The President's Message – 21 June
Hello, I’m Dr Jacqueline Small, President of the Royal Australasian College of Physicians. I would like to acknowledge the Gadigal people of the Eora Nation as the traditional owners and custodians of the lands I am speaking on today. I extend my respect to all Aboriginal, Torres Strait Islander, and Māori people. Together we restate our shared commitment to advancing Aboriginal, Torres Strait Islander and Māori health and education as core business of the RACP.
Today I’d like to talk with you about quality and safety in healthcare. At first glance, these two concepts might seem like a given. Surely for all the pressures and issues our healthcare sectors face, they are fundamentally high priorities. Australia and Aotearoa New Zealand healthcare systems generally sit in the middle of OECD international rankings of quality and safety.
In a 2022 Foundation for Research on Equal Opportunity Index of 31 nations ranking countries regarding their healthcare and medical innovation, Australia came eleventh overall but second behind Switzerland for quality of healthcare. Aotearoa New Zealand ranked twentieth overall and sixth for quality of healthcare. But I particularly want to highlight two areas, clinical standards and their relationship to patient centred care.
We all know the quality of healthcare can be highly variable across our two nations. One way of highlighting and then changing this is through the use of clinical standards. As you may know, these standards set the quality of care a patient should receive for a clinical condition or pathway in line with current best evidence. They’re both an aspirational target, and a litmus test of care in any setting.
Professor Anne Duggan is the CEO of the Australian Commission on Safety and Quality in Healthcare. She says:
“Patient safety and quality is often summarised as the right care, in the right place, at the right time and cost. Australia is a high performing health system, but we know we can do better.
We know from Hospital Acquired Complication (HAC) data that care is not always safe, and from Atlas data that there is unwarranted variation in the quality of care we provide.”
I have personally been involved with setting Australian National Standards for the rights of people with intellectual disability to equitable healthcare. People with intellectual disability experience significant barriers in accessing safe and quality healthcare.
They have higher mortality rates, increased incidence of preventable illness and more frequent hospital admissions. Working with the Australian Commission on Safety and Quality in Health Care, we now have four defined steps that set the standard of care that should be met, or aspired to, for people with intellectual disability.
Those steps are “plan with me, understand me, communicate with me and act with me”. Meeting those standards is the target, and anything less needs improvement. Why are these standards important? First, they ensure care is patient-centred. Treating a patient with dignity and respect, involving them in all decisions about their care which results in best health outcomes.
Clinical governance and national standards are key pillars in the safe delivery of healthcare. As Professor Duggan points out, “Good communication between clinicians and patients, their family and carers is also crucial to foster improvements in care. This is especially important during transitions of care, when people are moving between healthcare providers.
The Commission has developed a practical User Guide for the review of clinical variation in healthcare. Using this guide, clinicians can individually – or as part of their clinical review group – examine key clinical activities and outcomes. This allows reflection and may help clinicians identify opportunities to improve their evidence-based practice.” But healthcare standards have a much broader purpose.
They can also point to things we should stop doing, that provide little benefit to patients, and waste time and resources. Estimations of waste in delivering unwanted care are startling. In Australia alone it’s estimated nearly a third of the healthcare services delivered to patients makes little or no difference to their ongoing health. Healthcare standards guide us in reducing the burden on our health services and health professionals from activity that is simply not needed.
Think of what could be possible if we diverted time and resources away from these. What can you as a physician or paediatrician do? Healthcare standards are directly relevant for your Continuing Professional Development.
If you’re a clinician, get involved in the activities of the Australian Commission on Safety and Quality in Healthcare, or Te Tahu Hauora, the Health Quality and Safety Commission in Aotearoa New Zealand. And if you’re a clinical leader, ensure good standards of clinical governance with your clinical teams.
On a completely different topic, our focus as a College is primarily Australasian. It’s easy to forget that we have just over a thousand members internationally, in over 10 different countries and territories worldwide. In the United States recently, where we have 203 Fellows, I was at IM2023 in San Diego, and met one exceptional RACP Fellow.
