Doctor, my hospital's not well
The National Health Performance Authority was set up under the National Health Reform Act 2011 to shine a light on Australia's hospitals and health service providers - and to spur them into improving their medical and surgical performances. This week it published a comparison of national emergency department response times.
This being the first statistical snapshot of its kind, the results did not always confirm popular conceptions or beliefs. The emergency department of the Canberra Hospital, for example, is often maligned for its poor performance in treating Triage Category Five (or non-urgent) patients within the 120-minute targeted time - and indeed, the report found that only 54 per cent of patients presenting there left within four hours. But in a finding that punctures accusations that Canberra is a perpetual laggard, the report found that, on average, Australia's other major metropolitan hospitals also managed to shift only 54 per cent of all their emergency room patients within four hours. The worst performed hospital (Princess Alexandra in Brisbane) managed to clear only 33 per cent on time.
Calvary Hospital, which has always tended to post better emergency department response times than its south-side peer, cleared 63 per cent of its patients within four hours, a creditable performance. The quickest acting campus, Fremantle Hospital, saw 74 per cent of patients depart within four hours.
A less welcome aspect of this report was the evidence that some institutions may struggle to meet the key performance targets mandated by COAG, meaning some states or territories could miss out on additional federal health funding. Indeed, Chief Minister Katy Gallagher has said she does not expect Canberra Hospital to meet or better the target of clearing 64 per cent of all emergency room presentations within four hours, and that consequently the ACT will forgo a bonus payment of $800,000.
Canberra Hospital is said to have been on track to meet the COAG emergency room target, but it appears the data tampering uncovered in April has put paid to such ambitions. Ms Gallagher is said to be hopeful the Commonwealth may allow a dispensation for the disruptions caused by the doctoring of data. But if the Commonwealth relents it may be more because significant numbers of other major hospitals could struggle to post the necessary improvements.
Indeed, this report suggests the 2015 goal of hospitals treating, admitting or discharging 90 per cent of patients from emergency wards within four hours may be beyond the reach of many.
Encouragingly, some of the hospitals classified as large metropolitan, major regional, large regional, and medium are well advanced in attaining that goal. Indeed, two (Williamstown Hospital in Victoria and Albany Hospital in WA) have already reached it. But a number of others (Mount Druitt, Grafton and Hornsby Ku-ring-gai, all of which are NSW hospitals) are barely managing to move four in 10 of their emergency room patients within the prescribed time.
Logically, the smaller hospitals should find it relatively straightforward to meet national health reform targets. With their limited capacity and resources, they are largely bypassed by ambulance and emergency services crews ferrying critically injured patients. The major metropolitan hospitals, on the other hand, face considerable challenges in lifting their ratings, not least as a result of rapidly growing demand for their services. Indeed, some of the states and territories might reasonably argue that rapid population increase is the main reason their large hospitals are having trouble meeting the new targets, and that as the architect of Australia's policy of high immigration, the federal government is duty-bound not withhold any of the extra money it promised last year.
On the other hand, the states' administration of hospitals has, in certain cases, been egregious, and the Commonwealth's resort to performance-based payments is probably the only sure way to drive improvement. WA elected some years ago to try to lift the emergency room response times of its hospitals, which is why so many have figured as top performers in this report. Other states like NSW have either mismanaged or failed to invest adequately in their public hospitals. They may miss out on Commonwealth money as a result. This progress report, however, may serve the useful purpose of concentrating the laggards' minds .