National Health Reform

A Healthier Future for all Australians - Final Report June 2009

5.5 Knowledge-led continuous improvement, innovation and research

We believe that our future health system should be driven by a strong focus on continuous learning and being able to readily apply new best knowledge to improve the delivery and organisation of health services. Innovation should be rewarded and recognised, at local and national levels, with clear strategies to share and embed successful local innovations across the whole health system. A vibrant culture of innovation and research should permeate health services, with effective linkages and partnerships across universities, research institutes, and hospitals and health services. Evidence should drive investment and disinvestment in particular health care services, as well as influencing the allocation of resources and the deployment of our health workforce.

Our reforms seek to embed innovation, learning and research through actions targeted at both the national level and at the local level of individual health services.

5.5.1 Providing national leadership on evidence and knowledge management for our health system

There are many groups that play a key role in helping drive an evidence-based approach to health service delivery. Our major public teaching hospitals and health services, universities, major research institutes, the NHMRC, the CSIRO, professional colleges and special disease interest organisations all contribute to the ‘knowledge repository’ that helps influence and continuously improve health care. The efforts of the committed people working in such bodies are often poorly acknowledged and often without financial reward; they are to be commended.

Our recommendations have focused on supporting and complementing the work of these groups through strengthening some important national functions as follows:

• Establishing a permanent national safety and quality organisation: We want the Australian Commission on Safety and Quality in Health Care to shift from being a ‘temporary’ body to being established as a permanent, independent national organisation. It has a big job ahead of it. We have earlier (see Section 5.3.3) outlined how we want this agency to take the lead in analysing and reporting on safety and quality and in oversighting national patient experience surveys and the collection of patient reported outcome measures. We also want it to take on the leadership role in promoting a culture of safety and quality across our whole health system. Facilitating clinical improvement collaboratives and recognising high achievers are just two examples of national leadership which will help engender a bottom-up culture and enthusiasm for continuing quality improvement. We envisage that this agency could take responsibility for disseminating and promoting innovation, evidence and quality improvement tools. It also needs to identify research priorities, be an advocate, and monitor the regulatory framework for safety and quality;
• Dissemination of innovation and evidence: Getting evidence to health professionals at the coalface is also critical if we are to effect real improvements in health outcomes for people. We have recommended strengthening the role of the National Institute of Clinical Studies in disseminating knowledge and evidence about how we can best organise and deliver safe and high quality health care. We need to take the ‘legwork’ out of the process if we wish clinicians to keep up-to-date with the latest evidence and then support them to apply it in their everyday clinical practice. A dynamic national ‘clearinghouse’ of current health knowledge including evidence-based guidelines, protocols and ‘risk alerts’, potentially accessible via an electronic portal, can assist to promote a culture of excellence and continuous improvement across the health system;
• National direction on research priorities: We have recommended that the National Health and Medical Research Council set clear priorities for collaborative research centres and supportive grants. The ‘hub and spoke’ model used by the NHMRC Centres for Clinical Research Excellence offers real potential for a collaborative, multidisciplinary approach across health settings;
• National investment in research: We have recommended greater investment in public health, health policy and health services research including ongoing evaluation of health reforms. Research grants must incorporate the indirect infrastructure costs as well as the direct costs irrespective of the setting in which such grants are taken up (including within health services, universities or research institutes). In addition, research funds need to be allocated in a more flexible way to encourage uptake by, and collaboration between, practising clinicians, health service managers and policymakers via fellowships and exchanges; and
• National evaluation and assessment of health interventions: We have already briefly mentioned in discussing prevention and health promotion that we are recommending a new ‘umbrella’ approach to the assessment of health interventions. This involves bringing together the existing and separate approaches to evaluating new medical services (through the Medicare Services Advisory Committee), new pharmaceuticals (through the Pharmaceutical Benefits Advisory Committee) and other processes for reviewing technology and devices to form the platform of a nationally consistent approach to the evaluation of all health services. The potential of many emerging technologies highlighted in Chapter 1 will require a more rigorous cost-effectiveness evaluation framework if we are to ensure a value-driven approach to the uptake of new technologies.

5.5.2 Driving innovation and learning at the local level

Our health workforce also has to be empowered to take on the challenge of continuous learning, research and innovation. We must create structures and models that encourage knowledge transfer and the translation of evidence to everyday practice in an effective and pragmatic manner (such as clinical decision support).

We also need to train, develop and empower clinical and health service leaders to mould a culture of continuous reflection and self-improvement which will inspire the generations of health professionals to come. Promoting a culture of mutual respect and patient focus through shared values and educational experiences, collegiality between leaders of clinical and corporate governance, and appropriate recognition and compensation arrangements is intrinsic to job satisfaction and retention of our precious health workforce.

We have already described the value in ensuring that clinicians working in our health services have access to ‘smart data’ on the clinical quality and outcomes of their own practice, as well as the performance of their local health service. But they also need to have the time and the skills to interpret and compare performance data over time with other ‘like’ facilities if they are to identify and take positive action to change clinical practice. Access to quality improvement tools, techniques and networked systems of support are essential to helping clinicians lead changes in practice or apply new models of care. To make best use of performance data and quality improvement methodologies, all health professionals would undoubtedly benefit from the inclusion of standard national safety and quality training modules into accredited education and training programs.

Strong health leadership is vital to making change actually happen. It is unrealistic to think that our health workforce can take on leadership roles without action to train and develop those with potential. There must be investment in management and leadership skills development for existing and future managers and clinician leaders at all levels and across all sectors.
Valuing clinical leadership and embedding a culture which frees health professionals to invest time in quality improvement may be as important as structural change in achieving health reform. We heard:


Providing health professionals with opportunities to combine teaching and research with their service responsibilities builds a culture of quality and is demonstrated to lead to better uptake of new knowledge and better outcomes. Concerns have been voiced in a number of quarters that:


Clinical education and training must be ‘protected’ from the daily demands of health service delivery if we are to foster a culture of clinical engagement in health service management. Hence we have recommended that clinical education and training be funded through the use of dedicated ‘activity-based’ payments, so that these important functions are appropriately rewarded. Against this backdrop, we recognise the need to adequately invest in a broad array of research including health services research, public health and health policy research. We also want to see clinical research fellowships established across hospitals, aged care and primary health care settings so that research is visible and regarded as a normal part of providing health services.

Recognising and rewarding excellence in patient care and outcomes, innovation and research achievements and outstanding performance can build a cohesion and culture of pride in health services. Examples such as ‘magnet hospitals’²⁰⁵ and a range of prestigious research awards have demonstrated sustained and strengthened quality improvement in health services that aspire to and achieve such recognition. We have therefore recommended a national health care quality innovations awards program be established, which would apply to excellence achieved across all health service settings.

There are many good examples of existing programs that seek to encourage innovation and learning at the level of individual health services. We have already mentioned the Australian Primary Care Collaboratives Program. Similarly, many hospitals across Australia have participated in benchmarking groups and clinical forums that focus on ‘redesign’ and improving care. We want to encourage greater participation in forums such as breakthrough collaboratives and health roundtables that contribute to the sharing of ‘best practice’ lessons across health services. Sharing innovation is an essential prerequisite of a self-improving health system that is able to respond to a dynamic and changing environment.

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²⁰³Menzies Centre for Health Policy (2009), Submission 199 to the National Health and Hospitals Reform Commission: Second Round Submissions.
²⁰⁴D Pennington (2009), Submission 164 to the National Health and Hospitals Reform Commission: Second Round Submissions.
²⁰⁵ F Armstrong (2005), ‘Magnet hospitals: What’s the attraction?’, Australian Nursing Journal 12(8): 14-17.