Audits, errors and the misplace of clinical indicators: revisiting the Quality in Australian Health Care Study

Publication of the Quality in Australian Health Care Study in 1995 represented a defining moment for Australian health care providers. The high incidence and cost of preventable adverse events underscored a need for defined process, error recognition and audit cycle. Despite this, surgical audit has continued to emphasize clinical indicators relevant to technical performance. The greatest burden of preventable error can be traced to deficiencies in the process by which management expectations are supported. Recognizing this, the focus of clinical audit must be expanded. In particular, outcome assessment should be routine rather than sporadic, and should broadly encompass safety, effectiveness and efficiency. Devolving this responsibility to paraclinical groups is in itself insufficient. Quality and safety cannot be adequately addressed unless surgeons actively participate in audit cycle. Failure to meet this challenge in a transparent and timely manner potentially undermines the future of professional autonomy.