Improving the quality of health-care: personal reflections on some opportunities and impediments

There are considerable opportunities for improving quality of health-care but also significant impediments. Identifying, investigating and responding to adverse events in a way that will limit their chance of recurrence is probably the single greatest opportunity for quality improvement. However, this requires a shift from a culture of blame to one that recognises such events as almost always a system failure. A general rule, the shorter the duration of a hospital admission, the safer it will be, but regrettably this is not well understood by the community. The considerable variation in rates of many medical and surgical interventions between private and public patients and between patients living in different localities provides a great opportunity for determining what rates produce the best health outcomes. It is probable that reducing the health problems of the socioeconomically disadvantaged, a major quality issue, will require innovative approaches to delivery of their health-care.