Roxon says we will learn how any hospital performed compared to national average waiting times for elective surgery and emergency department care, and that the website will also list the medical services provided, bed numbers and if there are outpatient services, such as allied health and dental services. The range of information available on MyHospitals will continue to be developed in the future, including providing data on private hospitals and reporting data for each hospital against a range of safety and quality measures.
What else could the website include? This is a list of discussion-starters that I suggested, and keep reading below to see a wealth of other ideas from Croakey contributors:
• how healthy is the food provided to patients and available for visitors/staff etc
• how effectively the hospital engages with Indigenous patients and communities
• the demographics of patients compared with demographics of population need (to determine relative servicing of SES groups)
• how many staff smoke, drink to risky levels, are physically active (to determine the reach and effectiveness of health promotion programs for staff)
• the range and impact of efforts to improve local population’s health
• the support available to patients from rural or remote areas
• patients’ access to parking and its cost
• what proportion of the hospital’s funding is spent on administration, clinical service delivery, population health programs, research, teaching?
And here are stacks more suggestions from Croakey contributors…
Medical editor Dr John Dowden:
1. There is a focus on surgical waiting lists and waiting times in emergency departments, but the time a patient has to wait for an outpatient appointment is also important. GPs often have to try and negotiate an earlier appointment for people with problems that cannot wait months to be seen in a public outpatients clinic. It should also be clear what services the clinics actually provide eg. some specialist clinics won’t see people with particular problems.
2. Medication errors should be being recorded, but this may not be enough to ensure people are getting their drugs. For example, I have seen medicine put on a patient’s locker where it remains because the patient is unable to take it eg because of stroke, dementia etc.
3. On a similar note who feeds the patients? People disabled with a stroke may be unable to feed themselves.
4. Readmissions due to avoidable factors, such as incorrect discharge medication.
5. Speed of communication with the patients’ GPs. Despite modern technology patients are still being discharged without information being provided to them or their GPs.
6. Hospital culture/morale. Patient outcomes are unlikely to be improved if there is bullying or staff are working excessive hours. I would include here staff stability, because many hospitals use agency staff who will be working somewhere else tomorrow.
7. Supervision and training of medical staff eg. how many junior doctors are carrying out procedures they are not trained for?
8. The ratio of managers to clinical staff (The new UK government is proposing a greater role for doctors and nurses in running hospitals)
9. Complaints and how hospitals react when things go wrong. Openness and change or denial and cover up?
Sally Crossing, Chair, Cancer Voices NSW:
This is probably our only opportunity re consultation.
Cancer Voices NSW would like to see a MyHospital website provide a regularly updated report of waiting times for cancer surgery, for radiotherapy and for chemotherapy. Also for breast reconstructions.
We would like to know if there are multidisciplinary teams for the various cancers in place at the hospital, what the referral pathway is for GPs, are there cancer nurse co-ordiantors (CNCs), or breast cancer nurse (BCNs), and if so how many?.
Does this hospital have a Cancer Care Centre? If not, where are the nearest?
Does this hospital have a resource / info centre, with internet access and the full range of Cancer Council information for cancer patients & carers?
Is there a Lymphoedema Clinic on site?
What are the services for palliative care patients, and how are these connected to community palliative care services?
A MyHospital website should contain a Directory of its services, specialists and their specific contact details.
It should also list its network connections with other hospitals.
There is an excellent website which reports cancer outcomes and standards expected for the hospitals of Ontario Canada, which would make a good model for us.
Such websites would certainly be very useful for people affected by cancer, AND their GPs.
Anita Tang, NSW Cancer Council:
We would strongly support inclusion of information about:
• access to parking and its costs, including any provision for specific patient groups
• availability of accommodation for country patients and carers
• mechanisms to support consumer and community involvement in governance or advisory structures
• how the hospital deals with nicotine dependent patients
• mechanisms to monitor compliance with clinical standards
• whether the hospital is a “smoke free hospital” and what patients can do if they see someone smoking?
Dr Pieter Peach, clinician and web innovator:
I suppose the question is what actionable metrics will lead to positive behaviour change from within the hospital system. The idea that patients will choose hospitals based on this is sidetracking the real potential of this endeavour.
