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Issue 39 August 2015
The Hospital Alliance for Research Collaboration
In the news
Stroke: function, mobilisation and readmission
Admission and discharge safety
Hospital-based interventions

Taking a human factors approach to healthcare

Dr Terry Fairbanks

"We don't redesign humans. We redesign the system within which humans work," says Dr Terry Fairbanks, descrbing the human factors approach to healthcare.

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Safe systems: from aviation to healthcare

In this month’s e-Bulletin, we look at how the “human factors” approach adopted by the aviation industry has the potential to change the way the healthcare industry addresses safety issues.

We also meet one of the 2015 HARC scholars, Katinka Moran, from the Bureau of Health Information, who recently travelled to Canada and the UK to investigate how to optimise online reporting of healthcare performance data for wide-ranging audiences.

Our research section features new findings on stroke, including a study that raises questions about early mobilisation of stroke patients. And on the ever-fraught issue of hospital admissions and discharges, we look at an Australian study that shows GPs do not understand many of the abbreviations commonly used in hospital discharge letters.

Please forward this edition of the Bulletin to colleagues who might be interested in joining the HARC network and get in touch with your feedback, or suggestions at:

Megan Howe
Editor, HARC e-Bulletin

A human factors approach to healthcare

Trying to stop human errors happening in healthcare is futile, but hospitals can successfully design safer systems by adopting a human factors approach, international experts told a HARC roundtable this month.

Dr Terry Fairbanks, an emergency physician and human factors specialist from MedStar Health and Georgetown University in the US, and Dr Ken Catchpole, Director of Surgical Safety and Human Factors Research at Cedars-Sinai Medical Centre in LA, joined with local human factors expert Dr Thomas Loveday from the Clinical Excellence Commission (CEC) for the roundtable held at the Sax Institute.

From aviation to healthcare

Dr Fairbanks explained that human factors engineering was an alternative way of addressing safety, adopted broadly by the aviation industry.  Human error was as unavoidable in healthcare as in any other industry, he said, so it was important to design a system that took into account human strengths and weaknesses ‒ or human factors.

“We don’t redesign humans. We redesign the system within which humans work,” Dr Fairbanks said. “The goal isn’t to eliminate human error, but to understand why errors occur and to reduce the chance of that happening or to mitigate the effect.”

Strategies such as policies, training, discipline and vigilance had been shown to have little impact on the rate of errors, because no matter how well-intentioned healthcare professionals were, human error was inevitable, he said.

Instead, he suggested the systems surrounding how doctors and nurses work could be made safer.

He gave the example of a US hospital emergency department that sought to change the way nausea was managed, to ensure the two safest drugs were used.  Using a human factors approach, the five nausea drugs that carried a higher risk of side effects were taken out of the drug dispensing machine. Doctors could still order those five drugs from the hospital pharmacy, but it took longer to access them.

“There was no policy or guideline, but everyone started using the other two drugs,” he said. “Policy is not always the answer.”

Examining technology

Dr Ken Catchpole, a research psychologist and human factors practitioner, said healthcare was about 30 years behind the aviation industry in adopting the human factors approach to reducing error, but “it’s started”.

There were a number of dimensions to achieving a behavioural change, he said, including simple steps such as looking at whether the order in which people did things was effective. He cited the example of automatic teller machines, which do not dispense cash until the user has retrieved their card, reducing the risk of the card being left behind.

Technology could also enable or disable people’s ability to do their jobs. For example, some pieces of medical equipment had on/off buttons located in a spot where it was easy to accidentally switch them off, risking a patient’s life. 

The organisation and environmental levels also needed to be evaluated, often resulting in changes like marking an area on the floor that needs to remain clear to enable safe patient flow, Dr Catchpole suggested.

“Changes to one, or all of those dimensions, can make a big difference,” he said.

