This article was written by Croakey Professional Services and first published as sponsored content on 8 August 2019.
Ten years on from its launch, the Australian Charter of Healthcare Rights has been updated to reflect changing community expectations.
The charter sets out what people can expect from a health service, and the fundamental principles underpinning good practice. It is considered to be a cornerstone supporting the delivery of person-centred care, and is mandated in the National Safety and Quality Health Service Standards as an action to be met for the accreditation of hospitals, day surgeries, and most community health and dental practices across Australia.
In the decade since it was originally released, the health system has experienced a definitive shift away from the paternalistic model of healthcare, and a growing understanding of how people process information, with the empowered, health-literate patient now seen as central to best-practice care.
“There is good evidence that person-centered care is safer care,” explained Associate Professor Amanda Walker, clinical director of the Australian Commission on Safety and Quality in Health Care (the Commission).
"From a safety and quality perspective, it’s about ensuring that patients can speak up, that they can ask questions, and that they understand the information they get. That improves the care that everybody gets and it decreases complications.”
The first edition of the charter has been pivotal in the evolution of health care in Australia. However, it was at risk of becoming outdated amid a burgeoning patient rights and health literacy movement, prompting the need for a refresh.
Following a year-long, nationwide consultation process, the second edition of the charter has been signed off by the states and territories and will be officially launched today.
It places patients at the centre of the health partnership and, in clear and unambiguous terms, sets out what they can expect across a range of domains including access, safety, respect and privacy.
The second edition of the charter builds on the first edition and makes some important new distinctions, replacing the rights to communication and participation with partnership and information, and using simple, first-person language throughout.
Said Professor Walker,
"Rather than a generic motherhood statement or a series of principles, the second edition really clearly highlights what this means to me, on a practical basis.”
Partnership, communication and information
Where it had previously stated that patients ‘may join in decisions and choices about my care and about health service planning’ and receive ‘open, timely and appropriate communication about my health care in a way I can understand’, the charter now sets out in detail what these provisions actually mean.
For partnership, this involves having the right to ask questions, receive open and honest communication, make decisions in collaboration with their provider ‘to the extent that I choose and am able to’, and include others of their choice in planning and decision-making.
Much more guidance has been offered around the kinds of information consumers should receive, including benefits and risks of treatment, waiting times and costs, as well as assistance in understanding and using this information, and a right to accessing their own personal health data.
If something goes wrong, the new edition requires that an explanation be provided as to how it happened, the possible impacts, and what steps are being taken to ensure it doesn’t happen again.
Instead of a right to comment, the charter now safeguards ‘feedback’, specifying that this must not affect the way a patient is treated, and that concerns must be addressed in a transparent and timely way.
“What the charter does is highlight for consumers that they do have standing in the health system,” said Dr Grant Davies, South Australia’s Health and Community Services Complaints Commissioner.
"People no longer see themselves as being passive recipients of health care and I think this charter really encourages them to actively engage and to have legitimate expectations about what that health care looks like and how they experience it.”
As a mediator of disputes when services fail to deliver on the charter, Dr Davies is more familiar than most with its provisions and where, over the years, it has fallen short.
Overwhelmingly, he said, complaints revolve around poor communication, underscoring the importance of providing the right information in the right format and ensuring that it has been adequately understood. This is ever-more critical in the age of ‘Doctor Google’, he said, where a patient presented to a health service fully informed of not only their symptoms but the possible causes, tests to be done and potential treatments.
Communication emerged as a key theme during the Commission’s review, with consumers calling for the charter to be simplified, and for it to be available in a range of formats including infographics, posters and pamphlets, online, and in languages other than English. The second edition will be available in 19 languages as well as Auslan, Braille, and Easy English, all of which have been test-driven with consumers.
Putting the charter into practice
Melissa Fox, from Health Consumers Queensland, said these supplementary resources – and also a forthcoming guide for clinicians and induction materials for new health service staff – will be critical in ensuring that “it’s not just a poster on the wall, but a living, breathing driver for people being able to make decisions about their health care”.
"Yes, it is empowering to arrive at a health facility and see the poster and see that you have rights, but often that’s at a time where we are highly stressed or unwell, we’re worried about our loved ones, and it can be hard to process information when you are going through that. Those other opportunities to communicate this to people will be really important to look for.”
In practice, she said delivering these rights came down to the willingness of health services to truly listen to and engage with feedback, and to recognise that, for all the lip service paid to person-centered care, “it can be challenging to communicate with clinicians because of that power imbalance,” particularly for vulnerable groups.
The challenge of access
Guaranteeing access to health care amid mounting evidence of inequities in our health system, particularly for culturally and linguistically diverse communities, was also a challenge, Ms Fox said.
“It’s really tricky for someone to be told yes, you have the right to access health care and treatment that meets your needs, but actually you’re going to have to travel for three hours and only some of your travel costs will be covered,” she said. “How it unfolds in practice is not always equitable, and there is variation.”
In a country as sprawling and sparsely populated as Australia, with the allocation of finite resources an issue for the government of the day, equity of access will always be difficult.
Professor Walker says the charter describes access as, “if I need something, I can get to that level of care.”
"It doesn’t make sense to have an ICU in every health service, but it does make sense that every service must have a system to escalate patients who need specialist care to the right level,”
Importantly, she said, the right to feedback meant that patients could “run a flag up the flagpole about a lack of access, and point out that in this situation they found things really challenging”.
Professor Villis Marshall, chair of the Commission’s Board, described the charter as taking an important step by enshrining access as a fundamental right.
South Australia has taken the extra step of signing the charter into law, with access to health services also legislated as a right under Queensland’s new Human Rights Act. The rights provided under the charter are also mirrored as obligations for health service practitioners under the Medical Board of Australia’s Good Medical Practice Code of Conduct, meaning they are enforceable by the Australian Health Practitioner Regulation Agency.
An evolving work in progress
Professor Marshall described the second edition of the charter as the next stage in a lifelong journey of supporting and empowering patients within the healthcare system.
The landscape keeps changing. This new edition reflects community attitudes today, but one of the things now that the Commission will be doing is monitoring how successful the new charter is and ensuring that it continues to reflect changes in the system and people’s expectations.”