My metrics: Percentage of patients with a nominated GP who have discharge summaries sent to their GP.
Putting on my web development hat, I have to say that a site should offer a very limited number of value propositions at the outset. A “minimum viable product”. This is the simplest, cheapest service that provides value to the user. Adding too many features/datasets at the beginning is both a waste of time and money. Nobody knows which data sets and features people will find valuable, and you risk spending time on something nobody will use.
They should start with something simple, get that right, then add something else, and iterate again, getting and responding to feedback from the beginning. This whole process is roughly known as agile web development. The site grows with the users, rather than appears out of nowhere with the state’s false assumptions as the foundation.
Health economist Professor Gavin Mooney:
Rather than my saying what I want, what matters I think is that each local community has a say in what is on the Myhospital website for its hospital and my guess is that this will vary from community to community – and might well be very different from what the AIHW thinks should be there.
So I would like the Myhospital website to indicate whether or not the hospital has consulted its local community to find out what the community want from its hospital and then based the information on its Myhospital website on that. It might also indicate whether the hospital management will go back to the community from time to time to find out if the community is getting what it wants from its hospital.
Dr Andrew White, Paediatrician, Senior Lecturer, James Cook University:
• the proportion of Indigenous patients
• the proportion of Indigenous staff
• the availability of Indigenous liaison/interpreters
• does the hospital have an appropriate emergency department for children (or are children mixed in with adult patients)?
• an indication of the amount of outreach service provided by the hospital – to local community, to regional and remote centres.
Helen Hopkins, National Rural Health Alliance:
Suggest Croakey avoids fuelling the rather banal patient satisfaction surveys about hospital food and the furnishings, as if it was a hotel room, through asking about healthy food.
In fact the biggest issue with food for patients and their families, is whether the tray or drink is placed where the patient can reach it while they are lying in bed, and whether or not there are sufficient staff to help or encourage patients who are not able to feed themselves or are too sick or elderly to feel like eating or drinking. If family are not there to help, the tray is too often cleared untouched by kitchen staff whose role definition does not include patient care.
This extends to quality of care more broadly, with patients and their families valuing the human side of care very highly, but finding that it often seems to be rushed – there is a lot of sympathy for busy nurses. Families and patients often struggle to find out what’s going on with their care and progress, who to ask among the various staff around the wards, what help is available following discharge etc.
Maybe the question could be more like: patient feedback regarding availability of staff to help with personal care needs while in hospital and when making plans to go home?
The question about car parking and costs is very important – for country people who drive down to city hospitals too. Maybe include public transport, other transport arrangements to assist people who do not drive or come from out of town?
Some other suggestions:
• Does the hospital provide antenatal, birthing and post natal care routinely? Some maternity care in an emergency? If not, where is this provided in the region?
• Does the hospital have children’s beds or a children’s ward? Does it cater for their parents too? Does it have links to a major children’s hospital? What transition arrangements and support are in place for children with chronic conditions as they become teenagers and young adults?
• Does the hospital have a contact point for people travelling in from the country to assist with coordination of travel, medical records, family needs and to help plan discharge arrangements with local services close to home?
• Does the hospital have outreach services or community referral arrangements for mental health?
• Do hospital staff receive training and support regarding cultural safety for Aboriginal and Torres Strait Islander people or people from other cultures?
• What are the arrangements for interpreters? Indigenous liaison staff? Pastoral care?
• Can the hospital assist with rehabilitation services, aids and appliances, community outreach?
• Does the hospital or Multi-Purpose Service have aged care beds for respite or ongoing care?
• Is palliative care available in the hospital? As community outreach?
• What surgery can be done at the hospital? Where are patients referred for other surgery in the region? In the city?
• How do the rates of hospital infection compare with similar hospitals? With the national average? (Maybe some positives here for smaller hospitals…)
• Other performance measures… maybe down the track?
Carole Taylor, CRANAplus:
• Need to look at the rural and remote patient transport system
• Do all relevant hospitals have culturally aware birthing/translators
• What family support for Indigenous patients
• What support for parents of young people with terminal illnesses – everything there for under 18’s nothing 18 – 25
Dr Yvonne Luxford, Palliative Care Australia:
I like your list plus a couple of other items come to mind that would be useful for the public to know about a hospital:
§ Does the hospital have an Indigenous Liaison Unit?
