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Issue 42, November 2015
The Hospital Alliance for Research Collaboration
In the news
On the medical record
In the operating theatre
Cancer care challenges

A frontline perspective

CEC Chief Executive Carrie Marr

The Clinical Excellence Commission's new chief executive Carrie Marr hopes she never stops seeing the world through the eyes of a clinician.

read more

Medical records in the spotlight

In this month’s e-Bulletin, we focus on medical records ‒ an ever-changing but vital element of the healthcare system. One study finds that what patients say about their hospital experience on Twitter may well be an untapped indicator of hospital quality, while another raises questions about whether electronic medical records can prevent medication errors.

We also outline some of the latest research on cancer care, including research that suggests targeted programs of screening, vaccination and smoking cessation are needed to address cancer risks in Indigenous populations in developed countries including Australia.

In our profile article, we meet the Clinical Excellence Commission’s new Chief Executive Carrie Marr, who started her career as a nurse and maintains her frontline perspective on healthcare.

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

Where research and politics meet

Research evidence alone is not enough to influence health policy, according to the head of influential UK health think tank, The Kings Fund.

Rather, the “contact sport” of evidence-based policy making required strong relationships between researchers and policy makers, extensive communication and timely research, said Kings Fund Chief Executive Professor Chris Ham.

Professor Ham, who recently took part in a recent HARC roundtable meeting, also outlined some of the Fund’s strategies to promote the use of research evidence in policy in his address to the NHMRC Symposium on Research Translation, held jointly with CIPHER.

“In private we meet politicians and senior public officials on a regular basis – much of what we do could perhaps be described as a “contact sport”,’ he said. “We have good access to government but the nature of that relationship varies depending on people and personalities – not politics. 

“It’s not always an easy relationship. We have to tread carefully to manage our relationship with government, experts and stakeholders, especially when our findings challenge the assumptions of the ministers or departments.”

However, he said The Kings Fund’s value lay in it being able to “speak truth to power”‒ from a position of independence, while remaining close to policy makers.

Professor Ham said policy making was a process, not an event, and research was the accumulation of different kinds of evidence and not a product.

“Evidence has to be available ‘just in time’ when a policy window opens up in government, and not when researchers choose. We need the ability to work flexibly, but also to honor the rigor of the quality of evidence. On some issues, we have to acknowledge that research evidence is contested, or may simply be lacking,” he said.

However, he said policy making was not a scientific process and, at and its core, was driven by politics.

“Much of our work is not directed at achieving specific changes in policy, but is more about ‘sense-making’ or shaping the terms of public debate about health policy. We can influence the agenda under discussion and the way in which current issues are defined and understood,” he said.

“While policy making is more of a minestrone soup, and not a linear process, translators and knowledge brokers can help to connect the worlds of policy makers and researchers and to help shape health policy.”

Five-year strategy to tackle diabetes released

A new national strategy to tackle diabetes outlines seven goals for action that are aimed at improving the prevention, care and management of diabetes to the end of the decade.

Federal Health Minister Sussan Ley said diabetes was emerging as a major chronic illness for patients – and threat to the health of the economy – in Australia.

She said the emphasis of the strategy, which covers 2016‒2020, was on prevention, early diagnosis, intervention, management and treatment, centred on the role of primary care.

An implementation plan would now be developed for each of the seven goals:

  1. Prevent people developing type 2 diabetes
  2. Promote awareness and earlier detection of type 1 and type 2 diabetes
  3. Reduce the occurrence of diabetes-related complications and improve quality of life among people with diabetes
  4. Reduce the impact of pre-existing and gestational diabetes in pregnancy
  5. Reduce the impact of diabetes among Aboriginal and Torres Strait Islander peoples
  6. Reduce the impact of diabetes among other priority groups
  7. Strengthen prevention and care through research, evidence and data

Diabetes Australia welcomed the release of the strategy, describing it as a “once in a decade opportunity to strengthen the fight against the nation’s biggest health threat”.

“We have strong evidence about what works in terms of preventing people developing type 2 diabetes, and preventing the complications of diabetes – we now need to scale up the fight and focus more minds and more money in prevention,” said Diabetes Australia President Judi Moylan, who Co-Chaired the National Diabetes Strategy Advisory Group, which presented its advice to the Minister to inform the new strategy.

