Building a better system

IT IS AN HONOUR to be given the opportunity to serve as the President of AMA (NSW), following the inspiring leadership of Prof Brad Frankum over the last two years. I congratulate Dr Tony Bartone as our Federal President. As the body representing all doctors, the AMA is in a unique position to influence and lead healthcare in Australia.

Complex systems have complex solutions and perhaps nowhere is this more evident than in health. When we consider the broader WHO definition of health being more than just the absence of disease but a state of biopsychosocial wellbeing, it is clear that solutions lie beyond the walls of the hospital or medical office. Issues such as obesity present a clear example of the need to consider the broader factors influencing health, such as urban design, regulation, fresh food availability, health literacy and postcode. Health problems are not just medical problems.

As a general practitioner, I am confronted by the gaps in the health system on a daily basis. We don’t have a ‘health system’ so much as we have as a system of health silos, which leads to an inequitable distribution of resources and health outcomes. Gaps and disintegration make the job of providing quality healthcare more difficult. We need to better integrate care across the different sectors of health, improving meaningful communication, plugging gaps, and reducing fragmentation.

To improve care, I believe these three aspects of healthcare must be prioritised:

• General practices and practitioners need to be better supported to provide quality care to their patient population
• Hospitals and Local Health Districts need to be adequately resourced to look after the health of their population, rather than just hospitals
• Management of chronic illness needs to go beyond the provision of health services, and extend into the community, addressing the upstream factors leading to ill health

Through all the talk of systems, there remains one thing which must remain paramount – looking after the providers. The Triple Aim of Improved Patient Experience, Improved Population Outcomes and Sustainable Cost, is widely accepted as a framework to measure the success of a health system, however as Bodenheimer and Sinsky pointed out in 2014, in their article “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider” this cannot be successfully achieved without an engaged and satisfied workforce. This fourth aim, which makes up the Quadruple Aim, cannot be forgotten in any system change. The AMA Council of General Practice has adopted this as the overarching goal for primary care, but the principles apply across the whole system.

In NSW, I am grateful to have the support of a Council which brings together doctors with experience from many different facets of medicine, whether through their professional specialties, their location or work, gender or personal background. I am particularly pleased to be supported by Dr Danielle McMullen, as our Vice President.

As an association, we have a responsibility to build a better health system, leading to better health outcomes, according to the principles of the Quadruple Aim – better patient experience, improved population outcomes, at a sustainable cost and improved provider satisfaction. As an association we are able to directly support our medical practitioners and their practices, however we can also support their capacity to do their job better by advocating for a better system and the support needed for our patients to achieve a healthier life in its broader definition. Individually and collectively, we can work to create a culture and system to support the health of providers at all levels.

As an overarching goal we need to ensure our patients have access to quality care and our providers, from the most junior to the most senior levels, are given the opportunity, support and tools to provide the best care possible.