§ Does the hospital have a Palliative Care Team?
§ Is the hospital actively improving its environmentally sustainable practice? What steps is it taking to achieve this?
§ If a specific service is not offered by a hospital, how far away is the nearest hospital which does provide that service?
Dr David Briggs, Coordinator, Health Management and Gerontology Programs, University of New England:
• What measure do they have to demonstrate that all discharged patients have a discharge summary and care plan directed to community, chronic and extended care providers?
• Do the needs of elderly patients on discharge or transfer take into account transport needs and travel with daylight hours?
• In terms of food what arrangements in staffing are made to ensure patients who are elderly or clinically compromised get assistance to eat the food nutritious or not!
• Do patients requiring medication on discharge receive sufficient supply to allow time for a visit to the GP/pharmacy?
• What are the main factors addressed in patient, staff, visitor and community complaints
• What proportion of the budget is spent on ensuring that frontline health professionals and teams have health systems leadership/management competencies
• Do all health professionals engaged in substantially health management roles have management qualifications
• What is the unit cost compared to the average for cleaning, catering and maintenance (I suspect that they are underspending)
• What proportion of the Budget is reserved for replacement of ward furnishings and equipment on an ongoing annual basis
• What is the physical distance from the team/service or hospital of the accountable manager (centralised/remote and bureaucratic/deptl management)
• How often do team/service/hospital management meet with stakeholders from other agencies to develop common programs or improve service links
• How many community consultations about health need and health service development are held annually
Patrick Bolton, health service manager
I’d like to see standardised mortality rate. Sure there are all sorts of issues about interpretation, but it is objective and meaningful and the discussion about interpretation is an important part of public accountability and understanding of health services.
I haven’t been following the debate about the MyHospitals website but I do believe that information should be published about the medical or clinical performance and outcomes from hospitals. I know there are arguments for and against the publication of death rates and so on but it seems to me we should publish them, and certainly we should be moving in that direction.
Julie Leask, National Centre for Immunisation Research & Surveillance of Vaccine Preventable Diseases:
What are the vaccination rates of staff, re:
Influenza vaccination annually and
Vaccines or evidence for protection (eg serology) from the following:
MMR -measles mumps rubella
DTaP -diphtheria tetanus pertussis
Varicella (chicken pox)
At a minimum it should apply to staff with direct patient contact. Hospitals interpret that in varying ways.
Background that is NSW relevant:
In February 2007, NSW Health introduced a unique policy directive (PD) requiring employees to be vaccinated against specified vaccine preventable diseases (VPDs). Required vaccines include measles, mumps, rubella, varicella, hepatitis B, diphtheria, tetanus and pertussis. Annual influenza A vaccine is recommended, but not mandatory.
Some other states/territories are considering policy or have similar in development.
Associate Professor Ruth Colaguiri, Director, Health and Sustainability Unit, Menzies Centre for Health Policy, Univeristy of Sydney:
Your list (Croakey’s suggestions) is spot on, Before coming to USyd , I spent a total of almost 25 years in the public health system and as visitor to friends and family in hospital I can vouch that:
– in NSW parking charges at our public hospitals represent sheer exploitation by the government of people who are often already financially compromised. It is outrageous.
– staff are stressed and many do smoke and many drink well beyond safe limits
The food is awful and any reforms should also focus on the way it is served so that the bed tables onto which meal trays are dumped are at least positioned where people with restricted movement can reach them.
Nutritionist, Dr Rosemary Stanton:
How well does the food provided to patients and available for visitors/staff match the dietary guidelines for Australians
Professor Stephen Leeder, Menzies Centre for Health Policy, University of Sydney:
Although the quality of data from hospitals in Australia is pretty dreadful, it is desirable for patients seeking elective care to access information that enables them to compare the quality of the clinical care, including mortality rates for interventions, be they medical or surgical, so that they can make informed decisions about where they would wish to be treated.
In an emergency (and 60% or more of patients enter hospital via this pathway) such choices do not apply – people in need are treated where they are taken.