One in three cancers in Australia preventable

One in three cancers diagnosed in Australia each year could be prevented by addressing lifestyle factors  such as such as smoking, sun exposure, inadequate diet and obesity, new research into the burden of preventable cancers has revealed.

Up to 37,000 cancers could be prevented each year if the population avoided exposure to 13 common factors known or strongly suspected to cause cancer, according to a series of research papers commissioned by the Cancer Council Australia.

The research, conducted by QIMR Berghofer Medical Research Institute and published in the Australian and New Zealand Journal of Public Health, showed that the leading preventable factors associated with cancer diagnoses were tobacco smoke, which accounted for 13.4% of all cancers, solar radiation (6.2%), inadequate diet (6.1%) and overweight/obesity (3.4%).  Together with alcohol, those factors caused around 90% of preventable cancers.

Cancer Council Australia CEO, Professor Sanchia Aranda, said the findings showed the importance of research and evidence to inform public policy and individual choice.

“This is the most comprehensive study of its kind ever published in Australia and it provides clear guidance on cutting your cancer risk. It should help motivate all Australians to take simple steps towards a healthier lifestyle."

Picture of e-cigarette use emerges

Use of e-cigarettes in NSW is relatively low compared with countries such as the US and the UK, according to some of the first state data to emerge on the use of the controversial devices.

Findings from the 2014 New South Wales Population Health Survey of 12,502 adults showed that the 1.3% were currently use e-cigarettes, while an 8.4% of the population have tried an e-cigarette, according to a report in the MJA.

Current smokers were 7.5 times more likely to be current e-cigarette users than those who don’t smoke tobacco cigarettes, and those aged 18‒44 years were the more likely to have tried an e-cigarette than older people.

The findings would form a baseline from which future changes in e-cigarette use could be measured in the general population, the report stated.

The report was published as the ACT Government pledged to ban the sale of e-cigarettes to minors and place restrictions on their promotion, bringing the Territory into line with restrictions already introduced in NSW and Queensland.

ACT Minister for Health Simon Corbell said proposed legislation would also ban the use of e-cigarettes in smoke-free areas.

“While the risks and benefits of e-cigarettes are not fully known, the potential harms to public health warrant a precautionary approach,” he said.


Social media’s untapped potential in measuring health

Monitoring what patients say on Twitter can provide useful, real-time data about patient experiences, according to a US study which suggests tweets are a potentially untapped indicator of hospital quality.

The researchers found that about half (2349) of US hospitals had Twitter accounts, and they identified 404,065 tweets directed towards those hospitals over a one year period. 

The findings suggest that Twitter is a unique platform to engage with patients to collect potentially untapped feedback ‒ and possibly a useful measure for supplementing traditional approaches of assessing and improving quality of care.  
Positive and negative sentiment

Of those, 91% were original tweets and, using an automated process, they classified 34,725 as relating to patient experiences.

Tweets about hospital food, waiting times for treatment, staff communication and medication issues were among those revealed in the study.  Examples of patient tweets included:

  • Pain management:  “[hospital] pediatric ER sucks! No doctors to assist, nurses in the back having coffee while there is a sick child in pain in empty ER”
  • Medication instructions: “[hospital] gave my mom a prescription for a discontinued medicine. #Silly hospital. @Walgreens saved the day!”
  • Cafeteria food: “skipped dinner last night because of your terrible cafeteria food. Are you trying to get more patients? #eathealthy #healthcare”
  • General satisfaction: “I'm thankful for the [hospital], their staff, my Doctors and to be treated as a person, not just a patient.”

Sentiment towards hospitals in tweets was, on average, positive, according to findings in BMJ Quality and Safety. However, tweets on some topics, such as discussion of time, money or pain, were unsurprisingly negative, the authors said.

The study found tweets were generally not associated with the quality of hospital care as indicated by other measures of hospital quality.

While the number of positive or negative tweets on any topic at any one time might not be a useful measure, they suggested hospitals could monitor topics over time in order to detect when patient sentiment went above or below an established baseline.