User-centred design

Dr Thomas Loveday, a human factors engineer and psychologist, joined the CEC just over a year ago in the wake of research conducted by HARC scholar Bronwyn Shumack into human factors and their impact on healthcare.

He said the design of new e-health systems was among the areas he was focusing on, along with user-centred design of medical equipment and diagnostic error and system factors as contributors to sub-optimal decision-making in healthcare.

“We want to support Local Health Districts and help them to work better and safer,” he said.

Dr Loveday said he was also applying a human factors approach to reducing the incidence of worker injury in the health system.

Register now for next HARC Forum: Professor Nicholas Mays talks evaluating integrated care strategies

Next month, Professor Nicholas Mays, a leading thinker in the use of research to inform policy, will lead a HARC Forum on evaluation of integrated care strategies. Professor Mays directs the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine and has held senior roles in both government departments and academia. He also co-edits the Journal of Health Services Research & Policy and has extensive experience in evaluating government policies and programs.

See our events section below for details

HARC gains two new partners

NSW Kids and Families and Cancer Institute NSW have become the latest health agencies to partner in the Hospital Alliance for Research Collaboration (HARC), further broadening the Collaboration’s base as it aims to drive innovative thinking about current and emerging challenges in healthcare delivery.

They join the Sax Institute, the Clinical Excellence Commission (CEC), the Agency for Clinical Innovation (ACI) and the Bureau of Health Information (BHI) to make up a strong partnership of six agencies committed to HARC’s goal of increasing the use of research in healthcare.

Building networks

NSW Kids and Families Chief Executive Joanna Holt said “As a young organisation, NSW Kids and Families is looking forward to being part of the Hospital Alliance for Research Collaboration as it provides an opportunity for us to collaborate on research endeavours across the system, building networks and drawing on the external knowledge expertise from across the globe. It’s also an opportunity for raising the profile of the work that NSW Kids and Families is currently undertaking in research, policy development and paediatric and maternity services capability for NSW Health.”

Ms Holt said HARC would enable NSW Kids and Families staff to access validated and evidence-based research and information in the development of policies and guidelines for NSW Health. In addition, there would be visibility to some of the hot topics and exposure to high-profile experts, such as the presentation by Dan Wellings, Head of Insight and Feedback at NHS England, at the HARC Forum on Patient Reported Outcome Measures in April this year. 

“I’m particularly keen to pursue the opportunities for NSW Kids and Families staff through the HARC Scholarships scheme to facilitate the exchange of ideas between different health systems. This will enrich our growing knowledge base and understanding of how NSW Kids and Families can improve the policy and research agenda across NSW Health to benefit mothers, babies, children, young people and families,” Ms Holt said.

Delivering news

Chief Cancer Officer and Chief Executive Officer of the Cancer Institute NSW, Professor David Currow said: “The Cancer Institute NSW is proud to partner with the Sax Institute for the HARC e-bulletin. We look forward to sharing the latest news on cancer care and treatment with practitioners, managers and administrators in health services and hospitals across NSW and Australia.”

The HARC network links close to 5000 researchers, health managers, clinicians and policy makers so they can share ideas.  As well as publishing the monthly HARC e-Bulletin, it hosts regular forums and workshops with leading local and international health experts.

Green light for Medical Research Future Fund

The Government has been given the green light to establish its flagship $20 billion medical research body, the Medical Research Future Fund (MRFF), after legislation to establish the fund was passed by Parliament.

The legislation passed after several amendments were negotiated between the Greens and the Government. They included a change to the definition of medical innovation to broaden it beyond “treatments”, the publication of all funding decisions on a website and a review of the Fund Act to occur in 2023 to ensure that the Fund hadn’t been used to offset reductions in other Government funding for health and medical research.

The Government said the Fund would provide “stability and predictability in funding for medical research and innovation for the future”.

In a joint statement, the treasurer and health and finance ministers said the Fund would receive an initial contribution of $1 billion from the uncommitted balance of the previous Labor government’s health and hospitals fund.