There are many reasons that will prevent information about safety and quality of hospitals becoming generally available. We have only rudimentary data systems to provide safety and quality data to administering authorities to make judgments about these qualities. So the next step – of making such information available to the public – is logistically difficult unless the data are obtained from special-purpose surveys. Professional groups, akin to the various teachers’ unions, will protest that comparing the performance of institutions prejudices the opportunities of their members if they happen to work in a less-than-the-best institution.
I doubt that many citizens would be concerned about details that have to do with the clientele of the hospital or the food it serves. True, if there were a web site called MyGP, patients access it to find out about bulk-billing, home visits, whether there is a female doctor in the practice, how long you have to wait to get an appointment and how long you wait once in the waiting room.
So perhaps beside information about safety and quality, people accessing MyHospital may want a few such details but fundamentally their interest would be with how safe and effective the hospital is in managing illness and injury. Nothing else comes within a bull’s roar.
Professor Peter Brooks, Director, Australian Health Workforce Institute, The University of Melbourne:
• What research does the hospital actually carry out
• What are they like at implementing change – ie responding to their research findings
• What are patient outcomes – for simple DRGs ie hip/knee surgery , coronary bypass/ stenting – what is the re hospitalisation/ infection rate etc. This does start to get to real benchmarking.
• It would be useful to have somewhere the average time for hospitalisation for common conditions , what % have to be readmitted to hospital , how many get infections etc so the punters can make an informed choice
• A great service would be done if some idea of out of pocket expenses (mind the GAP) could be included
• A list of the cost of various procedures/beds might be included to provide the community with an idea of the cost of health
Caroline Homer, professor of midwifery, University of Technology, Sydney:
Having a maternity eye on these things – the standard maternity measures (normal birth rate, caesarean rate, admission to special care nursery, perinatal mortality rates) but also, access to immersion in water for labour and birth, access to community-based antenatal clinics, access to continuity of caregiver (midwifery and obstetric), access to home visits from midwives after birth, baby friendly health status (BFHI) would be a few to add as a start!
Associate Professor Hannah Dahlen, University of Western Sydney:
This is a prime opportunity for hospitals to make publicly available their stats on interventions in birth eg caesarean section rates, forceps and vacuum, episiotomy, epidurals, induction of labour etc . Many States have refused to do this NSW is an exception.
Sally Tracey, professor of women’s health nursing and midwifery, University of Technology, Sydney:
I think this would be a most useful thing to know – and as Hannah said – NSW already does this including their private hospitals – which is where many of the unaddressed problems lie, in that no one appears to be accountable for the continuing escalation (of interventions).
Associate Prof Gawaine Powell Davies, UNSW Research Centre for Primary Health Care and Equity:
Not really my area – but it would be nice to know what services a hospital offers…
Prue Power, Australian Healthcare and Hospitals Association:
1) It is important that all outcomes measures are standardised and risk-adjusted to enable consumers to make meaningful comparisons between hospitals with different patient populations and risk profiles. Without appropriate risk-adjustment hospitals may have a disincentive to take on high-risk patients.
2) It is also essential that the website also cover private hospitals to ensure consumers are given the most comprehensive information possible to inform their choice of care provider. As over 50% of admissions to public hospitals are via the ED, information on elective surgery will have relevance to only a minority of public hospital patients. However, given that a high percentage of private hospital work is elective surgery it is crucial that consumers are able to access activity and performance data on private as well as public hospitals in this area.
Professor Chris Del Mar, University of Queensland:
• Proportion of discharges with a letter to the GP
• Time until GP is notified about the patient admission
• The extent to which the information is complete (what procedures done; tests and their results; discharge drugs and doses)
Professor Drew Dawson, Director, Centre for Sleep Research, University of South Australia
• Patient safety data
• Doctors and Nurses working hours
Medical editor Marge Overs:
Are there multidisciplinary teams?
What are the complaints mechanisms
Are there patient advocates?
Policy on communication with patients’ GPs
Allied health people, eg physios, social workers
Commitment to patient rights? (eg follow Australian Charter of Patient Rights)
Emeritus Professor Kerry Goulston, University of Sydney:
Patient and staff satisfaction (and happiness!) survey results
Dr Peter Arnold:
The most important question of all (way more important than all the ideological ambit claims of the reformers or much of the purist, ideological ‘pie-in-the sky’ stuff in your list (ie Croakey’s list at the top of the post)):
Who is responsible for the patient’s care and for avoiding fundamental ‘snafus’?