“The findings suggest that Twitter is a unique platform to engage with patients to collect potentially untapped feedback ‒ and possibly a useful measure for supplementing traditional approaches of assessing and improving quality of care,” the authors wrote.

Meanwhile, a separate study found that many patients were willing to share and link their social media data with electronic medical record data. The study of 1432 Twitter and/or Facebook users found that 71% consented to share their social media data for the purposes of comparing it with their electronic medical record (EMR).

“This finding suggests that social media is a rich and promising avenue for exploring how patients conceptualise and communicate about specific health issues,” they wrote in BMJ Quality and Safety.

Hawkins JB, Brownstein JS, Tuli G, Runels T, Broecker K, et al. Measuring patient-perceived quality of care in US hospitals using Twitter. BMJ Qual Saf 2015 [Internet]doi:10.1136/bmjqs-2015-004309

Padrez KA, Ungar L, Schwartz HA, Smith RJ, Hill S, et al. Linking social media and medical record data: a study of adults presenting ot an academic, urban emergency department.  BMJ Qual Saf 2015: [Internet] doi:10.1136/bmjqs-2015-004489


“Meaningful use” of electronic records not linked to quality of care

Doctors who achieve a higher standard of “meaningful use” of electronic health records do not provide a higher quality of care to their patients than those who don’t meet the standard, a US study shows.

The two-year study involved 514 primary care physicians in New York State. Researchers analysed the quality of care provided by those doctors who achieved a measure set by the US Government for meaningful use (MU) of electronic health records ‒ known as 1 MU ‒ compared with the care provided by those doctors who did not achieve that standard.

The quality of ambulatory care was assessed using measures including eye visits, HbA1c testing, LDL testing and nephropathy screening patients with diabetes; screening of patients for breast cancer, colorectal cancer and Chlamydia; appropriate medications for patients with asthma and appropriate testing for children with pharyngitis.

The study found that 44% of physicians achieved MU and 56% did not ‒ but there was no difference in the quality of ambulatory care provided between the two groups, according to findings in the American Journal of Medical Quality.

The authors said more advanced stages of the MU process were designed to enable advanced clinical processes and improve outcomes, so quality differences may emerge further down the track.

However, they said the study highlighted the need for further follow-up to assess the full effects of the nation’s electronic health record strategy.

“Although it may seem intuitive that EHRs [electronic health records] and MU would improve quality, it is still important to measure whether the MU program achieves its intended goals,” they wrote.

Kern LM, Edwards A, Kaushal R, with the HITEC investigators. The meaningful use of Electronic health records and health care quality. American Journal of Medical Quality 2015;30:512‒19.


Medication errors rife despite electronic records: study

Electronic medical records that are accessible across healthcare levels fail to prevent medication errors, according to a study that found high rates of medication discrepancies upon patients’ admission and discharge from hospital.

The study, involving 814 largely elderly patients who were admitted to a regional hospital in Spain, involved clinical pharmacists conducting a medical reconciliation process at admission and discharge to ensure patients received all essential drugs at correct dosage regimens.

They found that 64.5% of patients had at least one error in their medication when admitted to hospital, with the omission of a necessary drug the most frequent problem. Upon discharge, medication discrepancies were identified in 32.4% of patients.

“This suggests that the early detection and correction of discrepancies at admission reduces the likelihood of these errors being repeated at discharge,” the authors wrote in the International Journal of Clinical Practice

The potential clinical impact of the discrepancies was classified as moderate or severe in 39% of the discrepancies at admission, and in just over half of those at discharge, they found.

While a single electronic clinical record system detailing patients’ prescribed medications had been proposed as an essential way of avoiding medication errors, the authors said it appeared the drugs listed in such records were frequently inaccurate. They said some prescribers did not use the electronic record, and patients often took non-prescribed over-the-counter drugs.

“Electronic health records should not be considered wholly reliable and may require detailed revision,” they wrote, adding that medication reconciliation procedures were needed at hospital admission and discharge to optimise patient safety.