The remaining contributions will come from budget savings in health that have passed or will pass the parliament, with the first $10m to be distributed this budget year.

The Fund will be administered by an independent expert advisory board, on which the CEO of the NHMRC will have a permanent seat.

Research Australia gave its support to the Fund. In a statement, it said the MRFF “opens the door to a new and innovative stream of funding for medical research and innovation which will provide enormous benefits for Australia in the years to come”.


Stroke linked to accelerated decline in cognition

Stroke survivors experience declines in cognitive function both acutely and over the long term, says a US study that suggests survivors should be monitored for cognitive impairment in the years after a stroke. Researchers studied cognitive changes in 23,572 stroke survivors without baseline cognitive impairment over six years.

Stroke survivors had faster declines in global cognition compared with those without stroke, and compared with their pre-stroke rate of decline  
Increased mortality, morbidity and costs 

Stroke was associated with a decline in global cognition, new learning and verbal memory, they found. Stroke survivors had faster declines in global cognition compared with those without stroke, and compared with their pre-stroke rate of decline, according to findings in JAMA.

The authors said the decline in global cognition and executive function significantly increased the risks of mortality, dementia, depression and accelerated functional decline, which in turn was associated with patients being institutionalised and extra burden on caregivers.

The finding had implications for clinical practice, research and healthcare policy, they wrote. They suggested cognitive assessments be performed before stroke patients were discharged from hospital and in post-acute settings. Long-term monitoring of survivors’ cognitive function was also warranted.

“As adults increasingly survive stroke, cases of post-stroke cognitive impairment will multiply,” the authors said. “Given that post-stroke cognitive impairment increases mortality, morbidity and health care costs, health systems and payers will need to develop cost-effective systems of care that will best manage the long-term needs and cognitive problems of this increasing and vulnerable stroke survivor population.”

Levine DA, Galecki AT, Langa KM, Unverzagt FW, Kabeto MU, et al. Trajectory of Cognitive Decline After Incident Stroke. JAMA. 2015;314(1):41‒51.


Study urges rethink on early mobilisation after stroke

The practice of getting patients out of bed and mobilised as soon as possible after acute stroke has been thrown into doubt by a study that finds early mobilisation may actually reduce patients’ chances of a favourable outcome.

Early mobilisation – comprising out-of-bed sitting, standing and walking ‒ was thought to contribute to stroke care and recovery and was recommended by many guidelines, the researchers said.

In the AVERT study, 2104 patients were randomised to receive either very early mobilisation or usual care within 24 hours of onset of acute stroke.

In findings that surprised the researchers, fewer patients in the early mobilisation group (median time to mobilisation 18 hours after stroke onset) had a favourable outcome after three months than those in usual care (median time to mobilisation 22 hours after stroke onset).

Patients in the early mobilisation group had a 27% reduced chance of a good overall functional outcome at three months, as measured by the Rankin Scale that rates level of disability, according to findings in The Lancet.

The authors said future research priorities included looking at who responds to post-stroke treatment, who doesn’t and why.
And they said the findings should prompt a rethink of many guidelines on post-stroke care.

The Avert Trial Collaboration Group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015;386:46‒55.


Data reveals stroke readmission risks

A picture has emerged of which patients are most likely to be readmitted to hospital within a year of having a stroke or transient ischaemic attack (TIA), after researchers linked data from the Australian Stroke Clinical Registry (AuSCR) and hospital databases.

Previous estimates of the frequency of readmission to hospital within the first year of stroke onset varied widely from 13% to 62%, the researchers said. They used linked data from the AuSCR at one Victorian hospital and datasets for admissions and emergency presentations in Victorian patients over an 18-month period to analyse the Australian readmission rate.

Data were successfully linked for 782 of 788 patients registered with AuSCR. Within one year of their stroke or TIA, the study found that 42% of patients were readmitted, 12% of whom went back to hospital due to stroke.