Professor Virginia Hood, FRACP originally completed her Fellowship training in nephrology at Royal Prince Alfred Hospital and her third year of fellowship training at the former Medical Center Hospital of Vermont. Resident in the US since then, she became a member of the American College of Physicians in 1991 and gained a master’s degree in public health from the Harvard School of Public Health two years later. She’s held many distinguished offices in the ACP but in 2011 she reached the pinnacle.
Virginia was elected for a two-year term as President of the American College of Physicians, leading 160,000 internal medicine physicians, subspecialists, residents, fellows, and medical students worldwide. I found meeting her inspirational, and she stands as an example of how our Fellows continue to contribute to the practice of medicine on the global stage.
Thank you for watching.
Dr Jacqueline Small
RACP President
To contact Jacqueline, please email president@racp.edu.au
We're launching the Switch off the Junk campaign to call on the Australian Government to act on childhood obesity by dealing with rampant junk food advertising saturating children, especially online. Our push comes as a Private Member’s Bill to regulate junk food advertising to children is introduced to the Australian Parliament this week by Independent MP Dr Sophie Scamps.
This is an exciting chance for action to reduce childhood obesity, but there’s still a long way to go before restrictions on junk food marketing are made into law, and we need your help.
Please sign the petition to call on our federal leaders to support regulation of junk food advertising for kids. Together, we can send a clear message to the Australian Parliament to listen to the voices of health professionals and families by putting protections in place.
Please sign the petition
The College has ceased the services of the vendor contracted to deliver the Tracc education technology system for implementation of our new training programs. There have been numerous technology challenges, and we know this will be frustrating and disappointing news for many members, particularly for our Early Adopter setting leads, trainees and supervisors who have championed implementation of our new Basic Training program. Unfortunately, this means the current delivery of the new Basic Training program with Early Adopters will be rolled back until we have suitable technology to enable a well-supported program delivery experience.
Our immediate concern is to ensure there is no disadvantage to trainees. Their ability to progress through training will not be affected. We will be working closely with our Early Adopter sites to smoothly transition trainees back to the PREP program.
We have informed our regulator, the AMC, of this decision. The evaluative feedback provided by our Early Adopter settings has been invaluable in confirming the appropriateness of the design of the new Basic Training program and what is needed from supporting technology to make implementation as easy as possible for members.
Trainee and evaluator data already in the system is safe and has been duplicated separately by the RACP. We remain committed to rolling out our new Basic Training programs with enabling technology as soon as we possibly can. We are actively exploring alternative technology solutions to enable this.
Congratulations to the 31 RACP Fellows recognised in the 2023 King's Birthday Honours list. These awards highlight the outstanding work RACP members do and the importance of that work in local, national and international communities.
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On Tuesday, 9 May 2023, the Treasurer, the Hon Jim Chalmers MP, delivered the Australian Federal budget. The Budget adopted many recommendations the RACP has been advocating for and mirrored several policy priorities championed by our members. It highlighted areas for ongoing RACP advocacy as we continue representing the interests of our patients, as well as the needs of specialists who care for and support them.
We have developed a summary of budget outcomes across the key areas of health system reform, prevention, priority populations, equity and the environment. It outlines key wins within the budget aligned with RACP policy and advocacy priorities, as well as core priorities for future action.
The RACP has responded to the budget via a media release, which provides our support for several budget outcomes. It asks for a stronger involvement and seamless integration of specialists in the proposed reforms of the health system.
Read the budget summary l Find out more
The Policy & Advocacy team continues working with members of the Paediatrics & Child Health Division to develop submissions relating to the health and wellbeing of children, in alignment with the RACP Child Health Advocacy Strategy 2022-2025.
In April, the RACP provided feedback to the Australian Department of Education’s review of the impact of COVID-19 on school students with disability. The review highlighted the key areas of impact for the education and wellbeing of school students with disability. The review also highlighted the areas which continue to be disproportionately impacted by COVID-related school closures. We also submitted a set of recommendations to address these issues.