Belda-Rustarazo S, Cantero-Hinojosa J, Salmeron-Garciá A, González-Garciá L, et al. Medication reconciliation at admission and discharge: an analysis of prevalence and associated factors. International Journal of Clinical Practice 2015;69:1268‒74.


Dissecting the evidence on surgery safety checklists

Safety checklists aimed at reducing mistakes in the operating theatre work best if they are implemented with active involvement from medical staff, an Australian study finds.

Approximately 40% of all hospital adverse events occurred in the operating room, and about half of those events were considered avoidable errors, the review authors said. The introduction of safety checklists in surgery was one strategy used to mitigate the potential for errors and omissions during surgery.

The researchers used a realist synthesis methodology to look at when, why and how implementation of surgical safety checklists worked, or did not work well.

The review, which included 35 studies, found that the sustained use of surgical checklists was discipline-specific, and was more successful when medical staff were actively participating and leading the implementation process, according to findings in Implementation Science.

“Second, involving clinicians in tailoring the checklist to the nuances of their context and encouraging them to reflect on and evaluate the implementation process enable greater participation and ownership,” they wrote.

Checklist tailoring could involve rationalising the items on the checklist to be more specific to the surgical specialist, for example, in a hospital that only does ophthalmology, they suggested.

The study findings could help clinical leaders and hospital administrators to choose appropriate interventions for their particular context, the authors concluded.

Gillespie BM, Marshall A. Implementation of safety checklists in surgery: a realist synthesis of evidence. Implementation Science 2015:10:137 [Internet] doi:10.1186/s13012-015-0319-9


Music plays a role in post-surgery recovery

Patients recovering from surgery experience less pain and anxiety if they listen to music, new findings show.

The “non-invasive, safe and inexpensive” intervention should be offered to all patients having operations, the systematic review and meta-analysis suggested.

Pain, analgesia use and anxiety were all reduced most when music was played before and after surgery, as compared with during the operation.  
No impact on length of stay

The review included 73 randomised controlled trials ranging in size from 20 to 458 participants and looked at the effect of patients listening to any type of music before, during or after surgery.

It found that music reduced patient’s postoperative pain, analgesia use and anxiety, and increased their satisfaction. Pain, analgesia use and anxiety were all reduced most when music was played pre-operatively, then post-operatively, as compared with during the operation. But music reduced pain even when given under general anaesthetic, the review found.

But the use of music had no impact on the patient’s length of stay in hospital, according to findings in The Lancet.

The authors said there were several potential mechanisms to explain the effects of music on patient’s recovery, including the theory that cognitive activities such as listening to music may affect perceived intensity and unpleasantness of pain, enabling patients’ sensation of pain to be reduced. Alternatively, music might reduce autonomic nervous system activity, resulting in reduced pulse, respiration rate and decreased blood pressure.

While the authors noted that care needs to be taken that music does not interfere with communication among the medical team, they said sufficient research had been done to show that it “should be available to all patients undergoing operative procedures”.

Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 2015;386:1659–71.


Weighing up the benefits of total knee replacement

Patients with knee osteoarthritis who undergo total knee replacement followed by nonsurgical treatment have less pain and greater functional improvement after a year compared to those who only have nonsurgical treatment, a new study shows.

However, there were a high number of adverse events among those undergoing surgery, which researchers said should be taken into consideration in patients’ decisions about whether or not to undergo surgery.

More than 670,000 total knee replacements are performed each year in the US, yet there is little high-quality evidence to support the procedure, according to the study in the New England Journal of Medicine.

The researchers randomly assigned 100 patients with moderate-to-severe knee osteoarthritis to undergo total knee replacement followed by 12 weeks of non-surgical treatment, or to 12-weeks of nonsurgical treatment including exercise, education, dietary advice, use of insoles and pain medication.

Before the 12-months follow-up, one quarter of the patients in the nonsurgical group ended up undergoing total knee replacement surgery.

The findings showed those who underwent total knee replacement had greater pain relief and functional improvement after 12 months than those who had nonsurgical treatment alone. But the surgery was associated with a higher number of serious adverse events including three cases of deep vein thrombosis and one deep infection.

More than two-thirds of the patients in the nonsurgical treatment group had clinically meaningful improvements in the pain score, coupled with a lower risk of complications as a result of avoiding surgery.

