Keeping it real: people at the heart of health care

It has been a year of unprecedented upheaval for health services globally. The challenges faced by healthcare professionals during the COVID-19 pandemic are unmatched in our lifetime.

As the Australian health service workforce strives to prioritise, reorganise and adapt to provide safe health care in the new COVID world, it’s vital that consumers take an active role in their own care.

It has been 12 months since the Australian Commission on Safety and Quality in Health Care (the Commission) released the second edition of the Australian Charter of Healthcare Rights (the Charter). The revision was timely — never has it been more critical to maintain a focus on person-centred care.

Fundamental to good clinical practice, person-centred care supports safe and high-quality care for each individual, so they receive the right care, in the right place, at the right time. The Charter provides clear guidance for all health practitioners on how to deliver person-centred care to consumers, including patients, carers and families.

Progressing to a new landscape

Developed through 12 months of consultation, the second edition of the Charter reflects feedback from consumers about the issues that are most important to them. It describes all of the rights that consumers have and fosters a shared understanding of what people can expect when they receive health care.

Updates to the Charter reflect the change in the healthcare landscape since it was first released in 2008, empowering consumers to ask questions, share decisions about their care and provide feedback. There is clear evidence that people who understand the risks and benefits of their decisions make better choices.

Australian health practitioners should use the Charter as a guide to ethical practice and person-centred care. It is also embedded in the National Safety and Quality Health Service (NSQHS) Standards that all public and private hospitals, day procedure services and public dental practices must meet to maintain their accreditation.

Valuing person-centred care

The revised Charter focuses on consumers being a partner in their own care, to the extent that they choose or are able.

Developed from the consumer perspective and backed up by extensive research, the Charter explains how health service organisations can place the consumer at the centre of planning and delivering health care across seven domains: access, safety, respect, information, partnership, privacy and feedback.

Evidence shows us that person-centred care improves both the safety and the quality of health care. When consumers are encouraged to speak up about their needs and ask questions, they are less likely to suffer complications as a result of better understanding their health situation and the care they require.

Using the Charter is also a requirement for accreditation to the NSQHS Standards, of which Action 2.3 states that health service organisations must use the Charter (or use a charter of rights that is consistent with the Commission’s Charter) and ensure that it is easily accessible to consumers.

A dynamic healthcare environment

The challenges of COVID-19 for our healthcare system are complex and far-reaching, and have changed the way many health service organisations provide care.

For some consumers, this has meant changes in the way they access their health care. While the rise in telehealth and the use of technology to improve patient access has empowered many, there have also been reports of consumers avoiding or delaying accessing health care. The impact of COVID-19 on people’s psychological health and wellbeing is another factor likely to influence decisions to access health care.

In this rapidly changing environment, with competing demands, anxieties and new ways of working, how can healthcare professionals keep consumers at the heart of health care?

It is worthwhile to consider:

• Has your health service organisation considered different approaches to planning and consumer engagement?
• What steps has your health service organisation taken to understand the changing needs of your consumers?

The Charter provides a useful framework that health service organisations can use to maintain their focus on person-centred care. It can be used as a guide — a way to think about and test how potential changes to systems and processes may impact on consumers across each of the seven domains. The Charter can also help to ensure that any changes made help to maintain consumers’ rights.

Supporting partnerships with consumers

Rights to information and partnerships between consumers and healthcare providers are cornerstones of the Charter. Sharing information about themselves can be challenging for some consumers who may not be aware of their rights, or perceive a power imbalance with healthcare providers. Periods of stress and difficulty may amplify these barriers.

However, it is a worthwhile challenge to address as encouraging the voice of the patient can bring about enormous improvements in the provision of care.

Discussing healthcare rights can build trust and help consumers to feel respected and empowered to share their personal information, experiences and preferences, all of which will help to identify the best path towards achieving their healthcare goals.

Health service organisations can use the Charter to support their partnerships with consumers and consumer groups. The Charter highlights the importance of respect, open communication, asking questions and sharing information in fostering successful partnerships.

It provides guidance to healthcare providers on the types of information that consumers should receive to inform their decision-making and provide informed consent. Consumers are also made aware of their right to privacy, to give feedback, to be provided with open disclosure when things have gone wrong and to contribute to improving the quality of health service organisations.

Spreading the word

Resources on the Charter are available to support health service organisations and their consumers to better understand healthcare rights — in both print and digital formats, including as audio recordings and an animation video for screening in waiting rooms.

Ensuring consumers receive information tailored to their needs is a key element of the information domain in the Charter. This is particularly important in reaching vulnerable groups and people from culturally and linguistically diverse backgrounds. In support of these consumers, the Charter has been translated into 19 languages and Braille, and is available in large print and an Easy English version on the Commission’s website. An implementation guide for health service organisations is coming soon.

It has never been more important for health service organisations to remain focused on person-centred care. The Charter provides a clear and accessible framework for health service organisations to ensure that consumers are kept at the heart of the healthcare system, both now and post-pandemic.

Associate Professor Amanda Walker is a Specialist in Palliative Medicine in the Southern Highlands of NSW who has led state-wide work in End-of-Life Care at the Clinical Excellence Commission in NSW. As Clinical Director at the Commission, she has focused on the development of clinical care standards, resources to address Hospital Acquired Complications, and support for clinicians to provide Comprehensive Care. Associate Professor Walker led the release of the revised Australian Charter of Healthcare Rights in 2019.

This article was developed with Lucia Chiappini from the Commission’s Partnering with Consumers team.

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