivery of
policies, strategies, actions and services to reduce the impact of chronic conditions in
Australia.This superseded the National Preventative Health Agency [ANPHA] created in 2011
to advise on preventative health issues to the Australian Health Ministries Council (AHMC),
including creating standards for practice, frameworks to guide health promotion and
implementing national campaigns that promote health. This was abolished in 2014.
The Australian Department of Health is part of the Federal Government and is
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responsible for allocating funds to state and territory governments for health promotion
programs, identifying National Health Priority Areas (NHPAs), facilitating and funding
national health promotion programs and creating health policies and legislation. The
department also funds health promotion for Aboriginal health services.
State and territory health departments are responsible for the delivery of health
promotion programs, as well as planning and development of policy and legislation at a
state/territory level. They also must distribute funds to non-government health promotion
agencies and regional health services.
Health promotion foundations have been created in several Australian states/territories
and are responsible for health promotion program delivery and research. The best known
health foundation in Victoria is VicHealth
Issue-specific non-government organisations (NGOs) are responsible for promoting
awareness about a specific health issue that affects the population as a whole. These are
organisations such as the Heart Foundation, Cancer Council and Diabetes Australia.
Regional health authorities are responsible for the management of hospitals and
community services and aim to equip health care professionals in prevention initiatives
and health promotion projects.
Community health services and hospitals are responsible for more local initiatives
focusing on specific groups such as public housing residents or refugees. The geographical
boundaries of these services are smaller (based on local government areas)
Aboriginal health services are run through organisations such as the National Aboriginal
Community Controlled Health Organisations (NACCHOs) and Aboriginal Medical Services
(AMS) and are responsible for health promotion within the indigenous communities. They
address areas such as drug and alcohol use, sexual health, diabetes and chronic disease
prevention.
General Practitioners can become involved in various initiatives through Divisions of
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General Practice. GPs are responsible for delivering health promotion education and
information directly to patients, in areas such as physical activity levels, healthy eating,
asthma management and the correct use of prescribed medicines.
Private health companies (including Medibank Private) are responsible for delivering
education and information through counselling and one-on-one sessions with clients. The
type of health promotion information given depends on consumer demand, but can range
from weight loss, fitness to stress management.
3. Opportunities for multidisciplinary engagement
The need for multidisciplinary health promotion has become apparent in recent years due
to the diverse areas of concern and the variety of factors influencing these issues.
Health promotion information can be given during direct service provision from health
professionals such as GPs, nurses, physiotherapists, health psychologists or occupational
therapists. This education can be personalised and used as preventative measures to
ensure changeable outcomes reduce or do not occur in the future. Interventions aimed at
the reduction of smoking, alcohol abuse and physical inactivity can be delivered by
multidisciplinary teams.
Important factors for health promotion through multidisciplinary teams include patient
assessment and reassessment, provision of education and resources to patients, follow up
post discharge and provision of support services to those that require them.
Multidisciplinary groups also provide an assortment of specialist skills to particular areas of
health promotion programs. For example, health psychologists can be involved in
implementing and evaluating introduction of healthy eating and exercise programs,
dieticians have been involved in school canteen programs, chiropractors, osteopaths,
physiotherapists and exercise scientists have been involved in programs promoting
increased physical activity and nurses, podiatrists and occupational therapists are involved
in falls prevention programs.
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4. Approaches/strategies to reduce health inequalities
With the increased focus on health promotion, there are still many health inequalities
within Australia. These are due to a number of factors such as age, ethnicity, gender,
socio-economic status, genetics and behaviour. These factors all come from the root of the
unequal distribution of resources and opportunities.
Two ways to address these inequalities are:
1. create policies that promotes a more even distribution of resources in an aim to
reduce inequalities in health between countries but also within them.
2. take into account socio-economic status of an area when funds are being allocated
in and between regional health services.
The creation and funding of specialised programs has also occurred in more recent years,
aiming their programs at disadvantaged sub groups within Australia such as Aboriginal and
Torres Strait Islander groups, refugee groups and homeless groups – especially youth
homeless groups. An example of this is the Closing the Gap for Indigenous Australians
strategy, which used cultural specific education and information to reduce the incidence of
chronic disease and alcohol and substance abuse. Programs have also been created that
focus on health inequalities arising from being disadvantaged such as socio-economic
disadvantage and food insecurity.
Inter-sectional collaboration is also an approach to reduce inequality, using these systems
to focus on inequality issues that are normally outside the scope of general health care
such as community safety and safe housing environments.
However, there are many inequality issues that have still not been addressed in the health
care system such as tax, social welfare entitlements, housing, privatisation of services,
some upstream services and some policies.
5. Six components associated with measuring quality.
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Quality is difficult to define in broad terms, however there is increasing focus on health
care quality as a system-wide approach and this has been driven by a number of factors.
According to Fletcher (2000) a systematic approach can be applied to consider critical
components of ‘quality’ in health care:
1. the structure of health care, which refers to the inputs to the care process (the
conditions in which health care treatment is provided and the training of the
provider)
2. the process of care, which refers to characteristics of what is done in giving and
receiving care
3. the outcome of care, which refers to the effect of care on the health of patients and
communities.
Quality and safety in the context of the Australian Health Care System
It is important in the health care system to provide quality care for all patients. Due to the
large amount of funding from the national budget that goes to health care, Governments
need to put in place systems that monitor the standard of care delivered.