The authors said the findings highlighted the need to consider individual patient’s preferences and values when making decisions about how to treat moderate-to-severe osteoarthritis.

Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, et al. A randomised, controlled trial of total knee replacement. N Engl J Med 2014:373:1597‒606


Indigenous cancer discrepancies revealed

Better-targeted programs of screening, vaccination and smoking cessation are needed to address cancer risks in Indigenous populations in developed countries including Australia, according to new research that reveals differences in the scale and profile of cancer between Indigenous and non-Indigenous people.

Researchers analysed 24,815 cases of cancer in Indigenous people and 5,685,264 cases in non-Indigenous people of any age in Australia, New Zealand, Canada and the US.

Among Indigenous men, lung cancer was the most frequent cancer in all Australian regions as well as in New Zealand and Alaska, US, while prostate cancer was the most common cancer in other US regions, according to findings in Lancet Oncology.

In women, breast cancer was the most common cancer in all jurisdictions except Alberta, Canada, where colorectal cancer was the most common. The incidence of cervical cancer was also found to be higher in Indigenous women than non-Indigenous women in most jurisdictions.

Compared with their non-Indigenous counterparts, the overall cancer burden in Indigenous populations was substantially lower in the US (except in Alaska), similar or slightly lower in Australia and Canada and higher in New Zealand, the study found

The lower incidence of cancer may be due to Indigenous people dying prematurely of other causes such as cardiovascular disease and diabetes, the authors suggested, as well as to lower frequency of cancer screening.

“The high incidence of several common and largely preventable neoplasms, including cervical and lung cancer, shows the need for better health surveillance and targeted prevention, early detection and vaccination programs in Australia, New Zealand, Canada and the USA,” they wrote.

They said it was essential to collect and map cancer risk-factor and screening data in Indigenous populations, and they urged governments and researchers to work in partnership with Indigenous communities to improve cancer surveillance and facilitate access to cancer data.

Moore SP, Antoni, S, Colquhoun, A, Healy, B, Ellison-Loschmann L, et al. Cancer incidence in indigenous people in Australia, New Zealand, Canada, and the USA: a comparative population-based study. Lancet Oncol 2015;16:1483‒92


Specialised cancer survivor clinics cut ED attendance

Adult survivors of childhood cancer are less likely to visit the ED for urgent care if they have attended a specialised cancer survivor clinic, new research shows.

By the age of 50 years, more than half of adult survivors of childhood cancer will develop a severe, disabling or life threatening condition or die prematurely, and their risk of hospitalisation is nearly three times higher compared with the general population, the authors said.

The study analysed ED visits among 3912 adult survivors of childhood cancer in Ontario, Canada, where the government established a network of specialised survivor clinics in 1999. It found that 57% of survivors had no visits to a survivor clinic, while the remaining 43% had at least one visit during the study period.

Findings in Cancer showed that those who attended at least one survivor clinic during adulthood had a 19% lower rate of subsequent ED visits compared with those who had never visited a survivor clinic, even after adjusting for treatment factors known to increase the risk of late effects, such as intensity of therapy and radiation.

Each additional visit to a survivor clinic was associated with a 5% decrease in the rate of subsequent ED visits.

“To our knowledge, this is the first evidence of an association between the systematic program of specialised survivor clinics and the utilisation of unanticipated health care services,” the authors wrote.

Further research was needed to demonstrate whether the clinics were linked to a reduction of the risk of morbidity and premature mortality for the growing population of childhood cancer survivors, they said.

Sutradhar R, Agha M, Pole J, Greenberg M, Guttmann A, et al. Specialized survivor clinic attendance is associated with decreased rates of emergency department visits in adult survivors of childhood cancer. Cancer 2015 [Internet] DOI: 10.1002/cncr.29679


Push to ready primary care for growing cancer care demand

Radical improvements in diagnostic services and policies that encourage integration between primary and specialist care are among the measures needed to ensure primary care doctors can meet the growing demand for cancer care, experts write in Lancet Oncology.

The issue was explored in a special Commission by the journal, led by Professor Greg Rubin of Durham University in the UK.

