Increased transparency in healthcare hasn’t yet lived up to its promise of transforming quality and cost
Australia’s health system is more transparent than most other countries.
Transparency is inherently a good thing – whether it is about clinical outcomes, financial performance, long-term treatment trends or other information. It allows patients to make more informed choices about their care and substantial, positive improvements in patient outcomes to drive better value for health systems.
A new report by KPMG International Through the looking glass assesses 32 systems worldwide based on a framework covering six areas: quality of healthcare; patient experience; finance; governance; personal healthcare data and communication of healthcare data. It puts Australia in the second tier of transparency alongside the UK and New Zealand, but behind the Scandinavian countries,
Internationally, there is good evidence that public reporting stimulates quality improvement activities, particularly at hospital level. By shining a light on healthcare data, the quality tends to get better over time as individuals and communities take greater notice and become more informed and involved. For example, in Canada, hospitals were found significantly more likely to report quality improvement initiatives in response to publication of mortality rates.
But it would be wrong to be too celebratory about the overall situation. Increased transparency has not yet lived up to its promise of transforming quality and cost. Even high-performing countries have faced difficult questions about the value created for all their effort. And there are instances where publication of sub-standard data has actually led to worse outcomes. Incomplete data, taken out of context, can have negative effects.
Even full transparency can sometimes have poorer outcomes with instances where team members are reluctant to work with colleagues in a clinical setting if their individual performances ratings have not been deemed satisfactory.
Turning to Australia, our healthcare systems are doing relatively well in terms of transparency. Though it should be noted that that there is some variations between the Commonwealth, states and territories.
On ‘Financial’ reporting we share top ranking. In relation to ‘Governance’, Australia is one of only a small minority of countries to score a bonus point for routinely publishing health service procurement prices and contracts as well as information about procurement processes.
But there are still areas where significant improvements can be made. In ‘Quality of Healthcare’ more standardised public reporting of risk-adjusted mortality/survival rates, re-admission rates, adverse events, and hospital-acquired infections should be made. Australian hospitals however do publish average waiting times for emergency care.
Similarly, there is room for improvement in data on ‘Patient Experience’ with a particular need for measurement and publication of patient reported outcomes and patient approval ratings.
Like all health systems, growth in the amount of data collected about Australian hospitals and healthcare services has grown exponentially over recent years. However, accessing that data – both within healthcare organisations and for patients seeking to information about performance of their hospital or indeed even their clinician – can still be difficult. I believe increasing and superior use of data and analytics tools by health systems will be crucial to improved outcomes.
This is particularly important, given the strength of emerging evidence that informed and engaged patients can improve outcomes and reduce costs associated with healthcare service delivery.
In Australia, patient data privacy and safeguarding is a legal obligation and the voluntary digital MyHealth Record allows patients to access their own information in a way that outperforms many other international jurisdictions. There is a potential risk of information overload for consumers, so it is important to focus on what really matters to patients. The more current the data and relevant to their situation the more receptive patients have proved to be.
Perhaps we need a healthcare equivalent of TripAdvisor? While there will be pros and cons to this, it is certainly the route in which we are heading.
Overall, the report shows that in healthcare, like in all industries, organisations deliver results in line with the indicators they measure. If we measure financial outcomes in detail, we improve financial performance.
The same is true of clinical outcomes.