tag:theconversation.com,2011:/ca-fr/topics/quality-control-25885/articlesQuality control – La Conversation2022-05-25T13:26:04Ztag:theconversation.com,2011:article/1830652022-05-25T13:26:04Z2022-05-25T13:26:04ZKenya’s push for a purely formal seed system could be bad for farmers<figure><img src="https://images.theconversation.com/files/463312/original/file-20220516-15-x942bb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Maize grown in a small-scale farm.
</span> <span class="attribution"><span class="source">Alexander Joe/AFP via Getty Images</span></span></figcaption></figure><p><em>Kenya’s government wants farmers to grow crops from <a href="https://www.devex.com/news/farmers-turn-to-indigenous-seed-banks-as-kenya-restricts-informal-trade-102945">licensed seeds</a> only. These are hybrid seeds that are certified free of various seed-borne pests and diseases. The <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/SeedsandPlantVarietiesActCap326.pdf">Seeds and Plant Varieties Act</a> makes it a crime to plant and exchange uncertified seeds. But many small-scale farmers rely on informal exchanges of seeds with their neighbours to secure their food supply. We spoke to Oliver Kirui, whose research focuses on agricultural and economic transformation policies, for insights into the implications of banning informal seed exchanges in Kenya.</em></p>
<h2>What are formal and informal seed exchanges?</h2>
<p>In the formal channel of seed exchanges, a registered seed company manages the production, processing and packaging – and sometimes even distribution – of seeds. This channel provides an idea of what to expect from harvests. </p>
<p>Kenya has about <a href="https://www.accesstoseeds.org/index/eastern-southern-africa/country-profile/kenya/#:%7E:text=Kenya%E2%80%99s%20seed%20industry%20is%20guided%20by%20its%20National,and%20Plant%20Varieties%20Act%20%28Cap%20326%29%20from%202016">26 registered seed companies</a> – 23 are local and three are multinational. The three are Syngenta, Monsanto and the East African Seed Company. The country’s oldest registered company is Kenya Seed Company, a state corporation established in 1956. </p>
<p>The aim of these companies is to produce and distribute superior seeds for commercial and domestic use.</p>
<p>It’s estimated that <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306919213001413?via%3Dihub">two-thirds</a> of the maize seeds planted in Kenyan farms are from formal sources. Maize is a staple food for over <a href="https://www.tegemeo.org/images/_tegemeo_institute/downloads/publications/policy_briefs/policy_brief18.pdf#:%7E:text=Maize%20is%20the%20staple%20food%20in%20Kenya%20with,for%20about%2070%20percent%20of%20the%20total%20production.">85% of the country’s population</a>. </p>
<p>The yield – or productivity – from improved or hybrid maize seeds is often <a href="https://www.econstor.eu/bitstream/10419/191055/1/104571111X.pdf">significantly higher</a> than from traditional varieties. Farmers can expect an average 87% higher yield from hybrid seeds.</p>
<p>Kenya is one of the <a href="https://tasai.org/wp-content/uploads/ken_2020_en_country_report_pub_web.pdf">leading countries in Africa</a> when it comes to formal seed distribution. </p>
<p>The second seed distribution channel is informal. This largely involves the production and exchange of seeds among small-scale farmers. This system is characterised by a lack of seed testing, formal registration or quality control. </p>
<p>Informality makes it difficult to assess the quality of seeds in farms and their harvest potential. It can potentially spread contaminated seeds and plant diseases. It could also mean that farmers are continually planting seeds that have consistently low yields. </p>
<h2>Why do informal seed exchanges exist?</h2>
<p>Informal seed exchanges exist because farmers don’t have access to quality seeds. This is because they are too costly, are unavailable in remote areas or are not available at the right time. </p>
<p>This has been an issue for generations. As a result, farmers often store a portion of their seeds after harvest, which they then plant or share with their neighbours. Sometimes this doesn’t involve an exchange of money. </p>
<p>Seed shortages in the formal system are particularly hard hitting during planting seasons. This is a reality across many small-scale farms in Kenya every year. So informality has thrived, not just because farmers prefer to share seeds, but also because of the distribution challenges they face. </p>
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Read more:
<a href="https://theconversation.com/what-changed-when-ugandan-farmers-rated-input-quality-and-local-vendor-services-177750">What changed when Ugandan farmers rated input quality and local vendor services</a>
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<p>With informal systems, farmers are sure they can get the seeds they need and when they need them.</p>