An accompanying editorial urged a review to look at whether the funding of primary and specialist services created the right incentives for primary care physicians to get involved in cancer care.  
Integration is vital, say experts

The authors said that as governments turned to primary care to play a larger role in healthcare, one of the greatest challenges was how to equip doctors to fulfil this role effectively for cancer

“With an ageing population and a rapidly increasing number of cancer survivors, the primary care cancer workload will increase substantially over the next 10 years,” Professor Rubin said in a statement. “Our challenge is how to prepare primary care doctors as the cornerstone of prevention, early detections, survivorship and palliative care.”

The Commission called for more effective integration between primary and specialist hospital care, citing evidence from the US showing that long-term cancer survivors who see both primary care doctors and oncologists are more likely to receive the full array of care they need.

Measures needed to achieve that integration included: better access to diagnostic tests underpinned by comprehensive guidelines; improved education and support; new models of shared care between primary care and oncology; greater communication with specialists and easy referral back to hospital care; and robust monitoring systems for detecting recurrence and the adverse effects of treatments, it stated.

An accompanying editorial urged a review to look at whether the funding of primary and specialist services created the right incentives for primary care physicians to get involved in cancer care.

In Australia, the reliance on fee-for-service provided an incentive for GPs to increase the volume of care and to generate revenue, rather than to provide continuity and integration of patient care, the authors said. This posed challenges for managing complex and continuing illnesses such as cancer, they said, but some form of capitation funding for such patients was now under consideration, which would be compatible with the goals of the Commission.

Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, et al. The expanding role of primary care in cancer control. Lancet Oncol. 2015:16:1231–72

de Abreu Lourenco R, Hall J. Paying for the expanding role of primary care in cancer control. Lancet Oncol. 2015:16:1228‒9.


A tick for NSW hospital care

Most NSW patients are positive about the care they receive in public hospitals, with three-quarters saying they would speak highly of their hospital experience, new reports show. The Bureau of Health Information Snapshot Report, based on a survey of 27,000 patients who went to a NSW public hospital in 2014, showed that there were significant improvements in the results of 13 out of 68 questions compared to the previous year while only one result declined.

A second BHI report, Patient Perspectives, developed with the Cancer Institute NSW, focused on the survey results of 6500 patients with cancer, finding that overall, they were more positive about their hospital experiences, and in particular, about access to health services, than admitted patients as a whole.

Download report

The primary care needs of older patients

This snapshot, which was produced by the BEACH program (Bettering the Evaluation And Care of Health) as part of its General Practice in Australia 2014‒15 report, focuses on the care of Australians aged 65 years and older in general practice over the past 15 years.  The increase in health resources used by older patients was greater than their increase as a proportion of the population, it found, because older patients see GPs more often and have more chronic conditions managed.

It urges targeted investment to strengthen the role of primary care in treating older people, saying general practices are in “prime position to act as the coordinators of care and help to lower the chance of ‘fragmented care’”.

Download report

New insights into children’s care in NSW hospitals

The majority of children and their parents say their care in NSW public hospitals is good or very good, according to the first survey asking them about their hospital experiences. The Bureau of Health Information Snapshot Report shows that nine in 10 young patients said doctors and nurses were always kind and caring and polite and courteous towards them, and eight in 10 parents reported having confidence and trust in the doctors and nurses treating their child. However, the report found half of parents did not always have the opportunity to speak to a doctor when needed and three in 10 said they were not fully informed about how to manage their child’s care at home after they were discharged.

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The pros and cons of bundled payments

This Australian Health and Hospitals Association paper entitled Bundled Payments: their role in Australian primary health care, outlines the benefits and risks of introducing a system of bundled care payments.

The paper, produced with funding support from Bupa, finds bundled care payments would reduce incentives for growth in volume of services and would promote quality and safety of care, the encouragement of team based care and a focus on care coordination. However, potential disadvantages include difficulties in defining and calculating costs and allocating payment across providers, and the potential to prevent access to healthcare for those most in need. There is an urgent need for quality data on outcomes and costs to support a transition towards a bundled payment system, the paper states.

