A Healthier Future for all Australians - Final Report June 2009
Chapter 5. Creating an agile and self-improving health system
Our third major tranche of reforms is about how we can create a continuous culture of reform through building a health system that is ’agile’ and ‘self-improving’.
Over the last quarter century, Australia has seen two other major health reform inquiries, such as this one160. Both included broad community debate about the sustainability of our health system, the production of expert reports, and the subsequent implementation of some reforms which ‘re-set’ our health system on a new course for the next ten or fifteen years. While this ‘episodic’ model has some advantages, we believe that it is also important to embed a culture of ongoing reform as an intrinsic feature of a sustainable health system, bringing the same culture of ‘continuous improvement’ to the system level, as we wish to encourage at the service level.
What do we mean by an agile and self-improving health system?
‘Agility’ has been described as a vital attribute in a ‘world of constant and sometimes rapid change’, driven by the need to respond to ‘complex problems in an uncertain environment’.161 Certainly, the Australian health system meets this description. It is dynamic, exposed to global economic trends, fads and fashions in health system design162 and international migration of new health care technologies, treatments and management ideas. Agility also suggests the concept of being ‘light on one’s feet’ in being able to respond quickly as circumstances change.
When we talk about a ‘self-improving’ health system, we are thinking of a health system that learns, creates and uses new information wisely, and is driven by innovation and continuous quality improvement. The important concept is that the ‘seeds of reform’ or self-improvement are built into the core of the health system. Reform is thus a continuous process that is owned and driven by the people who use and work in the health system, not a once in a decade ‘set and forget’ approach.
We believe that many of our reform recommendations fall into this category of creating an agile and self-improving health system. In this chapter, we have grouped these reforms under five levers for action, as follows:
- Strengthened consumer engagement and voice;
- A modern, learning and supported health workforce;
- Smart use of data, information and communication;
- Well-designed funding and strategic purchasing models; and
- Knowledge-led continuous improvement, innovation and research.
These levers are about governments (and others) creating the right ‘architecture’ for our health system. As we explained in Chapter 2, we expect that once we get the architecture for health system reform right, reform can be ‘everybody’s business’ and we can move to a health system that is agile and self-improving.
We now turn to identifying our reform recommendations under each of the five levers for action. We begin with the two levers related to our most important resource – the people who use our health system and the people who work in our health system.
160These two inquiries were the National Health Strategy in the early 1990s and the Commission of Inquiry into the Efficiency and Administration of Hospitals in the early 1980s. While not an inquiry, the Whitlam-era National Hospitals and Health Services Commission also provided a major reset of the health system, being notable particularly for the introduction of the Community Health Program.
161G Gallop (2007), Agile government, Paper presented at the Agile Government Roundtable, State Services Authority, Melbourne, 11 October 2007.
162T Marmor (2004), Fads in medical care management and policy: Rock Carling Fellowship (The Nuffield Trust: London).