Patients who had initially had a TIA had twice the risk of being readmitted within one year, compared with patients with stroke, the study showed.

Findings in the MJA also revealed that patients were significantly more likely to be readmitted if they had presented to an emergency department two or more times before the index event, and if they had a high level of co-morbidities.

The researchers said the study showed that data linkage between the AuSCR and routine hospital datasets was feasible, and that it could identify determinants of hospital readmission for patients who had stroke or TIA.

Meanwhile, an editorial in the MJA suggested that promising recent findings on neurointervention to treat ischaemic stroke ‒ involving using advanced imaging to identify patients who were most likely to benefit from endovascular reperfusion ‒ were set to drive a revolution in stroke care.

The authors said the challenge was working out how to redesign Australian stroke services and how best to build capacity in the neurointerventional workforce.

Kilkenny MF, Dewey HM, Sundararajan V, Andrew N, Lannin N. Readmissions after stroke: linked data from the Australian Stroke Clinical Registry and hospital databases. Med J Aust 2015; 203(2):102‒6.

Lindley RI, Levi CR. The spectacular recent trials of urgent neurointervention for acute stroke: fuel for a revolution. Med J Aust 2015;203(2):58‒60.


GPs in the dark on abbreviations used in discharge letters

GPs do not understand many of the abbreviations commonly used in hospital discharge letters, according to an Australian study that calls for urgent strategies to clear up discharge letter miscommunication.

Researchers audited the use of abbreviations in 200 electronic discharge letters from Nepean Hospital in western Sydney to identify the 15 most commonly used abbreviations plus five less frequently used but clinically important abbreviations. They then surveyed 132 local GPs to determine their understanding of the abbreviations. 

Findings in the MJA showed that the following six abbreviations were misinterpreted by more than a quarter of GPs:

• SNP: soft non-tender ‒ interpreted incorrectly by 47% of GPs
• TTE: transthoracic echocardiogram ‒interpreted incorrectly by 33.3% of GPs
• EST: exercise stress test ‒ interpreted incorrectly by 33.3% of GPs
• NKDA: no known drug allergies ‒ interpreted incorrectly by 32.6% of GPs
• CTPA: computed tomography pulmonary angiogram ‒ interpreted incorrectly by 31.1%      of GPs
• ORIF: open reduction and internal fixation ‒ interpreted incorrectly by 28% of GPs

Misinterpretation of abbreviations by GPs could result in duplication of investigations or them failing to institute treatment based on investigation results or failing to follow up with recommended management, the authors warned.

One potential solution was to ban the use of abbreviations in electronic discharge letters, but that was impractical, they concluded.

Other solutions included creating a list of approved medical abbreviations for use in discharge letters and providing GPs with that list, or using medical software to auto-complete mutually exclusive abbreviations.

Chemali M, Hibbert EJ, Sheen A. General practitioner understanding of abbreviations used in hospital discharge letters. Med J Aust. 2015;203(3):147.


Weekend effect a “systematic phenomenon”

The heightened risk of death after admission to a hospital at the weekend ‒or “weekend effect” ‒ is a systematic phenomenon, according to a study which found it occurred across several developed countries’ healthcare systems.


Risk of dying within 30 days after an emergency admission was between 8-20% higher if admitted at the weekend in three of the four countries  
Impact on emergency admissions

The researchers used international data from the Global Comparators project to study almost 3 million admissions from 28 metropolitan teaching hospitals in Australia, England, the US and The Netherlands.

Findings in BMJ Quality and Safety showed that patients’ risk of dying within 30 days after an emergency admission was between 8% and 20% higher if they were admitted at the weekend in three of the four countries. While the Australian data showed no significant daily variation in the heightened risk of 30-day death for emergency admissions, it found patients admitted on a weekend had significantly higher odds of death seven days after emergency admission.