Download report

Tackling ageing with optimism

The World Report on Ageing and Health released by the World Health Organization looks at the latest evidence about the ageing process, noting that many common perceptions and assumptions about older people are based on outdated stereotypes.

The loss of ability typically associated with ageing is only loosely related to a person’s chronological age, it finds, and contrary to common assumptions, ageing has far less influence on healthcare expenditure than other factors including the high costs of new medical technologies. The report’s overarching message is optimistic: with the right policies and services in place, ageing could be viewed as a new opportunity for both individuals and societies.

Download report

Global health comparisons

This report by the Commonwealth Fund compares health care spending, supply, utilisation, prices and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

In 2013, the US spent far more on healthcare than other countries, largely driven by greater use of medical technology and higher healthcare prices, rather than more frequent doctor visits or hospital admissions.  Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions. The report also shows all is not rosy for Australia, which has one of the highest out-of-pocket health expenditures.

Download report

Bronwyn Shumack  

Carrie Marr

Chief Executive

Clinical Excellence Commission

A frontline perspective

In every conversation about strategies and plans for improving health services, the Clinical Excellence Commission’s newly appointed chief executive Carrie Marr has one key question: how will it make a difference at the frontline of healthcare?

Having started her career a nurse in Scotland, working in oncology and then end-of-life care, she knows what it’s like to be at the front end of care.

“I have been privileged to experience a varied career pathway in healthcare,” she says.

Desire to make a difference

She moved from nursing into nursing education and then to the Scottish Government, holding a number of senior roles with the National Health Service, Scotland Tayside Health, specialising in organisational effectiveness, modernisation and development – always driven by a desire to make difference.

“I believe that if we continue to pursue waste, unwarranted variation and harm in our healthcare systems we can improve outcomes for patients and create the internal capability we need to support our quality improvement effort,” she says. “I have a firm belief that we need to demonstrate our commitment to support frontline teams to engage in safety and improvement ‒this is where improvement happens.”

Highlights of her career have included working with many talented people at Swedish health innovation centre Qulturum ‒ “a fantastic example of a learning organisation”; at Intermountain Healthcare in the US, which has developed sophisticated real-time data and measurement systems; and at NHS Scotland which she says had the courage and vision to drive a country-wide Patient Safety Program.

Seeing the world as a clinician

Two years ago, she moved to Australia to take up the position of Executive Director, Organisation Effectiveness at Western Sydney Local Health District. Despite her move into management roles, she says she “she hopes she never stops seeing the world as a clinician”.

“As executives, we can get into a lot of conversations about strategies and plans. But every single time we have a conversation, we have to think about what it means for patients outcomes.”

NSW healthcare providers face a number of challenges posed by the state’s changing demographics, she says.

“We have a fast-growing population who will require healthcare systems to support specific needs in aged care and early years. The demand on services to support long-term conditions is already evident as is our need to place more emphasis on the social dimensions of care and wellbeing”

Patient flow needs to be planned in a way that can shift pressure away from emergency departments, she says, and there is a need to continue to strengthen and sustain work on person-centred care and safety and quality.

The CEC’s main focus now is to build on the gains of the past decade, Mrs Marr says.

“I am spending my first months getting a sense of the organisation and the opportunity we now have to learn how to support Local Health Districts and local clinical teams with their improvement work and respond to the challenges ahead.”

These are challenges she’s ready to tackle ‒ while enjoying her new home’s pleasant climate.

“Moving out of my comfort zone and moving to Australia, a place I now call home, I have met so many talented and passionate people who have made me feel so welcome. Lastly, coming from the experience of Scottish weather, the climate of Sydney continues to be a highlight for me.”

9th Health Services and Policy Research Conference

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.

7‒9 December, Melbourne
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11th Annual Critical Care Conference in the Vineyards
6‒7 May, Hunter Valley, NSW
Read more

The 11th Annual Critical Care Conference in the Vineyards is organised by Hunter New England Health professionals, representing the different specialties of critical care. The conference has a national audience and targets the educational needs of multidisciplinary staff within the health care industry with a focus on critical care, including trauma, emergency, intensive care, high dependency, disaster and retrievals, in both the adult and paediatric populations.
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