Improving Health Care Safety and Quality: Reluctant Regulators

By Dr Judith Healy . Published by Ashgate , Farnham , UK , March 2011 , 350 pages , Hardback , ISBN: 978-0-7546-7644-7 , RRP $138.60 .

Reviewed by Maureen Davey

University of Tasmania

In the changing world of health care governance, this book provides an excellent overview of regulation and regulatory players in regard to patient safety in Australian hospitals. The author, Janet Healy, argues the case for a responsive and networked model of regulation that works through multiple interventions, including workforce training, organisational and professional cultural change, and system design. She then uses data and case studies from UK, Europe and USA to support her call for more effective systems of regulation.

Healy uses the first chapter to thoroughly and clearly describe models of regulation, including her preferred system of networked and responsive governance, while in the second chapter, she argues the need for regulation of the health sector to protect the public, improve performance and increase accountability. She devotes the third chapter to a description of the regulatory actors at national and state level in the Australia within the international and historical context.

In subsequent chapters Healy examines the regulation of professions, workforce, systems and organisations, and allocates separate chapters for the use of external reviews; legal, financial and monitoring strategies for enforcement; and patient participation and public reporting.

Health care quality and safety is a serious public health issue, and this book gives some indication of the population health burden of adverse consequences of health care by making estimates based on retrospective studies and audits at the level of hospitals and clinical units. As Healy reveals, this level of data is useful for designing and evaluating interventions to change clinician behaviour and clinical systems; however, it is not sufficiently robust to provide a reliable picture of health care safety at a population level. The lack of routine systematic data collection on quality and safety, and the lack of analysis regarding suitable indicators for population health purposes, means it is impossible to determine which problems or interventions are having the most impact on patient safety.

Despite the encompassing title, the book focuses on issues of safety in hospitals, rather than on wider issues of health care quality, and it doesn't cover in the health care system as a whole. There is a brief overview of issues relating to over-use, under-use and misuse of treatments, but not of the extent of the problems, the effectiveness or otherwise of interventions, and possibilities for the role of regulation in improving access to services and increasing use of best practice care.

In the preface Healy places value on patient centeredness, and acknowledges the complexity and interconnected nature of health care organisations. However, the discussion in the body of the book centres on hospitals – in isolation from the context of the lives of these people (patients) and as separate entities to other parts of the health system. There is no examination of governance in primary care, not even of those crucial moments for safety and quality when patients and their primary care providers are negotiating hospital entry and exit.

A disappointment was that the book did not address the challenges of applying regulation in health care to get the best population health outcomes and to decrease health and health care disparities based on Aboriginality, geography, socioeconomic status and health conditions. However, this publication will be a useful resource for policymakers, hospital administrators and students interested in understanding more about the regulation of health professionals, staff, and organisational and safety cultures in Australian hospitals.