PCHSS Winter Newsletter 2020
As the COVID-19 pandemic continues to disrupt our lives, research into the resilience and sustainability of our health systems has never been more important.
In our winter newsletter edition, we highlight some of the recent work of our investigators and system partners.
Who are the PCHSS?
The PCHSS is a $10.75M, five-year collaboration involving 17 lead investigators, 20 expert advisors and over 40 system implementation partners from around Australia. Our vision is that our research findings significantly influence the development of a more resilient health care system – one that is affordable, cost-effective and delivers improved health outcomes for all Australians.
- Consumers Health Forum of Australia will be hosting a webinar entitled “Social prescribing – a script for better living” on 31 August. Organised in collaboration with Mental Health Australia, the webinar will feature commentary from leading experts, including international colleagues and local consumers. Details for the session can be found here.
- Professor Johanna Westbrook from PCHSS’ Using Analytics, Technology and Shared Data Research Stream will be a featured speaker at the upcoming International Society for Quality in Health Care (ISQua) virtual conference on patient safety on September 1st and 2nd. See details here.
- PCHSS will be holding webinars in October on Market Forces in Healthcare and in November on AI and Patient Safety. Details will be available shortly.
PCHSS Annual Investigator meeting – 20 July 2020
PCHSS completed its third year of operation in June. Despite the disruption caused by COVID-19, it was a very productive year. Here is a quick overview of PCHSS accomplishments in Year 3:
To mark the end of our third year, we held our Annual Investigator meeting followed by a workshop on virtual care and prioritising health system research. The online Annual Investigator meeting on 20 July brought together over 40 of our researchers, system partners and other associates. Over the course of the afternoon session, participants presented on the wide-ranging themes that constitute the PCHSS’ work, took stock of the network’s growth over the years, and consulted on avenues for future research and collaboration as we enter our fourth year.
Our Annual Report, available on our website, has more details about our research outcomes.
Snapshot from online PCHSS’ 2020 Annual Investigator meeting
PCHSS Workshop on Virtual Care and Research Priority Setting Strategies – 21 July 2020
On 21 July, the PCHSS hosted an online workshop on the topics of virtual care and research priority setting processes. We were joined once again by more than 40 investigators, health system partners and collaborators for this two-hour workshop.
The virtual care session was chaired by Associate Professor Liam Caffery from the University of Queensland and PCHSS’ Telehealth Research Steam. He explained what virtual care is and how it relates to telehealth, and set the stage for the presentations by:
- Dr Tracey Tay from the NSW Agency for Clinical Innovation, who spoke about the NSW Health Virtual Care Initiatives and,
- Drs Teresa Anderson and Miranda Shaw from Sydney Local Health District who spoke about the RPA Virtual.
The Research Priority Setting Strategies session was hosted by Professor Paul Glasziou from Bond University. He is also the Research Lead for the PCHSS Research Stream Impact of Different Sources of Health Care Waste. Professor Glasziou explained the need to balance extensive priority setting processes with new opportunities that arise.
The two other presentations in this session were by:
- Dr Denise O’Connor, from the PCHSS Research Stream Lower Cost Delivery of Effective and Appropriate Services and Monash University and Cabrini Institute, who spoke about priority setting processes, such as Delphi studies, and
- Dr Zoe Michaleff, from PCHSS’ Research Stream Impact of different sources of healthcare waste Research Stream and Bond University, who presented several specific cases using a project to identify healthcare waste and low-value care to exemplify the need to balance rapid priority setting with more resource intensive methods.
Professor Rachelle Buchbinder from PCHSS Research Stream: Lower cost delivery of effective and appropriate services and Monash University and Cabrini Institute provided a wrap-up of the session.
Finally, Professor Braithwaite closed the two sessions with some thoughts on creating a more sustainable health system.
A summary of the day is available on the PCHSS website.
PCHSS researchers published over 220 papers on health system sustainability in our third year of operation (2019-2020). Check the Our Publications page on our website for these and other papers.
In the last quarter, some of our publication highlights include:
- Braithwaite, Glasziou, Westbrook (2020) The three numbers you need to know about healthcare: the 60-30-10 Challenge. BMC Medicine — Previous research has shown that 60% of care is in line with evidence or consensus-based guidelines, 30% has little or no value for the patient, and 10% is harmful. This 60:30:10 Challenge has persisted for three decades. In this paper, Professors Braithwaite, Glasziou and Westbrook propose a solution to this wicked problem.
- Glasziou, Sanders, Hoffmann (2020) Waste in covid-19 research. BMJ — Prior to the pandemic, it was estimated that up to 85% of research effort was wasted. The causes included poor research design, inappropriate reporting of results, and inefficient regulation. Unfortunately, COVID-19 has only exacerbated these problems. The authors recognise the need for immediate action to tackle the problem and call for a long-term strategy to reduce research waste before the next pandemic.
- Westbrook, Li, Raban, Woods, Koyama, Baysari, Day, McCullagh, Prgomet, Mumford, Dalla-Pozza, Gazarian, Gates, Lichtner, Barclay, Gardo, Wiggins, White (2020) Associations between doublechecking and medication administration errors: a direct observational study of paediatric inpatients. BMJ Quality & Safety — While doublechecking the administration of medications in paediatric hospitals has been standard practice for decades, there is little evidence of its effectiveness in reducing errors. Carrying out a direct observational study of 298 nurses administering over 5000 medication doses to more than 1500 patients, Professor Westbrook and colleagues found that compliance with mandated doublechecking was very high, but that it had no significant association with medication administration errors. The study raises questions about whether doublechecking policies should be reconsidered.