Patients who had elective surgery on a Friday, Saturday or Sunday had a higher risk of 30-day death compared with a Monday procedure, with Australian patients who had surgery on a Sunday facing twice the risk of 30-day death compared with those who had Monday surgery.

While the researchers cautioned that the findings were limited to a small number of hospitals, they said they suggested the ‘day-of-the-week’ effect was a systematic phenomenon affecting hospitals across international borders.

They surmised the weekend effect could be associated with reduced access to test results and diagnostics on weekends or perhaps to there being fewer and less experienced staff on weekends, but they urged further research into the factors behind the phenomenon.

The study was published as the UK NHS launched a controversial drive towards providing seven-day healthcare services. In an article on The Conversation,  Peter Silvey of LaTrobe University warned that evidence from overseas suggested forcing hospitals to provide all services equally distributed through the week was not the answer, with seven-day services coming at a high cost in relation to any health benefit.

Ruiz M, Bottle A, Aylin PP. The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week. BMJ Qual Saf. 2015;24(8):492‒504.


Weekend discharge after major surgery doesn’t increase risk of readmission

While research shows that patients experience worse outcomes if they are admitted to hospital or have surgery on a weekend, those who are discharged on a Saturday or Sunday after major surgery do not have  an increased risk of readmission, a new study shows.

Researchers studied the “weekend-effect” on 30- and 90-day readmission rates among 128,057 Californian patients who had undergone abdominal aortic aneurysm (AAA) repair, colectomy, total hip arthroplasty and pancreatectomy. Overall, 23% of patients were discharged on a weekend.

Patients discharged on a weekend had shorter lengths of stay and were less often discharged to a skilled nursing facility than those discharged during the week.

However, hospital readmission rates were similar for those discharged on a weekend compared to those discharged on weekdays after AAA repair and pancreatectomy, and weekend discharge was associated with a lower 30-day readmission rate for patients undergoing colectomy and hip replacement.

“Contrary to our hypothesis, weekend discharge was not associated with an increased risk for hospital admission,” the authors wrote in JAMA Surgery.

They noted that a significant percentage of patients who were readmitted went to a different hospital than the discharging hospital.

The study concluded that hospitals with adequate staffing, appropriate coordination of care protocols and discharge systems in place could consider discharging postoperative patients on a weekend without concern that they would have a higher risk of being readmitted.

Cloyd JM, Chen J, Ma Y, Rhoads KF. Association between weekend discharge and hospital readmission rates following major surgery. JAMA Surg. [Internet] 2015. Epub 3 June 2015. DOI:10.1001/jamasurg.2015.1087


Increasing intensive care throughput

Simple changes to intensive care unit (ICU) processes for triaging and transferring patients can improve throughput without adversely affecting clinical outcomes, a study shows.

The researchers used process improvement methodology in an ICU which had 53 beds spread across four geographic locations in a 1400-bed tertiary care hospital.

A multidisciplinary working group of staff including ICU physicians, nurses, medical operations, transport administration, unit secretaries and chief internal medicine residents was tasked with creating a more efficient throughput process.

Changes they instituted included giving the ICU team the ultimate triaging authority for transferring patients, assigning patients moving out of ICU to any hospital bed if a bed on the respective services’ ward wasn’t immediately available, identifying patients suitable for transfer by 9am and giving the ICU team responsibility for writing transfer orders once a ward bed was assigned.

The findings, in the American Journal of Medical Quality, showed that the new processes reduced wait times for admissions, optimised the discharge of patients and reduced patients’ length of stay in both the ICU and the hospital.

The study estimated that the new processes saved an average of $US1947 per ICU admission, and the faster patient throughput translated into 157 additional admissions per year.

There was no increase in mortality or readmissions to the ICU.

“Though these processes might not apply to every hospital, this study has shown that interventions that decrease capacity can affect ICU LOS ([length of stay] and allow for the treatment of more critically ill patients,” the authors wrote.