This month, the RACP provided a submission to the Early Years Strategy Discussion Paper. The strategy will help the Commonwealth create a more integrated, holistic approach to the early years and better support the education, wellbeing and development of Australia’s children. The RACP submission highlights the need for investment in the early years of children’s health, development and wellbeing as the most cost-effective means of tackling long-term health conditions and health inequity.
We also made a submission to the Productivity Commission Inquiry into Early Childhood Education and Care. The key recommendation within this submission calls on the Australian Government to implement universal access to quality early childhood education programs for all three-year-olds, in alignment with recommendation five of the RACP Kids Catch Up campaign.
Ep95: Machine Learning 101
Artificial intelligence-assisted healthcare is reaching maturity in many applications. It could alleviate some of the capacity gaps that are increasingly faced by health systems today. Over the next three podcasts, we focus on artificial intelligence (AI) tools that are designed to assist with clinical practice directly. Most common are the algorithms capable of pattern recognition on medical images, that in some settings perform as well or better than expert diagnosticians at classifying disease. AI models have also been developed to perform regression analyses more complex than classical risk stratification aids.
The standard statistical algorithms used to solve these problems struggle when many variables are introduced, in which case deep learning models that mimic brain networks are sometimes a powerful alternative. In this episode we explain how machine learning algorithms are trained on particular tasks and where the risks of error and bias are being introduced. In part two, we identify the ergonomic issues that affect practical implementation of AI tools in the clinic and in the decision cascade. And in the final episode of the series, we discuss the questions that regulators and lawyers should be asking of this new technology and what role natural language processors might have in medicine.
Guest
Dr Ian Scott FRACP MHA MEd (Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital; Professor of Medicine, University of Queensland)
Please visit the Pomegranate Health webpage for a transcript and supporting references. Log in to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.
RACP Online Learning offers a wide array of dynamic online resources to support you in maintaining the highest professional standards in your field. Our comprehensive resources will enable you to upskill and develop across all of the professional practice domains, including in areas such as quality and safety, ethics, cultural safety, advocacy, communication and beyond. Unleash your full potential with our diverse range of educational resources.
Don’t forget to claim CPD hours for time spent on RACP Online Learning.
RACP Evolve is working on a series of animations to share Evolve Top-5 recommendations to reduce low-value care. RACP Evolve has released another animation to complement the Australian and New Zealand Society of Blood Transfusion Top-5 recommendations. The Evolve animations are an educational tool to visually explain specialty societies’ Evolve Top-5 practices to reduce low-value care.
Watch the Australian and New Zealand Society of Blood Transfusion’s Top-5 animation to find out more.
Read the recommendations on the
Evolve website.
We are seeking Expressions of Interest from specialists including Fellows and qualified non-Fellow candidates where applicable to help us develop draft competency-based curricula for selected Advanced Training programs. We have up to 16 roles available to represent each of the specialties participating in curricula renewal in 2023.
This is an opportunity to shape the future of training in your specialty.
For more information, visit the website. To apply, please email your completed expression of interest form and a copy of your latest CV by 11.59pm AEST Monday, 3 July to curriculum@racp.edu.au.
If you're an RACP member with a passionate interest in policy and advocacy, we want to hear from you. The College is seeking expressions of interest from members to contribute their support and expertise to the policy and advocacy work of the College in their specialty areas. To find out more and the different ways you can contribute please visit:
Represent your profession
Whether you are a New Fellow, established within your career, or beginning to wind down for retirement, the RACP CPD Home can support you to meet your specialist regulatory requirements.
We have a long history as an accredited CPD provider within Australia and Aotearoa New Zealand, and our MyCPD team are at hand to provide you with tailored guidance throughout the annual CPD cycle. Plus, your RACP membership means you can access the RACP Online Learning platform for a selection of tools and resources relevant to you throughout your career.
You have never stopped learning, we’re here to make sure that continues. My RACP. MyCPD Home.
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