Monday, November 17, 2014

Quantum Leap 2104 Conference Report -Lisa Harris

The massive white 
Novotel Brighton Beach Sydney
1970s developer’s folly dominating the landscape as you fly into Sydney is the Novotel Brighton, which was the location for  the Quantum Leap conference  ( Sept 9-10). An opportunity for the organisers Australian Healthcare and Hospitals Association (AHHA) and the Australian Council on Healthcare Standards (ACHS) to combine their annual conference with a look at health innovation and research. I was there on behalf of the HCCA along with a couple of hundred other delegates exploring this notion of the Quantum Leap, which, according to ACHS Christine Dennis is the emergence of patient safety into the 1,400 hospitals across Australia.

On day one delegates discussed the big news in first world healthcare - the recent mammoth task of reforming the US health system. So there was a lot of anticipation to hear keynote speaker Prof John McDonough from Harvard University, a key health adviser to the Democrats and co‑developer of Medicaid or Obamacare. The brutal politics of reforming the US health system were laid bare by McDonough. The fundamental hurdle? It just wasn’t part of the US national identity to have equity in the health system. That made it a tough gig and a ‘kinda nutty time’ staring down the republicans, educating for a new system, and most importantly a new set of American values. He talked of the financial imperatives for change - that US health spending was out of control but there was no corresponding benefits to quality, access, cost, equity or mortality. Extraordinary also was the brute fact that medical costs were the highest cause of personal bankruptcy in the US. What really hurt, quipped the affable McDonough, was the fact that the US had ‘Canadian Healthcare Envy’.
Coupled (interestingly) with the fact that all major US health associated sectors wanted change, was the Affordable Care Act. Amongst other changes this guaranteed health insurance to all Americans and immigrants, except of course to those on low incomes in the states that vetoed reform. Interesting was the fact that hospital and physician quality reporting and ranking is an integral part of the US reform package.

In addition the primary aim of the new US system is to improve the patient care experience, as well as a lower per capita cost of care and improving the population health. McDonough closed with the thought provoking comments that perhaps Australia can learn from the US move to transparency and accountability in health insurance and financial incentives for outcomes.

At this point at the conference I quickly realised a few things, in addition to noting that Australia’s largest private hospital provider Ramsay were on the speakers’ agenda.* Firstly, people often confuse the HCCA with the CHF (Consumers Health Forum). Secondly, just who thought it was a good idea to put the giant platters of jam donuts at a health conference!! By far and away my biggest anxiety was the fact that I looked like I was the only health care consumer in this crowd of 250 or more. That probably makes sense as the bulk of the sessions on day-one were ‘process technology’ (my terminology). These presentations talked about the benefits of hospital technologies like SmartWard (electronic lanyards for nurses), Lean Thinking (a kind of brain training for managers) and the companies that make the technology (Cerner). In this context we heard about Australia’s first fully integrated digital hospital St Stephens in QLD’s Hervey Bay, where 30 devices manage everything from patient entertainment, dispensing cabinets and enable real-time nurse location. Their mantra is One record, Multiple Users, Multiple Locations. They made it sound a reality but I wondered how the doctors and nurses adapted to these new ways of doing business?

One of the most powerful conference statements came from Dr Mark Britnell who after 20 years in the NHS now heads KPMG’s Global Health Practice. ‘As individuals we wouldn’t fly if the current random control systems at work in healthcare were adopted by the aviation industry.’ Britnell who performed with the ease of a Ricky Gervais at the podium – ‘Hey guys help me out here’ was the message to the audience when one of his questions drew a blank response. ‘Taxi, Britnell’ was the call when he felt he had delivered a particularly witty response to a query. Notwithstanding slickness his message was both confrontational and common sense. He observed that the siren call of power, not the aim of delivering better care for patients, is often the primary motive for regulating healthcare. Britnell’s bruising experience with NHS bureaucrats and UK politics has led him to some tough conclusions, that the healthcare industry must gain control over quality and become obsessed with outcomes and safety.

One of the best speakers had one of the smallest audiences, Dr Bronwyn King from Epworth Hospital talked with modest charm how she took on the local superannuation industry – who were channelling super money into the tobacco industry - and won. This was a great example of a health professional - who as a cancer specialist was appalled that health industry super funds were divested into big tobacco - became a policy activist.
Consumer engagement didn’t focus strongly at the conference with one panel session dedicated to the issue. An interesting angle might have been to look at the incredibly rapid technological developments in patient safety and hospital practice and compare that to the relatively slow emergence of consumer engagement. What is the role of universities, medical associations and hospital bureaucracies in fostering genuine consumer engagement? Nevertheless, Mary Draper from the Health Issues Centre made the call for an ‘equal partnership’ between consumers and clinicians. My observation that despite displaying lip service to patient communication, fundamentally doctors are trained to be intellectually superior was shot down in flames. The Canadian health system, where consumers are fully engaged in governance arrangements, was once again hailed, this time by the Australian Commission for Standards in Quality Healthcare’s Nicola Dunbar. It led me to thinking that while embedded consumer practice is achievable, selling the practice will be a long road. A brilliant question from the floor to ‘bring back the joy’ in healthcare, or in other words more dopamine and less adrenaline had the audience smiling.

There were some wise words to come out the conference final forum including those from Elizabeth Koff from Sydney Children’s Network, that branding and rebranding in the name of reform is a big issue in Australian healthcare. This was a pervasive theme. The influence of political ideology on health policy and the nature of bi‑partisanship were also keenly debated at conversational level, with Medicare Local staff I spoke to exasperated at the turn of recent events. Are consumers the ‘secret weapon’ to break down the barriers one delegate wondered? With that and a sincere tribute by the chair to the long-time efforts of the HCCA’s Russell McGowan, among other health advocates, it was time to dream of a future of a free and fair system deserved of a wealthy county devoid of funk and day to day circumstance and head back to Canberra.

*Ramsay’s secret to effective consumer participation in its 70 hospitals across Australia lies with external providers assessing patient satisfaction.

By Lisa Harris

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