Reddy AJ, Pappas R, Suri S, Whinney C, Yerian L, Guzman JA. Impact of Throughput Optimization on Intensive Care Unit Occupancy. Am J Med Qual. 2015;30(4):317‒22.


Measures to halt spread of C. difficile fall short

A range of hospital-based strategies aimed at preventing the spread of the gastrointestinal infection Clostridium difficile are falling short, a new study finds, with patient-level factors found to be more significant.

C. difficile is the most common cause of healthcare-acquired infection, the Canadian researchers said, yet the real-world impacts of some of the prevention processes used by hospitals were unknown.

They analysed data on 650,000 patients admitted to Ontario’s 159 acute care hospitals over a year. C. difficile infection complicated 2341 admissions, and the hospitals’ implementation of prevention practices varied, they found.

The strategy of isolating all patients at onset of diarrhoea was adopted by 27% of hospitals, auditing of antibiotic stewardship compliance by 16%, auditing of cleaning practices by 72%, on-site diagnostic testing by 47%, use of vancomycin as first-line treatment by 15% and reporting infection rates to senior management by 33%, according to findings in BMJ Quality and Safety.

However, none of the prevention strategies were associated with significant reductions in the rate of C. difficile after adjustment for baseline infection rates.

The authors said patient characteristics, such as age, comorbidities and the patient’s type of admission (non-elective and medical admission) were the factors most strongly associated with the risk of acquiring the infection.

The researchers said the findings highlighted the need to better implement C. difficle prevention practices, as well as to assess the system-wide benefits of currently-used prevention processes. Research was needed to uncover other innovative ways of halting the spread of the infection, they added.

Daneman N, Guttmann, A, Wang X, Ma X, Gibson D, et al. The association of hospital prevention processes and patient risk factors with risk of Clostridium difficile infection: a population-based cohort study. BMJ Qual Saf 2015;24:435‒43


Coordinated care may not be the answer

A hospital-based coordinated care program for patients with chronic illness does not improve the quality of their life or reduce unplanned hospitalisations, despite it resulting in patients using almost twice as many community health services, an Australian study finds. In the study, 500 patients with chronic illness presenting to the emergency service at Nepean Hospital in Western Sydney were randomised to either standard care or to the Care Navigation (CN) program.

Patients in the intervention group received almost twice as many community health services as those receiving standard care, mostly as a result of referrals from hospital, but there was no difference in their outcomes  
Unplanned hospitalisations unchanged

Under the program, specialised nurses assessed the patients’ current health status and risk of readmission and directed them to the best method of care in the hospital or community. They also monitored the progress of the patients’ care in hospital and assessed their need for out-of-hospital care facilities, making   arrangements for the patients’ care after discharge.

Despite a growing body of evidence that the integration of patient care across primary, secondary and acute care could improve outcomes for people with chronic illness, the Care Navigation process failed to either improve the patients’ quality of life or reduce unplanned hospital presentations or admissions, according to findings in the MJA.

Patients in the intervention group received almost twice as many community health services (mainly nursing services) as those receiving standard care, mostly as a result of referrals from hospital, but there was no difference in their outcomes.

The researchers said that CN was an attempt to organise better coordination of the care for patients with chronic illness from a hospital base, but despite the patients receiving more community services, it was found to be no more effective than existing processes of care on any of the outcomes studied.

They concluded: “Future service development should explore potential benefits of linking navigated intrahospital care to ongoing, proactive care planning and delivery in the community.”

Plant NA, Kelly PJ, Leeder SR, D'Souza M, Mallitt KA, Usherwood T, et al. Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial. Med J Aust. 2015;203(1):33‒8.


Reforming primary care

Patients with chronic conditions could be enrolled with a single healthcare provider who would co-ordinate their care under one of the options canvassed in a discussion paper from the Federal Government’s Primary Health Care Advisory Group. The discussion paper, released by Federal Health Minister Sussan Ley, puts forward the options of establishing set chronic disease payments for a defined package of care and pay-for-performance incentives. 