There are six principles that define what it means to provide quality health care.
1. The effectiveness of the health care provided is important to evaluate whether or
not services are achieving what they set out to achieve.
2. The efficiency of health care not only minimizes costs, but allows health care
professionals to provide the best treatment possible for their patients.
3. Equity is one of the most important parts of health care, ensuring all patients are
treated equally and fairly.
4. Ease of access is vital in health care to ensure that those who need health care can
get it as quickly as possible when they need it. This includes things like bed
availability and location of health services.
5. Services also have to be acceptable to recipients and this is often judged by an
impartial third party organisation.
6. Finally, health services provided have to be appropriate to the patient’s needs and
condition. It must be correct and fit with standards provided by legislation and
policies.
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6. Safety and Errors
The Australian Health care system attempts to understand and minimize the number of
mistakes or errors that occur in all parts of service delivery. An error is defined as a mistake
that leads to harm toward patients or clients and while it can lead to death, many cause
increased pain and suffering and a much longer time to recovery. There are two major
views of errors: the ‘person approach’ [humans make errors] and the ‘system approach’
[the organization’s structure leads to an increase in errors]. Human error is the largest
cause of concern for our health care system in comparison to technical errors. However, an
analysis of errors in Healthcare systems leads to the conclusion that errors have multiple
causes, are understandable and are preventable. Creating a high level of industry
standards and ensuring all staff members comply with these standards helps minimize
errors.
There are three major sources of errors:
1. Random human errors are those that are normally blamed on the direct caregiver,
most often doctors and nurses. It is normally caused by personal behaviour. These
human errors occur randomly and are normally isolated incidents. For example,
even though a staff member follows guidelines, he/she may still miscalculate a
dosage. Many of these errors are picked up by systematic procedures such as all
dosage calculations are checked by a second staff member
2. Systemic human errors are a type of error that occurs consistently and are often
due to an underlying factor that has not been detected previously or in training.
Often human errors are intensified by systemic factors. For example, staff members
in busy emergency departments may be distracted by multiple demands and these
lapses in attention increase the chances of making an error. The focus here is for
the organization to put in place organizational procedures at the local level to
decrease the causes of these errors
3. Systemic errors fall under the system approach and are errors that are due to issues
related with the organisation itself. To reduce these errors, there is a focus on the
overall design and management of the organization and then an emphasis on
health care education (with a focus on safety and training).
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The most common human factor that affects how health care professionals deliver service
is stress. The reality of modern hospitals is an increase in high pressure situations. These
lead to mental overload, distractions, a poorly managed physical environment, extra time
and work demands on staff and a breakdown in team work that is designed to detect the
occurrence of errors. The way work place processes, systems and tools are set up also
impact on the health care professional’s ability to perform their job.
The existence of errors has become a huge problem in the health care system. The
problems include both the health and safety of patients/clients, but also the cost and
disruption to the health care system when these errors are detected and investigated.
Government inquiries or public inquiries have been undertaken to evaluate the harm
caused to patients during their treatment in a hospital and to make recommendations on
how these errors can be prevented from happening in the future.
http://www.ceufast.com/course/medical-errors/
Figure above: Analysis of hospital practices that may increase medication errors.
Public Inquiries
Government or public inquiries research and evaluate the significance of errors in the
health care system. The outcome for patients from these errors is also evaluated to
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determine if harm came to patients from their hospital stay. These inquiries have become
an integral part of the health care system overseas and in Australia.
One overseas inquiry in the UK called the Kennedy Inquiry examined the malpractice of
infant heart surgeries. It found that no safety systems were in place and inappropriate
work culture causing the issue to not be identified for several years. The Shipman Inquiry
was also in the UK, and examined the actions of general practitioner Harold Shipman.
Shipman was accused and convicted of intentionally killing hundreds of his patients. The
findings discussed accountability of health care professionals for below standard patient
outcomes. The inquiry also found that the hospitals interests were focussed too much on
the best outcome for the doctors, disregarding the safety of the patients.
In Australia, there have been several government inquiries. These include the King Edward
Memorial Inquiry, the Camden-Campbelltown Inquiry and the Garling Inquiry. The findings
of the King Edward Memorial Inquiry found that the errors were occurring in the systems of
the hospital in the gynaecology and obstetrics departments. The Camden-Campbelltown
Inquiry revealed that the care being provided by staff was unsafe. Due to this inquiry, a
safety commission in NSW was created called the Clinical Excellence Commission. The
Garling Inquiry spanned over several months and resulted in many different
recommendations such as trainee doctor supervision, how key performance indicators
should be interpreted and revised consistently and the need for medical specialities to
communicate thoroughly across specialty boundaries when required. This inquiry occurred
due to the death of Vanessa Anderson, a girl that was hit by a golf ball and did not receive
appropriate care. The inquiry was also fuelled by an extensive amount of complaints from
previous patients, relatives of patients and other clinicians.
In summary, these inquiries are designed to give voice to all stakeholders: organizations
[hospitals]; professionals [doctors, nurses, etc] and patients and their families. By full and
open discussion, the cause of errors can be determined and then the Health Care System
can work to put in place procedures and training to ensure that such errors will not
re-occur in the future.
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