In a 2013 televised address the Chief of the Australian Army, Lt. Gen. David Morrison, said 'The standard you walk past is the standard you accept'.1 While Morrison was talking about unacceptable behaviour in the Australian Army at the time, equally there are messages here for those who are involved in managing and leading health services. What is the standard of healthcare expected in Australia today? The alternative questions could be: What standards do we walk past in relation to patient safety and quality or compassionate care? or What standards do we walk past in terms of bridging the gap in Indigenous health disadvantage?, among others.If there is a commitment to improving health care in Australia, the system can be viewed in terms of examining five interconnected elements: patients (or clients), processes, people, priorities and partnerships. Focussing on these five elements provides a framework to understand critical health service components if there is a desire to make systems improvement.PatientsThe revelations from the 2013 Francis Inquiry into the failings of the NHS Mid Staffordshire Trust are a case study of failing standards across the five elements, however what appeared to be the most telling were the reports of nursing care that were callous and uncaring. The Inquiry reported among other things '. . .call bells going unanswered, patients leftlying in their own urine or excrement, or with food and drink out of reach'.2 Tellingly, the 'Trust was operating in an environment in which its leadership was expected to focus on financial issues, and there is little doubt that this is what it did. Sadly, it paid insufficient attention to the risks in relation to the quality of service delivery this entailed'3 (p. 45). Clearly, there was a lack of professional courage or an acceptance that the level of care that was being provided to those patients was good enough, which led to adverse patient outcomes and deaths. Surely these are standards that are unacceptable, but somehow they were overlooked, ignored or walked past.Francis made the point in his executive summary '. . .there needs to be a relentless focus on the patients' interests and the obligation to keep patients safe and protected from substandard care. This means that the patient must be first in everything that is done: there must be no tolerance of substandard care'3 (p.66). Improving the health system will require putting patients in the centre of all care and healthcare decisions, with processes, people, priorities and partnerships being critical elements to understand and actively manage.ProcessesOver the past 3 years an increasing emphasis on critical health service processes by the Australian Commission on Safety and Quality in Healthcare has seen the implementation of 10 core mandatory health service standards.4 These standards focus on organisational processes to ensure quality and safety in the patient experience. Even still in today's healthcare system, with these standards and the available technology, we can still give the patient the wrong drug, undertake the wrong surgery or give a patient an infection through failing to undertake simple procedures such as handwashing. Processes are only as good as the people who implement them and it requires every member of the healthcare team to play a part in identifying, speaking up and not walking past when a process is breached. In TeamSTEPPS® training to improve team communication and patient safety, every team member has ability to 'stop the line' if they sense or discover an essential safety breach.5 It is evident that we need more 'stop the line' moments to improve our healthcare system.PeopleIf patients are considered the centre of care, then staffare essential to make this happen. In addition to proactive workforce development and providing positive safe work cultures, the interactions of staffare critical if there is a commitment to patients' interests. …
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Mar 26, 2015
John Tingle 
Open Access