Download report

Troubling findings on teens’ mental health

A landmark report into youth mental health in Australia released by Federal Health Minister Sussan Ley found that one in seven children or young people experienced a mental health disorder in the previous 12 months, and one in 10 teenagers had engaged in some form of self-harm in their life. The report was based on a survey of more than 6300 families and youths aged 4−17 years,

Download report

Delving into the discharge process

The "Safely home" report from the UK consumer health advocacy group Healthwatch England details the findings of an inquiry into the hospital discharge process, based on interviews with more than 3000 patients. It focuses on the human cost of poor experiences of the discharge process and five key reasons for poor discharge planning are identified: lack of co-ordination between services; patients feeling stigmatised; patients feeling unsupported after discharge; lack of patient involvement; and lack of understanding of individual needs.

Download report

Improvement in Indigenous cardiac mortality rates

There have been some improvements in cardiac care and mortality rates from cardiac conditions for Aboriginal and Torres Strait Islander people, according to this report from the Australian Institute of Health and Welfare (AIHW). The death rate from cardiac conditions for Indigenous Australians decreased by 41% between 1998 and 2012. However, Aboriginal and Torres Strait Islander people continue to have higher rates of cardiac conditions and poorer access to health services to prevent and treat these conditions.

Download report

How does health spending in Australia compare?

The OECD Health Statistics 2015 report gives a snapshot of the latest figures on how Australian health spending compares to that in other OECD countries.The latest data shows that per capita health spending in Australia increased by 2.9% in 2012/13, compared to growth of less than 1% on average across the OECD.

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Nursing workforce on the rise

The total number of nurses and midwives registered in Australia rose by almost 7% between 2011 and 2014, but not all are finding work in their field, according to new data released by the Australian Institute of Health and Welfare. More than 9000 registered nurses and midwives were looking for work in the field, up from 8200 in 2013 and 4500 in 2011.

Download report

Bronwyn Shumack  

Katinka Moran

HARC Scholar

Bureau of Health Information

Data on the performance of health services is increasingly being reported online both in Australia and internationally ‒ and Katinka Moran wants to know the best way to ensure that information on such sites is useful and accessible.

The senior health services researcher with the Bureau of Health Information (BHI) was recently awarded a HARC scholarship to investigate how to optimise online reporting of healthcare performance data for heterogenous audiences.

Mrs Moran, who has a masters degree in psychology, has worked in roles focusing on qualitative and survey research for about 15 years, and moved into the healthcare arena a few years ago.

“Healthcare is an area that has a more human focus than other areas of research I've worked in and it is an area where you can actually see the outcomes and where research is actually applied,” she says.

Developing a performance data portal

She joined BHI in 2014, and was involved with the launch of the Healthcare Observer portal through which users can explore and analyse data about the performance of the NSW healthcare system, including data from the Hospital Quarterly report and NSW Patient Survey Program.

She says the work on the portal, which launched in March 2014, prompted her to apply for the scholarship so she could learn more about the approaches being taken by other jurisdictions that have longer histories of reporting their health performance data online.

“There is a lot of potential to develop Healthcare Observer and the scholarship allowed BHI to engage with organisations in other countries to take a closer look at the tools they are using and the plans they have for the future,” she says.”

The international experience

The scholarship took her to Canada and the UK  in June where she visited organisations including the Canadian Institute of Healthcare Information, the NHS consumer website NHS Choices, the UK Care Quality Commission, Nuffield Trust and Dr Foster, a company that works with healthcare agencies to monitor and benchmark performance.

She says there was no “one-size-fits-all” approach to disseminating healthcare data online, with each organisation approaching the task differently. However, she returned with several key learnings that she hopes will help guide BHI’s future delivery of online healthcare performance data.

To maximise functionality of websites, agencies had a major commitment to stakeholder engagement, with processes in place to ask users what they wanted to see on the websites and how they wanted to see it, she says.

