Resilience and strength in healthcare standards

Standards exist at many levels with many objectives in healthcare and are essential to the work we do as health care professionals.

Across professions and in all settings, high-quality, enforceable standards mean that I know my colleagues have at least met basic standards in their training and education, the service I am working in meets required safety standards, and the tools I use have met the relevant standards.

I know from personal experience meeting all accreditation standards in a general practice requires consistent and deliberate effort, but we do this because it upholds patient safety and supports the best outcomes.

The launch of the revised Advanced Pharmacy Australia Clinical Pharmacy Standards¹ is a positive contribution to our health system and to driving collaboration between professions.

Despite this, the Australian Medical Association (AMA) is deeply concerned standards in healthcare are under threat.

The challenge to standards we currently face is a political one. Australia is suffering serious health workforce pressures which are experienced by the public as delayed access and by health professionals as increased pressure and often expectations to do more with less. Lowering standards to facilitate workforce growth is an appealing solution, but not the right one.

Despite our current workforce shortages, Australia continues to have one of the best health systems in the world. The most recent report from the Commonwealth Fund comparing the health systems of 10 wealthy, developed nations ranked Australia's system as the best overall and the best in health outcomes.² Rigorous standards in safety, accreditation, education, and training contribute to these outcomes.

Australia performed far worse in terms of access, ranking ninth.²

The challenge before us as health professionals is to resist lowering standards to improve access. Lowering standards puts positive health outcomes at risk. We have seen this threat to standards proposed as a solution in successive reviews driven largely by the health ministers' meeting. Notably, the recent Independent review of Australia's regulatory settings relating to overseas health practitioners (known as the ‘Kruk Review’) has proposed lowering English language standards and introducing a new pathway for specialist international medical graduates to register in Australia outside the control of the medical colleges.³

The specialist medical colleges are responsible for ensuring their training programs develop medical professionals who can demonstrate clinical competence and meet patient expectations. The training programs provided by these colleges are comprehensive, involving a strong emphasis on evidence-based medicine, patient safety, and clinical decision-making. Importantly, the programs are designed for the Australian health system to equip our doctors to work here.

Standards are sometimes framed as obstacles in reviews and as conflicting with workforce demands. The AMA does not agree with this assessment. A lack of workforce modelling and planning over the past decade has contributed to our current situation. We should not undo decades of refining and improving the standards we learn, train and work under to fix what is a workforce issue. It is important to note the Australian Health Practitioner Regulation Agency (Ahpra) has already implemented significant improvements to the bureaucratic processes for overseas applicants, reducing the average time to complete an assessment by 23 days.⁴

The AMA continues to advocate for an independent health workforce agency to perform necessary modelling and planning. This will not solve our immediate issues, but the challenge we have right now is we do not have the full picture of the scale and severity of the problem, and so the problem goes on.

Advanced Pharmacy Australia (AdPha) has demonstrated an important commitment to improving standards in the field of pharmacy. This is commendable and represents the direction our health system should be headed in. AdPha has also championed collaborative models of care that function safely and effectively under clear protocols with strong clinical governance arrangements. This demonstrates we can implement innovative models of care safely; we can maximise patient outcomes, and we can improve our experience as practitioners, all while abiding by our existing standards and frameworks.

Dr Danielle McMullen is the Federal President of the Australian Medical Association and a General Practitioner. Dr Danielle McMullen is also Director of Doctors Health Services Pty Ltd; Member of the Therapeutic Goods Administration Committee for Medicines Scheduling; and Board Member of Australian Digital Health Agency.

Danielle McMullen: conceptualisation, writing – original draft, writing – reviewing and editing.

Ethics approval was not required for this editorial as it did not contain any human data or participants.

Commissioned, not externally peer reviewed.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.