<p>Informality has other advantages. For example, it allows farmers to preserve some of the <a href="https://www.sciencedirect.com/science/article/pii/S1369848615001284">genetic traits</a> they would like in a seed. </p>
<h2>What does the Kenyan law seek to address?</h2>
<p>This isn’t the first time the government has tried to use the law to fully formalise Kenya’s seed systems. </p>
<p>In 2010, the <a href="https://repository.kippra.or.ke/bitstream/handle/123456789/1102/Kenya-Seed-Policy-2010-1-1.pdf?sequence=1&isAllowed=y">National Seed Policy</a> was published and launched. It was aimed at enhancing the seed sector’s ability to provide farmers with high quality seeds. </p>
<p>In 2016, the <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/SeedsandPlantVarietiesActCap326.pdf">Seeds and Plant Varieties Act</a> came into effect. It aims to develop, promote and regulate a <a href="https://www.accesstoseeds.org/index/eastern-southern-africa/country-profile/kenya/#:%7E:text=Kenya%E2%80%99s%20seed%20industry%20is%20guided%20by%20its%20National,and%20Plant%20Varieties%20Act%20%28Cap%20326%29%20from%202016">modern and competitive</a> seed industry.</p>
<p>Licensed seeds and companies are supposed to ensure that farmers have access to quality seeds, especially for maize and legumes, which are critical Kenyan food staples. </p>
<p>So the concern for the government, as I see it, is that the formal system can assure the country that quality seeds are circulating in the market. With informality, it’s impossible to know exactly what farmers are exchanging and planting. </p>
<h2>Implications of the push for a fully formal seed system?</h2>
<p>I think the big fear with a fully formal system is that it would lead to the rise of monopolistic seed companies. </p>
<p>The heated debates that followed the development of genetically modified and bioengineered seeds included concerns that major producers like Bayer and Corteva <a href="https://grain.org/fr/article/entries/5142-seed-laws-that-criminalise-farmers-resistance-and-fightback#1%20making%20seeds%20illegal">would limit</a> how farmers can use the varieties they sell. </p>
<p>Usually, buyers of these seeds sign agreements that prohibit them from saving seeds from their crops to exchange or resow. Yet, if these companies ran into distribution challenges, household food security would suffer. </p>
<p>Consider maize, for instance. More than 75% of Kenya’s total maize output is produced by <a href="https://basis.ucdavis.edu/publication/policy-brief-maize-technology-bundles-and-food-security-kenya">smallholder farmers</a>. If they were unable to secure maize seed, plant and harvest it, there would be <a href="https://agricultureandfoodsecurity.biomedcentral.com/articles/10.1186/2048-7010-1-S1-S6">chaos</a> in the market.</p>
<p>To avoid this scenario, many farmers have over the years seen the need to save some seeds to grow the following cropping season. It gives them some control.</p>
<p>Aside from dealing with distribution challenges, farmers would also be required to make upfront financial investments in a fully formal system. They will need money to buy certified seeds and fertiliser. While there are microcredit facilities available, they are <a href="https://www.nber.org/papers/w22686">inaccessible to a majority</a> of small-scale farmers.</p>
<p>If farmers cannot afford to buy superior varieties and have no access to an alternative, it means that in six or seven months, the country can expect a harvest shortage. This has huge implications for food security at the household level.</p>
<h2>Is a fully formal system feasible?</h2>
<p>I think formalising seed systems is a good thing because it makes harvests more predictable. But banning the informal system is not the way to go. </p>
<p>In my opinion, the country should work towards a decentralised system that offers a mix of formal and informal seed distribution systems. The government should encourage seed improvements and support local communities to establish seed businesses. But farmers should have a choice. </p>
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Read more:
<a href="https://theconversation.com/why-more-ugandan-farmers-arent-adopting-drought-tolerant-maize-144583">Why more Ugandan farmers aren't adopting drought tolerant maize</a>
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<p>If the government can ensure that there is enough certified seed and the costs make sense, informality will naturally reduce in the long run.</p>