She also discovered that healthcare data websites “can’t be all things to all people”.

“Consumer sites needed to be different from healthcare provider sites,” she says, adding that while consumers wanted data to be interpretable, healthcare users sought credibility and applicability.

Mrs Moran says online reporting is not enough on its own. 

“You need to be mindful of the variation in the resources and ability of healthcare providers to interpret and use the data,” she says.

And she now has another area to add to a list of future research topics, after discovering there is a “dearth of knowledge” about how people are actually using healthcare performance data portals.

“More needs to be done on understating how people use these sites,” she says.

HARC Forum: Evaluating Integrated Care Strategies

The keynote speaker at this HARC forum is Professor Nicholas Mays, Director of the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine, and co-editor of the Journal of Health Services Research & Policy. Professor Mays, a leading thinker in the use of research to inform policy, will join a panel of experts to discuss initiatives and challenges in evaluating integrated care programs from a local perspective.

Please note: The event is free but registration is essential. Register here via the Read More link.

16 September, Sydney
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Patient-Centred Medical Home - Solution Design and Priorities Workshop
3 September, Sydney
Read more

This one-day workshop hosted by ACI in partnership with Wentwest Primary Health Network and supported by NSW PHN Chief Executives, focuses on the Patient-Centred Medical Home. The workshop program comprises morning presentation sessions from experts and key practitioners in NSW, and interactive afternoon workshop activities allowing participants to review and comment on PCMH project plans, discuss change concepts and provide feedback on local initiatives and implementation priorities.

National Dementia Research & Knowledge Translation Forum 2015

This is the ninth forum organised by the Dementia Collaborative Research Centres, to be held at the Wesley Conference Centre and has the theme:  “Science and Practice – The Big Questions”. The focus of day one is “Knowledge Generators: What are the latest dementia research findings? The focus on day two  is “Knowledge Users: how is dementia research informing practice and policy?”

7‒8 September, Sydney
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Intellectual Disability Health Network Annual Forum
10 September, Sydney
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This half-day forum hosted by the Agency for Clinical Innovation, NSW gives an update on the work of the Intellectual Disability Network which aims to improve the care and health of people with intellectual disability by providing clinical leadership, research and education to enhance the capacity of primary and secondary health services.

Innovations in Cancer Treatment and Care Conference

This is an annual, free event hosted by the Cancer Institute NSW, to provide health professionals with an opportunity to hear, collaborate and share the latest innovations in quality cancer treatment and care. The keynote address will be delivered by Professor Thomas Feeley, an esteemed US academic and doctor of medicine whose areas of interest include health care quality, value creation and cancer care innovation.

15 October, Sydney
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4th Annual NHMRC Symposium on Research Translation jointly with CIPHER
27‒28 October, Sydney
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This year’s NHMRC Research Translation Faculty Symposium will be held in collaboration with CIPHER – the Centre for Informing Policy in Health with Evidence from Research. The goal of the Symposium is to create more effective working relationships between health and medical researchers.

NSW Respiratory Clinical Innovations Forum 2015

This forum, hosted by the Agency for Clinical Innovation will target multidisciplinary clinicians and managers involved in the delivery of care to adults or children with respiratory disease across acute, subacute, community and primary care settings. NSW clinicians, managers and researchers will showcase their work across the themes of delivering evidence-based care, integrated care and effective partnerships, patient-centred outcomes and solutions to address local needs.

27 November, Sydney
Read more
9th Health Services and Policy Research Conference
7‒9 December, Melbourne
Read more

The Health Services Research Association of Australia and New Zealand (HSRAANZ) biennial conference at the Melbourne Convention and Exhibition Centre has the theme: “From data to delivery: Connecting research, policy and practice for better health outcomes” and will focus on the interface between research, practice and policy, with the ultimate aim of using research to improve health outcomes for society.
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