Hospi­tal wait­ing lists need qual­ity con­trol, not sim­plis­tic cut­ting to a tar­get

The Weekend Australian - Travel - - Health - MITCH MESSER

WHEN sta­tis­tics about hospi­tal wait­ing lists are be­ing thrown around in the me­dia, it’s easy to for­get that there are real peo­ple be­hind the head­lines.

In­creas­ing ac­cess to hospi­tal treat­ment can make a big dif­fer­ence to the qual­ity of life of thou­sands of Aus­tralians cur­rently on hospi­tal wait­ing lists. But in an ef­fort to get the num­bers right, we should not lose sight of why it is so im­por­tant to im­prove those wait­ing-list sta­tis­tics.

Many Aus­tralians wait­ing for surgery live with con­di­tions that cause sig­nif­i­cant pain and dis­abil­ity. Of­ten they can­not work or par­tic­i­pate fully in fam­ily and com­mu­nity ac­tiv­i­ties, and daily life can be a strug­gle.

As well as the dif­fi­cul­ties in­volved with liv­ing with a chronic con­di­tion or dis­abil­ity, peo­ple on hospi­tal wait­ing lists of­ten have the added stress of not know­ing when their op­er­a­tion will take place. Op­er­a­tions can be sched­uled and then can­celled at the last minute if a more ur­gent case comes up.

Peo­ple wait­ing for surgery of­ten feel like they are in limbo, un­able to get on with their lives un­til they re­ceive the op­er­a­tion they need. Some­times this can go on for months, or even years.

Of course hos­pi­tals can’t treat ev­ery­one at once, and it is im­por­tant that peo­ple re­quir­ing emer­gency or life­sav­ing treat­ment are the high­est pri­or­ity for surgery. How­ever, it is a mis­take to think that peo­ple whose con­di­tions are not im­me­di­ately life-threat­en­ing are not also in des­per­ate need.

This is why the Con­sumers’ Health Fo­rum of Aus­tralia sup­ports the Fed­eral Gov­ern­ment’s al­lo­ca­tion of $600 mil­lion in ad­di­tional fund­ing to help re­duce wait­ing times for surgery and the agree­ment be­tween the Com­mon­wealth and State/Ter­ri­tory Gov­ern­ments to work to­gether to achieve this goal.

In par­tic­u­lar, we wel­come the com­mit­ment from the Fed­eral Gov­ern­ment to end the ‘‘ blame game’’ in health and to im­prove co­or­di­na­tion be­tween dif­fer­ent lev­els of gov­ern­ment in the de­liv­ery of health care.

Hospi­tal wait­ing lists are a good place to start in im­prov­ing col­lab­o­ra­tion be­tween ju­ris­dic­tions. But for this ini­tia­tive to be a suc­cess, the fo­cus needs to be on im­prov­ing over­all hospi­tal per­for­mance and not just on in­creas­ing through­put of pa­tients. Im­prov­ing the ex­pe­ri­ence of peo­ple un­der­go­ing surgery in hospi­tal should be one of the out­comes at­tached to this ad­di­tional fund­ing.

One im­por­tant area of­ten nom­i­nated by con­sumers as need­ing im­prove­ment is in com­mu­ni­ca­tion be­tween hospi­tal staff and pa­tients (and their fam­i­lies and car­ers), in­clud­ing in­volv­ing them in plan­ning their post-oper­a­tive care, in hospi­tal as well as in re­la­tion to their dis­charge ar­range­ments and fol­low-up care in the com­mu­nity. As poor post-oper­a­tive care can de­lay re­cov­ery, and in some cases com­pro­mise the out­comes of surgery, in­volv­ing con­sumers in im­prov­ing the de­liv­ery of care af­ter surgery makes both med­i­cal and eco­nomic sense.

Pro­vid­ing hos­pi­tals with


to in­crease elec­tive surgery ac­tiv­ity could place ad­di­tional stress on a sys­tem that is al­ready strug­gling to pro­vide ad­e­quate post-oper­a­tive care to ex­ist­ing pa­tients. There­fore it is vi­tal that some of the ad­di­tional re­sources are tar­geted at im­prov­ing care for pa­tients af­ter their op­er­a­tions, both in the hospi­tal and post­dis­charge in the com­mu­nity.

It is also im­por­tant that those peo­ple in the great­est need of treat­ment ben­e­fit from this ini­tia­tive. This may not oc­cur if the ad­di­tional fund­ing is tied sim­ply to in­creas­ing the num­bers of sur­gi­cal pro­ce­dures per­formed as this will cre­ate an in­cen­tive for hos­pi­tals to in­crease the num­bers of the most straight­for­ward pro­ce­dures, at the ex­pense of more com­plex and dif­fi­cult op­er­a­tions. This could re­sult in peo­ple with rel­a­tively mi­nor con­di­tions be­ing treated be­fore those with more se­ri­ous prob­lems. To en­sure that the fund­ing is used as eq­ui­tably as pos­si­ble and to achieve the max­i­mum ben­e­fits to con­sumers, the qual­ity of life of peo­ple on wait­ing lists needs to be taken into ac­count when de­ter­min­ing pri­or­i­ties for treat­ment.

This may not be easy to achieve. This is partly be­cause the com­mon­wealth has not pre­vi­ously played an ac­tive role in this area, and does not have a good un­der­stand­ing of how wait­ing lists are man­aged by hos­pi­tals. The me­dia makes the is­sue look sim­ple, but in ac­tual fact how wait­ing lists are con­structed and man­aged is ex­tremely com­plex. Fac­tors such as the role of the private hospi­tal sys­tem in per­form­ing some elec­tive sur­gi­cal pro­ce­dures on be­half of pub­lic hos­pi­tals, and de­ci­sions made by spe­cial­ists about where their pa­tients re­ceive treat­ment, can both have an im­pact on wait­ing list sta­tis­tics but they are also not well un­der­stood.

Th­ese is­sues can­not be over­come in the short term and may present bar­ri­ers to the ef­fec­tive tar­get­ing of this fund­ing. How­ever, by fo­cus­ing on in­creas­ing the qual­ity of hospi­tal care, rather than on achiev­ing sim­plis­tic tar­gets for in­creas­ing ac­tiv­ity, this ini­tia­tive has the po­ten­tial to pro­vide im­me­di­ate ben­e­fits to peo­ple cur­rently on wait­ing lists as well as on­go­ing im­prove­ments in hospi­tal care in the fu­ture. Mitch Messer is chair­man of the Con­sumers’ Health Fo­rum of Aus­tralia

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