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VICTORIAN MANAGED INSURANCE AUTHORITY 

Patient Safety Research and Innovation Program

Victorians enjoy a world-class public healthcare system with state-of-the-art facilities and highly trained staff who put care and compassion at the centre of everything they do. But in a complex health system where so many decisions are made under pressure, things sometimes go wrong.


As the state’s insurer, the Victorian Managed Insurance Authority sees those rare cases where they do. The causes are many and varied, but human behaviour plays a part.


To prevent harm and reduce medical indemnity claims, VMIA works with Victorian health services to implement patient safety strategies.


In 2015, VMIA recognised that research evidence and innovation in the area of patient safety was limited, so it decided to embark on a research journey, calling for tenders from academic institutions to collaborate on a three-year $1.5M Patient Safety Research and Innovation Program


BehaviourWorks was ideally placed to partner with VMIA, given that it has been advising government and non-government organisations for almost a decade on how to ensure that the habits, attitudes, social norms and cognitive biases we all share don’t get in the way of good decision-making and action.


Creative engagement

BWA’s partnership with The Shannon Company, a behaviour change communications company responsible for creating some of Victoria’s most iconic public messaging campaigns, was also beneficial, as it gave the team the ability to creatively engage hospital staff and patients in the program.


Priority challenges

With the Victorian Department of Health and Human Services, Safer Care Victoria and other health organisations, the research team, led by A/Prof Peter Bragge and Dr Breanna Wright identified 40 candidate health challenges affecting patient safety – key among them, misdiagnosis and miscommunication.


Using an established prioritisation process, the team worked with these groups, as well as health services, clinicians and other key stakeholders, to prioritise six trials based on a set of agreed criteria including the impact they would have, how feasible they would be and how important they were.


A seventh, separately-funded project was also added.


Deeper engagement 

To sharpen their focus, the team used a range of tools within the BehaviourWorks Method to review the literature, gather patient perspectives and conduct a series of one-on-one interviews and group dialogues with a diverse array of stakeholder groups including VMIA, DHHS, researchers, nurses, doctors, representatives of Ambulance Victoria, hospital managers, communications specialists and researchers.


Further details on the resulting trials can be found on the right.


Microsite

The trial results were to be presented to key stakeholders in 2020 but COVID-19 meant that the event had to be cancelled. Instead, The Shannon Company created a unique microsite on the patient journey through the trials. Click on the image below to view.

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Simple, scalable interventions

The trials looked at the whole patient journey and were deliberately simple and low cost; intended to provide indicative results on where VMIA and health services could invest in the future.


The trials below were conducted between 2018 and 2020 – please visit the individual pages to see the results.

TRIAL 1 - IMPROVING MEDICAL DIAGNOSIS

This trial tested the effectiveness of a Rapid Diagnosis Discussion tool in reducing cognitive bias among clinicians by facilitating a structured discussion about the possible causes of abdominal pain in 155 patient cases.

TRIAL 2 - COMMUNICATING TEST RESULTS

Ensuring that test results are shared quickly and effectively is a key part of the diagnostic process. This trial looked at the usability and impact of a secure messenging app – myBeepr – to improve communication. 

TRIAL 3 - SUPPORTING INFORMED CONSENT

This trial – which was halted due to Covid-19 – aimed to explore the potential of a behavioural reflection tool in encouraging clinicians to reflect on their conversations with patients and improve informed consent discussions. 

TRIAL 4 - ENHANCING THE PATIENT VOICE

This trial involved the co-design of a simple bedside notepad that allowed patients to write down questions they’d like to ask their healthcare team, but didn’t have the confidence or feel that they had the opportunity to ask.

TRIAL 5 - ESCALATION OF PATIENT CARE

This trial explored whether an interactive training video could help clinicians overcome some of the behavioural barriers to the timely escalation of care for deteriorating patients.

TRIAL 6 - IMPROVING HOSPITAL COLLABORATION

This trial focused on improving the inter-hospital transfer process by fostering an empathetic and collaborative mindset among clinicians who receive non-critical patient transfer requests, typically from regional or rural hospitals.

TRIAL 7 - COMMUNICATION IN THE BOARDROOM

This trial explored the potential of simulated training with a trained actor to give health service board members greater confidence in having difficult conversations.