To: Professor Chris Baggoley
Chief Executive
Australian Commission on Safety and Quality in Health Care

Dear Chris

As usual, health is hitting the headlines. This week alone we’ve had the Butcher from Bega, the new National Health and Hospitals Reform Commission, and the predictable pitches by health funds and state governments for more money. Today’s health ministers meeting will chew up yet more media space. And it’s safe to predict that coming weeks will bring more stories about disasters in the system.

So where have you been?

If you and your Commission care about these issues, we haven’t heard. And yet you’ve had every chance, given the ongoing media interest in issues so closely related to patient care, to talk publicly about your work and why it’s important. There have been so many missed opportunities to explain why health reform will miss the point if it focuses narrowly on reducing hospital waiting lists rather than putting improved safety and quality of care right at the top of the agenda.

Maybe it’s not fair to put the blame on you; after all, you really only got the Commission gig quite recently. And I know there are plenty of people with high hopes that your personal and professional mix – being an engaging, energetic sort of bloke, as well as a respected medical specialist with experience in health bureaucracy – might make a difference.

But then they also point out that, no matter how well you do, the Commission has, in a sense, been set up to fail. It’s got no teeth to ensure its policies are implemented. It’s mainly focused on hospitals, when the picture should be so much bigger than that.

And it’s governed by a mob of Commissioners who are not exactly brimming with the sort of change management expertise and drive you’d hope to find in the group responsible for pushing the system-wide change that’s needed. (Mind you, the same criticism could be equally levelled at the National Health and Hospital Reforms Commission).

It’s not surprising that patient safety experts are lamenting how little has changed in the decade since the Australian Quality in Healthcare Study showed 17% of all hospital admissions were associated with adverse events related to health care, the majority considered preventable. A recent article in the Journal of Internal Medicine noted, for example, that more than half of 670 hospitals recently reviewed by the Australian Council of Healthcare Standards had inadequate quality control systems for patient safety.

I hear you’ve been out around the traps, talking to some of the leading patient safety experts about what you should do. I also gather you’ve been advised to engage in a little bridge-building, as your predecessor, Diana Horvath, didn’t exactly endear herself to many of those people and organisations the Commission needs to enlist.

But there is at least one thing you could achieve without a major overhaul of the Commission. Hit the hustings and tell us what you want to achieve, why it’s important, what needs to change for it happen, and how you will know whether you’ve succeeded. Or not.

You may disagree, but I reckon that means engaging with the media and the public. If the public isn’t well informed enough to care about patient safety, then you can’t expect the politicians to get it. Creating a patient-centred health system, as the jargon goes, means you have to focus on patients at least as much as bureaucrats, doctors and other health professionals.

By the way, I reckon it’s no coincidence that you got the gig. As a former vet, you must be used to working with animals (and we all know that the turf wars in health care make the animal kingdom look positively civilised). And, being an emergency medicine specialist, I’m sure you can recognise a disaster when you see one.

Good luck – you’ll need it.

Melissa Sweet
Health journalist

Peter Fray

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