I came away with two take-home messages after reading the Health Quality & Safety Commission’s 2017 report, A window on the quality of New Zealand’s health care.
The first was like a school report; good, but could do better.
The report indicates that death from conditions that health care can do something about has steadily reduced over the last decade. Our lives free from illness or disability are similar to other developed countries (and at a lower health care cost than many) so delivers value for money.
Since 2012, through concerted efforts (and resourcing), hand hygiene has steadily improved in our hospitals. There has been an 81 percent decrease in central line associated bacteraemia in intensive care units, a 38 percent reduction in in-hospital falls resulting in a hip fracture and a 39 percent reduction in surgical site infections.
All good, but the report highlights that work still needs to be done addressing equity of access, communication and handover, patient and whānau experience of care, health literacy and the wide and unexplained variation in care processes and outcomes.
The second message was that it’s time to focus on New Zealand’s primary care.
Evidence shows that countries with strong primary care systems have better population health, lower rates of avoidable hospitalisations and relatively lower inequality.1
I agree with Paul Batalden, who observed that, ‘every system is perfectly designed to get the results it gets’. My question is, after leaving the hospital door, where are the nationally coordinated quality improvement programmes supporting integration of services, community-based care, allied health, general practice and aged residential care?
While hospitals are hugely expensive services, the majority of health care occurs outside of secondary care walls. If we use general practice as an example, the sector receives approximately five cents out of every health care dollar but has a massive influence on overall health care spending (eg, pharmaceutical prescribing, laboratory monitoring, access to radiology and other diagnostic tests, and referral to specialist services).
The Health Quality & Safety Commission has recognised this gap and is initiating change. Its attention has turned to shining the light on primary care (eg, Atlas of Healthcare Variation), adapting and integrating existing programmes (eg, medication safety) and lending a hand to support frontline quality improvement efforts (eg, Whakakotahi primary care improvement challenge). Whakakotahi has been purposefully small-scale, with three projects this year, six in 2018 and 12 in 2019. Its aim is for successful quality improvement work to be supported regionally and then into national programmes.
Working with the sector on these and other programmes, by the next Window report, I hope primary care will have its place in the sun.
Author: Dr Susan Wells is a member of the Commission's Primary Care expert advisory group. and the programme's clinical advisor. Sue's contributions offer insights on the context for primary care quality improvement success. Sue works as an Associate Professor of Health Innovation and Quality Improvement at the School of Population Health, University of Auckland, and before becoming a public health medicine specialist was a GP for 10 years.
 Kringos DS, Boerma W, van der Zee J, Groenewegen P. 2013. Europe's strong primary care systems are linked to better population health but also to higher health spending. Health Affairs 32(4): 686–94.