<p>The other question to consider is how the government will implement this policy. It’s a very difficult thing to put into operation and monitor, and the government is unlikely to have the infrastructure to do so. This move is reminiscent of the country’s 2013 effort to ban the hawking of raw milk. The government was unable to implement the ban and it was <a href="https://www.citizen.digital/business/kenya-dairy-board-suspends-controversial-plan-to-ban-milk-hawking-237603">eventually suspended</a>. Today, 85% of the milk consumed in Kenya is raw and hawked informally.</p><img src="https://counter.theconversation.com/content/183065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oliver Kiptoo Kirui does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If small-scale farmers can’t afford to grow certified seeds – or can’t find them – food shortages would follow.Oliver Kiptoo Kirui, Research Fellow, International Food Policy Research Institute (IFPRI) Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1583002021-04-01T20:07:11Z2021-04-01T20:07:11ZWhy Johnson & Johnson throwing out 15 million COVID-19 vaccine doses shouldn’t scare you<figure><img src="https://images.theconversation.com/files/393200/original/file-20210401-21-1aa4vgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine production staff demonstrate operations at a facility in Germany.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakGermanyVaccineManufacturing/5d45624961da484aaf748f5e5e0859db/photo">AP Photo/Michael Probst</a></span></figcaption></figure><p>Human errors at a manufacturing plant forced Johnson & Johnson to throw out <a href="https://www.politico.com/news/2021/03/31/johnson-johnson-vaccine-15-million-ruined-478776">15 million doses</a> of its COVID-19 vaccine – enough to vaccinate 7% of the U.S. adult population. </p>
<p>The New York Times, which first reported the loss on March 31, 2021, called it “<a href="https://www.nytimes.com/2021/03/31/world/johnson-and-johnson-vaccine-mixup.html?smtyp=cur&smid=tw-nytimes">a major embarrassment</a>” for the vaccine-maker and its subcontractor, Emergent BioSolutions.</p>
<p>But while errors with an impact of that magnitude sound shocking, they’re also a reminder that the U.S. vaccine manufacturing process has strict quality control measures designed to catch these problems before they reach the public.</p>
<p>Vaccine manufacturing is complex, with many potential points for errors. As an expert in <a href="https://scholar.google.com/citations?user=cpd3_bYAAAAJ&hl=en">health care operations</a> and the <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3797192">COVID-19 vaccine rollout</a>, I closely follow vaccine manufacturing and approval processes. The multiple layers of quality checks by the producer and external inspectors throughout the process are essential to protect public health.</p>
<h2>Checking the vaccines, and checking them again</h2>
<p>After authorizing a vaccine, the U.S. Food and Drug Administration must <a href="https://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation">approve and regularly inspect</a> each vaccine manufacturing facility. </p>
<p>Before each batch of vaccines is released by the FDA, it undergoes rigorous and extensive testing to ensure vaccine safety. In the case of COVID-19 vaccines, manufacturers are required to submit the results of each quality control test for each batch of vaccines <a href="https://www.fda.gov/media/144412/download">48 hours</a> prior to its distribution. This stringent quality control process has led to what the FDA describes as the <a href="https://www.fda.gov/files/vaccines,%20blood%20&%20biologics/published/Ensuring-the-Safety-of-Vaccines-in-the-United-States.pdf">safest vaccine supply</a> in U.S. history.</p>
<p>The quality control process is also how <a href="https://www.jnj.com/johnson-johnson-statement-on-u-s-covid-19-vaccine-manufacturing">Johnson & Johnson discovered</a> defects within the batch of 15 million doses at the Emergent BioSolutions facility. </p>
<p>The Baltimore plant was one of several <a href="https://www.hhs.gov/about/news/2020/06/01/hhs-adds-628-million-contract-emergent-biosolutions-secure-manufacturing-capacity-operation-warp-speed.html">contracted by the federal government</a> in 2020 to help vaccine-makers ramp up production. The facility was still awaiting authorization from the FDA to deliver the vaccines for U.S. use when the problems were discovered. As standard practice, Johnson & Johnson said it had <a href="https://www.jnj.com/johnson-johnson-statement-on-u-s-covid-19-vaccine-manufacturing">specialists at the facility</a> to check safety and quality. The Washington Post reported that workers at the facility in late February <a href="https://www.washingtonpost.com/business/2021/03/31/vaccine-johnson-johnson-emergent/">mixed up</a> the ingredients for the AstraZeneca and Johnson & Johnson vaccines both being produced there, throwing the entire batch into question. The FDA had <a href="https://apnews.com/article/virus-vaccine-johnson-and-johnson-emergent-biosolutions-d9edd171f8013e17c0be8b13a6db7fed">previously flagged quality control concerns</a> at Emergent’s Baltimore plant related to its testing of a potential treatment for anthrax, according to the records obtained by the Associated Press. </p>
