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In 2012 an important study was published in The Lancet by a team led by nursing researchers from Griffith University. It showed that changing peripheral intravenous catheters only when the clinician thought it appropriate, rather than every three days, had no adverse impact on patients. AusHSI funded research showed this saved Queensland Health $1M each year, providing an opportunity for funds to be used for cost-effective services.

The research team soon became an implementation team and worked hard to push the new policy in their hospital. And after 2 years of effort routine IV changes were stopped. This is how health services research is supposed to be: find an issue; assemble evidence to support an improvement; then implement it.

The new policy lasted less than 12 months before it was overturned, quickly and without much discussion. It happened when a key healthcare associated infection indicator rose above a national benchmark. Despite no proof the new policy was to blame the hospital executive returned to routine 3-day

changes. A magic wand had been waved to re-invigorate old inefficiencies. It nullified a massive research and implementation effort and pushed costs up again for no health benefit. Spreading this innovation among other Australian hospitals and other health services is now less likely.  An opportunity for a simple and important efficiency gain that could have spread across countries has been magicked away.

The wand was waved because the new policy was an easy target, after the national benchmark was missed. The wand waving worked due to poor incentives faced by the hospital executives.

  • The cost-savings from the new policy were based on staff time and reduced use of consumables. These savings are soft and diffuse, and difficult to convert into cash. No one could drop $1M onto the CEO’s desk each year.
  • After the benchmark was missed the hospital executive was likely acutely aware that an isolated patient safety incident might be linked back to the new low cost policy.  The headlines would read “Cost Cutting in Hospitals Harm Patients”. This keeps hospital administrators awake at night and journalists should be aware of this.

I hate to admit it, but if I were the decision maker on this one and was forced

to choose between improving social welfare by saving health services costs, or risking a nasty splash in the media, I would consider an inefficient but easy alternative.

That this wand of inefficiency could be waved so easily and with so much effect is a problem for health services researchers. We need strong and independent governance about how we organise our health services. See Elizabeth Martin’s issues brief on rationing for an excellent treatment of this idea.

Nick Graves
AusHSI Academic Director

The study was undertaken by the AVATAR group at Griffith University.
Follow them on Twitter @AVATAR_grp