Avoid harm – listen to consumers

Safety, quality and health literacy bring together three vital strands of consumer-centered health care. Each of these three aspects demand recognition and participation of consumers in the development and administration of health services. Safer Care Victoria shares this view. We believe that consumers play a vital role in helping us to avoid making the same mistakes repeatedly. Hindsight shows that in nearly every instance of avoidable harm, consumer letters, emails and phone calls have attempted to warn us about system failures that contributed to that harm. Partnering with consumers is a key driver behind our mission of outstanding healthcare for all Victorians. Always. Safer Care Victoria works with health services to improve opportunities for consumers and community representatives to participate in quality and safety improvement activities.

Safer Care Victoria’s new Partnering in healthcare framework sets out the needs and expectations of consumers. It aims to help health services involve consumers to deliver care that is safe, person and family centered, equitable and clinically effective.

Over 750 consumers told us what was required to improve healthcare services in Victoria.

As part of our methodology, we asked people what was most important to them. Over 750 consumers told us what was required to improve healthcare services in Victoria. This is summarized in the framework which consists of five domains for action: personalised and holistic, working together, shared decision making, equity and inclusion and communication. These five domains represent collective focus areas where work could improve consumer experience and outcomes.

The importance of partnering with consumers in health care is also reflected in national and other key Victorian frameworks, including the National Safety and Quality Health Service (NSQHS) Standards,[1] and Victoria’s Health 2040.[2] Consumer partnership is of overarching importance (NSQHS Standard 2 – Partnering with Consumers), and should be embedded in all work related to quality and safety across health organisations.

 Safer Care Victoria’s Partnering in Healthcare Framework identifies health literacy as an asset that can be built. Healthcare providers and the health system should provide information and improve interaction with individuals, communities and each other to respond to and improve health literacy.

Poor communication in health is a serious problem that can lead to poorer patient outcomes and increased costs to patients and the health system.

Furthermore, we see effective communication between consumers and health professionals as a key element of health literacy. In fact, health literacy is an enabler of communication and participation in health care. Poor communication in health is a serious problem that can lead to poorer patient outcomes and increased costs to patients and the health system. We see this in our work at Safer Care Victoria. That is why we have supported a range of interventions to build clinical communication capability across health services and we will prioritise shared decision-making and effective communication domains for implementation. We aim to support health services increase the use of and application of shared decision aids such as question prompt sheets. This will be incorporated into our clinical communication training programs, so we can ensure clinicians understand their purpose, enhance their skills in using them and actively encourage their patients to adopt them.

While consumer health information is only one type of communication in the clinician-patient relationship, it is a crucial intervention that supports interpersonal communication[3] . Quality information can improve patient knowledge and understanding of their wellbeing, facilitate engagement and help people make informed decisions about their health care choices. In other words, quality health information can improve patient health literacy.

To further support Victorian health services and consumers, Safer Care Victoria in collaboration with the Centre for Health Communication and Participation have developed the ‘Victorian Guide to Producing and Sourcing Quality Health Information’. The guide highlights the importance of increasing the availability of accessible formats and a focus on meeting the needs of diverse populations. It has been developed to address all facets required for high quality health information from governance through to co-design and development of accessible material. All vital to building health literacy. The guide also captures consumer views about health literacy and summarises their views as follows:

  • Health literacy is an asset that could be built and a deficit approach to health literacy – one that sees it only as a problem facing individuals – should be avoided.
  • Efforts to improve health literacy should focus on equity and address patients and carers most in need but with approaches that are relevant to everyone.
  • Health literacy should be improved by having people working in partnerships at all levels as it is a shared concern of consumers, carers, community members, and health professionals and organisations.
  • Improving health literacy requires a shift in culture because leadership is needed for changes to be initiated and sustained.
  • Improving health literacy requires developing or enhancing systems that support people or services to address health literacy.4

You can be literate in many areas of your life and not be health literate.

I used to think that health literacy was just about how well a person could find, understand and use health information — their skills and abilities and what they know about health. But it is much more than this, because the way health information and services are provided affects what you know and what you do about your health. I have also realised that you can be literate in many areas of your life and not be health literate. To be truly empowered as a patient is quite a challenge – even for those of us that know how to navigate the system.

Personally, I think that all too often we focus too much on the patient’s abilities rather than the health care professional’s or the providers. What I have learned in recent years is that we need to focus more on how we can lower the barriers to participation and access to quality, person-centred care. We need to find those who are hard to hear and find their voice. We also need to engage with consumers earlier in the design and development of our health services. Health literacy needs to be integrated into planning, evaluation measures, patient safety, and quality improvement and we also need to build leadership that makes health literacy integral to the mission, structure and operations of the organisation. This will be our focus at Safer Care Victoria in the coming years and we hope that our two guidance documents support our health services to deliver what our consumers have asked of us.

[1] Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC. 2017

[2] Department of Health and Human Services. Health 2040: Advancing health, access and care. Melbourne: Victorian Government. 2016

[3] Coulter A, Ellins, J. Effectiveness of strategies for informing, educating and involving patients. 2007;335(7609):24-7

4 Hill SJ, Sofra TA. How could health information be improved? Recommended actions from the Victorian Consultation on Health Literacy. Australian Health Review. 2017; 42(2):134-9. [Available at https://www.publish.csiro.au/AH/AH16106]