Does the patient have anyone who checks that:
- they are getting the right medications when they should;
- their other ailments are being looked after (most hospital occupants are aged with multiple pathologies – yet they are in hospital UNDER one sub-(perhaps micro-sub) specialist whose name is above their bed), and who calls in other ‘microsubs’ to handle anything slightly outside his/her microsub area – resulting in dilution of responsibility so that no one is in charge!;
- they are mobile enough to get to the toilet unaided;
- alert enough (and physically able) to safely negotiate a shower;
- they are getting the right diet;
- they are actually eating their food; (trays are often dumped on trolleys out of reach and no one checks that the patient can actually get the food into their mouths);
- they are drinking enough;
You have listed the cherries on the top of the ice-cream on the top of the fruit salad. I am more concerned that the patient actually eats the fruit.
I have taken to advising anyone who has had a relative admitted to hospital to be there with them almost all the time to make sure that all of these things are done. This is good enough for the third-world country where I come from. It is now essential in the first world country where I now live.
Dr Peter R Mansfield, GP and Director, Healthy Skepticism Inc:
Given that exposure of prescribers to information from drug companies usually just wastes time or is associated with lower quality of care, what restrictions does the hospital have against drug company information?
Kathy Flitcroft, University of Sydney:
• staff to patient ratios
• ratio of senior/experienced nursing and medical staff compared with new or more junior staff, and the number of regular versus agency nurses (you can probably tell I am a former nurse!)
• I think collecting data on the health status of the staff would be difficult (to get honest answers at least). It may make more sense to ask if they have a health promotion program for staff or not, and if so, what does that involve, the percentage of staff that attend etc. Back in my day, there weren’t such programs for staff at all.
• what arrangements are available to support relatives of patients – physically and emotionally (eg nearby accommodation and counseling)?
Infectious diseases specialist Professor Peter Collignon:
I would like something on healthcare associated infections on all hospital websites. Starting with Staph aureus bacteraemia. This should be presented in a form that makes it harder for hospitals to “game” the data, so they have to list all episodes seen not just those they themselves deicide are related to their institution.
Professor Lesley Barclay, Northern Rivers University Department of Rural Health:
• Post operative infection rates
• The number of serious level adverse events
• How patients complaints are handled
• Caesarean section rates
Dr David Monash, rural GP, Victoria:
• Waiting lists for outpatient appointments as well as surgery. In Victoria the hospitals have reduced their surgery waiting lists artificially by preventing surgeons seeing them as outpatients and therefore putting them on the surgical waiting list. We therefore have a “waiting list” to get on the “waiting list”. This fact needs to be made public.
Professor David Penington, Grattan Institute:
Some indicators of range of specialist services – full-time or part-time – and in due course some objective indicator of quality, once these are developed
Dr Jeanette Young, University of SA:
I think it could be good to have a little more info re this point: “what proportion of the hospital‟s funding is spent on administration, clinical service delivery, population health programs, research, teaching?” It could also include health promotion activities (eg all nurses at the Royal Adelaide Hospital have “health promotion” in their job description but I don’t think any information about whether they do this is ever recorded – but not sure). Do they collect data across all these? (population health usually gets missed statistically) If they do collect this – what is the breakdown across categories?
Also note Accessibility re public transport (drop off and pick up points; timing; hours eg can late shift staff get home using public transport?)
For the record, the AIHW says: MyHospitals will be evaluated through ongoing focus groups, feedback through the website and a MyHospitals call centre.
If Croakey readers have other suggestions for what MyHospitals should – or should not – include, please speak up…
Update: I also wrote about these issues for Crikey today. As often happens, I thought of how I should have ended the story after it was published. I finished by saying the “agile web development” approach proposed by Pieter Peach might be useful more broadly in health reform – ie start small and modify/develop according to feedback from users. What I should have added is: this might be called “agile policy development”…
Update 26 July: Interesting that the concerns about vulernable patients going unfed were also raised in this Sydney Morning Herald story.