- Snoswell, Caffery (2020) Current Economic Evidence for Teledermoscopy. Current Dermatology Reports — Given the low number of dermatologists compared to the general population in many places, teledermoscopy has the potential to increase access to timely dermatology surveillance and diagnosis for numerous patients. Reviewing the (still limited) economic evidence on this practice, the authors found that teledermoscopy — which has been shown to have good diagnostic accuracy — can be cost-effective in some situations, such as when it leads to avoidance of unnecessary referrals to specialist consults. Moreover, consumers have been shown to be positive about and willing to pay for teledermoscopy.
- Braithwaite, Ludlow, Testa, Herkes, Augustsson, Lamprell, McPherson, Zurynski (2020) Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review. BMJ Open — This systematic review of the literature on healthcare sustainability from a systems or organisational point of view examined definitions, theoretical frameworks, and measures of sustainability. It found that few studies evaluated the sustainability of interventions over the long term.
- Wiig, Braithwaite, Clay-Williams (2020) It’s time to step it up. Why safety investigations in healthcare should look more to safety science. International Journal for Quality in Health Care — In this article, the authors draw on currently underutilised models and theory from safety science to suggest new ways to support safety investigations in healthcare.
- Cheng, Scott, Sundararajan, Yan, Yong (2020) An Examination of Public Hospital Productivity and its Persistence: An Index Number Approach. Australian Economic Review — In this paper, the authors examined the level and changes in the productivity of public hospitals over time in Victoria, Australia, using the concept of total factor productivity. Overall, the study found substantial differences in productivity across public hospitals in Victoria. The findings suggest new policy recommendations for managing small hospitals.
Since the last edition of our newsletter, PCHSS researchers have been featured in more than 80 popular press stories.
Here are just a few recent news stories:
- Australia bragged it was leading the world in its coronavirus response. What went wrong? (The Independent, 9 July 2020, featuring the commentary of Paul Glasziou)
- Telehealth in lockdown meant 7 million fewer chances to transmit the coronavirus (The Conversation, 22 June 2020, by Centaine Snoswell, Anthony Smith and Liam Caffery)
- Health inequalities, COVID-19, Black Lives Matter (ISQua, 15 June 2020, by Jeffrey Braithwaite and Wendy Nickin)
- Australia joins world-first AI group to tackle ethics, commercialisation (Financial Review, 15 June 2020, article describing new group, including Enrico Coiera, nominated to represent Australia in a global artificial intelligence partnership)
- Walking and talking our way to good health: social prescribing and prevention (Health Voices, May 2020, by Yvonne Zurynski)
- Waste in COVID-19 research (ABC News, 18 May 2020, radio interview with Paul Glasziou)
- ‘Iso’ – a spur to think about social prescribing (Croakey, 13 May 2020, by Leanne Wells)
- Benefits vs costs: Is it time for pubs and restaurants to re-open? (The Conversation, 11 May 2020, by Jonathan Karnon)
- ‘The genie is out of the bottle’: telehealth points way for Australia post pandemic (The Guardian, 13 May 2020, featuring the commentary of Teresa Anderson)
- As a Roadmap to Recovery is released, what can health economics offer decision-making? (Croakey, 29 April 2020, by Anthony Scott)
- What if the vaccine or drugs don’t save us? Plan B for coronavirus means research on alternatives is urgently needed (The Conversation, 21 April 2020, by Tammy Hoffmann and Paul Glasziou)
In May, Professor Rachelle Buchbinder, Research Lead on PCHSS’ Lower Cost Delivery of Effective and Appropriate Services stream, received a nearly $3M, five-year NHMRC Investigator Grant, entitled, “Better evidence more rapidly implemented to optimise health for people with musculoskeletal conditions.”
As Professor Buchbinder explains,
“Musculoskeletal conditions place a huge burden on the world’s population. There remain large gaps in the evidence, large delays in getting evidence into practice and policy, and large societal and clinician misconceptions about best care for these conditions. My focus for the next five years will be to improve outcomes for people with musculoskeletal conditions through better evidence, more rapid uptake of evidence into practice, and better strategies to reduce low-value care.”
- @WePublicHealth: PCHSS took over @WePublicHealth for the week of 20-25 July! We posted a retrospective of our accomplishments in Year 3. You can see the full set of tweets and reactions in our Twitter moment. https://twitter.com/i/events/1287502828286570496
- New YouTube Videos: PCHSS posted two new, short videos featuring Professor Jeffrey Braithwaite and Associate Professor Yvonne Zurynski speaking on health system sustainability
- PCHSS COVID-19 Research Page: In rising to the challenge of these unprecedented times, PCHSS Investigators and partners have published research, resources, and editorials to increase the evidence base around COVID-19 and to inform policy makers, healthcare professionals, the public and other decision makers. We have created, and are continually updating, a new webpage of these resources. Visit it here.
If you would like to partner with a stream of health system sustainability research, or you have an interest in any of the above areas of research, please contact us.
The Partnership Centre Team on behalf of:
Chief Investigator Professor Jeffrey Braithwaite
Founding Director, Australian Institute of Health Innovation, Macquarie University