The personal, public and social costs of mistakes in health. John Menadue

After examining more than 14,000 hospital admissions in NSW and SA, the national cost of harm from avoidable  adverse events (mistakes) in our hospitals was estimated at  just over$2 b pa in 1995/96. This study was undertaken by the Task Force on Quality of Australian Health Care which reported to Health Minister Carmen Lawrence.  51% of all  mistakes were estimated to be avoidable and would represent nearly 500,000 preventable hospital bed days per year. The task force commented that these mistakes “are a problem that overshadows all others in the health sector”

Professor Richardson and Dr McKie from the Centre for Health Economics at Monash University in 2008 commented ‘preventable deaths … occur at a rate equivalent to a Bali bombing every three days’. Deaths, losses and costs are staggering.

In 2011 Professor Richardson told the Melbourne Age that the issue of adverse events in the Australian health system should dominate all others. However it would be closer to the truth to describe it as Australia’s best kept secret”

Ministers, clinicians and administrators all prefer to brush it under the carpet.

If we take the $2 billion cost in 1995/96, project it forward, include non-hospital mistakes as well as the cost to families and individuals denied an income earner, or the effects of disability, the cost is close to $5 billion p.a. I think this is a very conservative estimate

Despite tens of millions of dollars spent on inquiries and committees; no discernible progress has been made in improving quality and enhancing safety. COAG established the Australian Commission on Safety and Quality in Health Care in 2006 but improvements are hard to find. “Insiders “are still in charge. Asking “insiders “to keep reviewing our health sector is a major reason for the lack of success in health reform. To paraphrase Rudyard Kipling “What do they know of health who only health know”? A lot could be learned about safety from other industries e.g. aviation.

Professor Jeffrey Braithwaite, Faculty of Medicine, University of New South Wales  recently commented to me …”No one thinks that we are reducing the levels in rates  or absolute numbers of adverse events much at all despite much effort” Regular newspaper stories confirm the continuing problem. But there is little analysis of the system problems that are at the heart of the malaise. Some hospitals are not safe and should be closed. Others require role delineation to ensure a sufficient scale for efficient and safe operation. The lack of effective action by the Commonwealth and State Governments is scandalous.

In many of our hospitals managerial governance and clinical governance run in parallel but not together. It is an absurd way to run often quite large enterprises. Some hospitals are run more like a cottage enterprise, with clinicians coming and going from their private practises. Mandatory disclosures and compulsory hospital accreditation, as well as transparency, are urgent requirements.

Good people are caught up in a bad system. The aviation industry has shown that culture is a very important determinant of safety. In aviation, the question is asked ‘what went wrong and how do we find a systemic solution?’ Unfortunately in health, the question often is ‘what went wrong and who can we blame?’

John Menadue


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