To reduce fatal medical errors, look to the world of accountancy



AFTER heart attacks and cancer, medical errors are the third biggest cause of death in Australia. And believe it or not, there’s an easy solution without having to invest the billions we spend on other medical research.

For full video presentation click here

Human error accounts for about 40 deaths per day in Australia’s health care system, according to a recent article in relation to a BMJ study. A further 50,000 Australians are injured annually through medical mistakes. In comparison, Australia’s national death road toll is far lower at 1,400 a year.

Medical Error Third biggest cause of deathAustralia is not alone in having this problem. In the US, for example, 250,000 people die a year due to medical errors. This is equivalent to one Airbus A380 crashing each day. Yet, the broader problem gets no national or international media attention despite the regular headlines about further scandals – most recently, the deadly gas mix-up that left one baby dead and another with suspected brain damage at Bankstown-Lindcombe Hospital.

ahpraIt’s easy to say we should leave it up to the regulators and governments to solve the problem. But so far, budget-strapped governments are only making the healthcare system sicker and financially weaker. Indeed, tighter healthcare funding is only compounding the problem and leading to more mistakes.

Even the Government’s national regulation agency cannot get it right. Dr Kerry Breen, a former president of both the Medical Practitioners Board of Victoria and the Australian Medical Council, recently alleged numerous problems with the AHPRA scheme and called for its powers to be pared back so that it merely maintains a national registration database.

Healthcare standards matter but they do not exist!

11In addition, Research by the Australian Patient Safety Foundation National founder, W B Runciman, Professor of Patient Safety at the Centre for Population Health Research at the University of South Australia, reveals that 50% of GPs’ consultations are sub-optimal and that GPs have limited access to vital data, work in silos and don’t follow any guidelines they have.

So perhaps the solution should not be left in the hands of government or doctors, some of whom have a vested interest in covering their backs after mistakes.

Delving into this problem, I have been amazed to discover that there are no internationally accepted bodies or standards that ensure a timely response to systemic medical errors. In addition, no one is monitoring the problem.

The February 2016 Towards public reporting of standardised hospital mortality in Australia report spectacularly reveals there are no international or local clinical standard methods for collecting hospital death information, consistent policies, coding or reporting in all Australian hospitals.

1This data, of course, is vital in ensuring better advice and treatment from healthcare providers, better funding from governments and more innovation and development for technology companies and research organisations.

aThe most telling of research papers is from the former national chairman of the Federal Government controlled Australian Medical Board who reaffirms these concerns and calls for an “independent body” away from government because the current legislative process is too costly and time consuming for patients.

As an accountant, I believe we can borrow from my profession, one that has also experienced numerous scandals and disastrous errors over the years.  In response to corporate failures, in 1973, the profession set up the International Accounting Standards Board/International Financial Reporting Standards which has lowered the number of large corporate collapses.

Its International Financial Reporting Standards (IFRS) have raised the standards to encourage public trust in the accounting and financial system.

These did not stop the global financial crisis. However, the US later response to move to full adoption of these standards illustrates that they are a way forward in reducing the unnecessary corporate collapses that have resulted in so many ordinary people losing their family homes.

It is important to note the post-mortem comments from UK Speech by Hans Hoogervorst, chairman of the IASB in 2014, on the global financial crises:

b“In fact, I remain convinced that pre-crisis IFRS delivered all the essential information for market participants to see that trouble was brewing. Everybody could have seen that the banks had next to no tangible capital. In sum, IFRS clearly showed the biggest dangers in the financial system.

But these dangers were so big and manifold that most people simply closed their eyes to them.”

The story sounds familiar in the healthcare system. Active professional bodies can fix this problem. It is people and not governments that are empowered to fix this problem and who can make a difference.

Professional Bodies need to play a greater role or else…!

cSince the last financial crisis, it was agreed by the competing national professional accounting bodies the common enemy was the Government and doing nothing was not an option or they would over regulate.

How it works today!

Each of the competing national professional bodies (similar to the medical and allied health colleges) – for example, the Institute of Chartered Accountants and CPA Australia – joined the international standards board’s national body representative.

These same national bodies specialise in different disciplines, but jointly represent the accounting profession to the Government for any smart ideas for change.

dThey implement change amongst their members with little conflict. Ultimately, the framework shows that it is in everyone’s best interest to work together with the community’s best interest at the forefront. Robust open and transparent debate is encouraged before ideas are put into practice. This depoliticises an issue.

eThe standards and ethics are enforced on members by professional bodies like the Institute of Chartered Accountants or CPA Australia. Members and their practices are regularly monitored to ensure they are meeting peer-reviewed standards and ethics. Members are kept up-to-date with all changes so the public can have confidence in their services.

If they do not, members of the public can complain to these professional bodies and have members disciplined or removed from their registers. This also can affect government registrations, such as their tax agent board licence and professional indemnity premiums.

If the professional bodies do not respond to complaints appropriately, they risk losing accreditation to the international body. Rival professional bodies can also be established if they meet the criteria.

angryMembers of the public can complain directly to government bodies if they want to. The professional bodies cannot control this, but have an opportunity to mediate. The key role of the profession is to act as a cushion and avoid any unnecessary legal costs and stress for the member, client or members of the public.

Maintaining public confidence is critical. This reduces government regulation and red tape.

Looking at 2015 annual financial reports, there were less than 80 complaints made against 250,000 accountants compared to 4,500 complaints against doctors in Australia. We could also borrow from the aviation industry which has its own successful standards board.

Where to from here?

gI would like to see the medical and healthcare professions set up a self-funded International Healthcare Standards and Ethics Board, to help us move towards best practice and which can be customised to at the local level in each country.

An Australian-based body would enable immediate centralised patient incident reporting and standards. It would also review the ethical challenges around this and other shortfalls in the system. This type of board is likely to decrease lawsuits, bullying and intimidation, duplication and wastage, commoditisation of health and political or vested interests.

It would also provide a central reference point to coordinate and interact with the professions, local and international governments and organisations involved in research, teaching, workforce, funding, medical device and software research and development.

In addition, it would save government budgets and improve the quality of healthcare, health outcomes and health literacy. This model would also provide many exciting employment opportunities locally and around the world. (To find out more, click here.)

To get debate going, we have planned a meeting at the end of the year with the heads of all the key medical and health professional bodies and stakeholders. Invitations are being sent.

But we also need your help!

tPlay a small but an important big for change if you want to help the people you care about the most. Support us by simply talking and sharing this story with your friends and colleagues.

If you want to improve access to healthcare and make it more affordable and accessible, click on the information below and then like our new Facebook page and share:

    1. Key Letters of Support – Professor Bill Runciman, Senator Nick Xenophon and others;
    2. The solution: To establish and international standards and ethics board;
    3. Our solution was cited in the American Journal of Physicians and Surgeons December 2016;
    4. For an Overview watch the video A Fair Go for Patients and Providers
    5. Facebook like and share our page at A Fair Go for Patients and Providers.
    6. One last thing! We are looking for self-portrait photographs of people who have suffered or passed away due to a health system error to put a human face to this project.

We hope it will be used in a forthcoming Ted Talk we are planning for next year. We need 250,000 photos.

Send a photo via send a facebook direct message at A Fair Go for Patients and Providers.

Reproduced from Medical Observer 13 September 2016

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