Quality improvement a "threat to health", or is it?

Dr Alasdair Millar, the clinical director at New Zealand’s Southland Hospital, said that while the aims of QI – to ensure patient safety, avoid errors and achieve optimum health outcomes – were good, there was little evidence of clinical benefit.

“I argue that clinical QI is failing to satisfy its ostensible aims and is a threat to health,” Dr Millar said.

“Aggregate costs are high. Every hospital has a quality unit, and there are state and federal quality organisations under various names with duplicated or overlapping roles. The cost of government-funded QI across Australasia could easily exceed seven figures, without including the unknown costs of individual projects.”

Dr Millar said that modern hospitals operated at a high degree of safety, with error rates of less than two per cent.

“Improvement is possible, but is necessarily affected by the law of diminishing marginal returns,” he said.

“Since QI is funded from within the health budget, funds are siphoned from direct patient care, compromising clinical outcomes.”

However, in an opposing view, Professor Bill Runciman of the University of South Australia said that the argument for diverting resources from QI to clinical care made sense only if all clinical care was appropriate and properly delivered, and if all QI activities were futile and did not improve care or outcomes.

While much QI activity had resulted in a plethora of poorly designed, underpowered local projects, current practices in clinical care were also often deeply flawed, Prof Runciman said.

“At least 10 per cent of admissions to acute care hospitals are associated with health care-associated harm, as are over a million general practice consultations each year in Australia. This is not a ‘good look’ for a health care system that costs over $100 billion a year (nearly 10 per cent of gross domestic product) and which is on a trajectory to becoming unaffordable,” Prof Runciman said.

“Diverting funds to ‘more of the same’ will produce more of the same.”

Well-designed QI activities represented remarkable value for money, he said.

“The effective use of surgical checklists can reduce perioperative morbidity by a third and mortality by nearly half – potentially saving thousands of lives each year in Australia,” Prof Runciman said.

“What is really remarkable is that uptake of these fairly straightforward interventions has been slow and patchy in Australia.”

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

CONTACT:            Prof Alasdair Millar                          0011 64 211 577 121

                           Prof William Runciman                     0412 183 889