National Health Reform

Expert Panel - Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on Improving Public Hospital Services: Supplementary Annexure

3.7 Data Requirements

Stakeholder Views

Stakeholders stated strongly that a nationally consistent approach to data is needed as a foundation for reform. Collection of robust, consistent and comparable data was seen to be necessary to minimise the misuse, misinterpretation and politicisation of what are considered highly visible health system indicators (elective surgery and emergency department waiting times).

In regard to elective surgery, many stakeholders argued that there is a need to measure the waiting time from GP referral to surgery, and to break that down into its two components: the time from GP referral to outpatient clinical appointment (which is not currently measured); and the time on the surgical waiting list. Stakeholders also felt there is a need to standardise patient categorisation across jurisdictions. There were fewer stakeholders arguing for a suite of patient safety and quality indicators for the elective surgery targets than for emergency departments. As noted, additional indicators mentioned to support elective surgery waiting times included emergency surgery performance, median waiting times, measures of extended waiting times (such as maximum waiting times or 99^th percentile waiting times) and complication rates.

For the emergency department target, all stakeholders identified the need for a suite of indicators, covering patient safety and quality, workforce measures and patient experience. Indeed, the challenge was seen to be reducing the number of indicators to those required nationally. A number of stakeholders, including the Australian Commission on Safety and Quality in Health Care, nominated the patient safety and quality measures currently being measured in England as a good starting point. The Cross Jurisdictional Clinical Advisory Group’s five safety and quality indicators and Western Australia’s Key Performance Indicators were also mentioned as being worthy of consideration. Some stakeholders identified a need to monitor performance across the entire acute care process, not just within the emergency department itself, with possible measures including mortality, length of stay in wards and infection rates.

Other possible measures included access block and patient experience across acute care. Further, performance indicators for Short Stay Units may be necessary so that clinicians can assess whether they lead to better care for those patients and/or other emergency department patients. Finally, it was made clear that workforce measures would be necessary to ensure the quality and quantity of the workforce can be maintained.

Consumer Views

All consumer groups expressed the need for information regarding progress towards targets to be publicly reported. While many consumers acknowledged they would be unlikely to check such reports regularly, they liked the reassurance and transparency of knowing they were available. In line with safety and quality concerns expressed in relation to the implementation of the targets, consumers emphasised the importance of reporting associated safety and quality indicators. Consumers often did not see waiting times as a safety and quality issue, and associated ‘safety and quality’ with what happened once they were being directly consulted or treated by a clinician.