'More care needed' in health care

Patient Safety and Quality Improvement executive director More complex surgeries and procedures, more powerful drugs and new technology had made huge improvements in health services, but health professionals need to have a greater focus on patient care.
That from a leading patient safety expert who spoke to Whanganui District Health Board clinicians and staff last week.
Dr John Wakefield, executive director of Queensland Health Patient Safety and Quality Improvement Service, said that, while health care had made major advances in recent years, the risks had not abated.
"We've created an environment that's very effective and we're living longer than ever, but at the same time the risks have crept up on us without us realising it," Dr Wakefield said.
His job involves driving patient safety improvement across his home state. While all health staff were well intentioned and focussed on patient care, he said, "if you scratch the service you'll find they're not all aware of some of the risks of health care".
The risk in health care had only started to emerge over the past 10 years.
"Lack of awareness is one thing and another is how we design the health system. In the past we assumed all you had to do was train the doctor really well, train the nurses the same, put them together and, hey presto, it will all work," he said.But other high risk industries, such as aviation and mining, had learned was that it was not just about training individuals. It involved team work and communication.
"The main things are staff awareness and creating the culture about what we value and how we behave. It's not that we've not been safe but it's just that we've not been as safe as we can be."
He said historically the health profession was noted for its silo mentality, with nurses working in their areas of expertise in a team environment while doctors worked as individuals.
"This is a belief and culture that's evolved in a couple of hundred years so we're very one-eyed about how we work."
He said in the past the patient was not expected to ask questions but now society demanded greater transparency.
"Our primary job is to get safety and quality right. It's a people business and while it's never going to be perfect and things will go wrong, there's a lot we can do to make it safer and reduce the statistical risk of something going wrong," he said.
Every death in the Wanganui Hospital, whether expected or unexpected, was thoroughly investigated and the families kept fully informed, all aimed at making sure similar events are not repeated. He said in this regard Wanganui Hospital was "doing really great things" in terms of open disclosure.
"I've been to plenty of places that say they're doing great things but under a thin veneer there's nothing going on. But what's happening in Wanganui is fabulous work."
He said in Queensland they had talked to patients and their families who had been part of the open disclosure process.
"It showed clearly that when something goes wrong in the health system the people want to have it recognised. They want to know what's going to happen next and what will hospital be doing to stop this from occurring again.
"No one ever wants anything to go wrong in the first place but if it does those people affected don't want to be left alone and feel abandoned."
Dr Wakefield said before this push for open disclosure hospitals would often close ranks and not accept responsibility and families would left with nothing.
"By the time the answers get to those families their grief can often be profound and even pathological," he said.
This process was already well advanced at Wanganui Hospital and he said that showed that this hospital cared.
"That's the culture of an organisation that's not just safe but one that's constantly looking for ways to improve. That's what the community needs to know - that while their hospital is not perfect it's constantly looking for ways to improve," he said.
"We've become more of a health treatment system which may have improved our health but what people crave above all else is care," he said.
"The loss of a loved one is devastating but we need to take the time to find out why it happened and we need to be beside the family at that time.
"Things will go wrong, but it's what we do after that event. The agenda is to move is from a health treatment to a health care system. The important side is the people as much as the treatment."