<p>All vaccine manufacturing plants – domestic and international – require authorization from the FDA before they can supply vaccines to the U.S. population. The Johnson & Johnson vaccines currently used in the U.S. were manufactured in Johnson & Johnson’s own <a href="https://www.cbsnews.com/news/quality-control-issues-force-johnson-johnson-to-scrap-doses-of-covid-19-vaccine/">facility in the Netherlands</a>. </p>
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<img alt="A worker looks closely at a series of packaged syringes" src="https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Quality control for the COVID-19 vaccines includes checking the vials, syringes and every other part of the vaccine process.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-photograph-taken-on-september-2-a-worker-checks-news-photo/1228416934">Sajjad Hussain/AFP via Getty Images</a></span>
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<p>The U.S. government’s Operation Warp Speed has also been involved in quality control. At one point, it deployed <a href="https://www.gao.gov/assets/gao-21-319.pdf">16 Department of Defense personnel</a> to two manufacturing sites to fill gaps in the quality control workforce so production could continue.</p>
<p>After vaccines have been distributed, the Centers for Disease Control and Prevention continues to <a href="http://dx.doi.org/10.15585/mmwr.mm7008e3">monitor for any problems in patients</a>.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p>
<h2>How much time goes into quality checks?</h2>
<p>The U.S. learned years ago how crucial quality control checks and independent verification are for vaccine safety. In 1955, the <a href="https://theconversation.com/the-great-polio-vaccine-mess-and-the-lessons-it-holds-about-federal-coordination-for-todays-covid-19-vaccination-effort-152806">polio vaccine rollout</a> led to <a href="https://www.statnews.com/2020/12/07/covid-19-vaccine-safety-lessons-paul-meier-polio/">40,000 vaccine-induced polio infections</a>.</p>
<p>Flu vaccine-maker <a href="https://www.sanofi.com/en/your-health/flu-vaccine-a-race-against-the-clock">Sanofi says it now spends about 70%</a> of its production time on quality checks, and its vaccines are checked again by health officials once they’re shipped from the facility.</p>
<p>The new mRNA technology used by COVID-19 vaccine-makers Moderna and Pfizer is somewhat <a href="http://doi.org/10.1208/s12249-020-01744-7">less challenging</a> because it doesn’t involve live virus, as traditional flu vaccines do. Pfizer says it spends <a href="https://www.usatoday.com/in-depth/news/health/2021/02/07/how-covid-vaccine-made-step-step-journey-pfizer-dose/4371693001/">more than half</a> of its production time on assuring the quality of each batch. </p>
<h2>Manufacturing improvements are also crucial</h2>
<p>Manufacturing process improvement is just as important as thorough quality testing, because errors do happen.</p>
<p>In 2020, <a href="https://apnews.com/article/international-news-oxford-coronavirus-pandemic-883e783962dc562a99864b4b63de9897">AstraZeneca</a> revealed that a manufacturing error led to one-and-a-half – instead of two – doses of its vaccine being given to nearly 3,000 study patients. That error clouded its study results and <a href="https://www.newyorker.com/news/daily-comment/why-there-is-so-much-confusion-about-the-astrazeneca-vaccine">delayed</a> the U.S. approval process by months.</p>
<p>The Biden administration has asked Johnson & Johnson to <a href="https://www.politico.com/news/2021/03/31/johnson-johnson-vaccine-15-million-ruined-478776">step up</a> its supervision of Emergent’s production process. </p>
<p>The incident shows that the industry has work to do to minimize manufacturing errors. Yet, I would argue that the public has every reason to remain confident in the rigorous quality control process that prevents bad vaccines from circulating and ensures vaccine safety.</p><img src="https://counter.theconversation.com/content/158300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tinglong Dai does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccine manufacturing is complex, with lots of potential points for errors. But it also has extensive quality control checks and approvals.Tinglong Dai, Associate Professor of Operations Management & Business Analytics, Johns Hopkins Carey Business School, Johns Hopkins University School of NursingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1110732019-02-05T01:28:17Z2019-02-05T01:28:17ZCladding fires expose gaps in building material safety checks. Here’s a solution<figure><img src="https://images.theconversation.com/files/257129/original/file-20190204-86236-b3h0zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The fire in the Melbourne CBD on Monday was a reminder of the urgency of developing a system that guarantees only materials that meet building safety standards are used. </span> <span class="attribution"><a class="source" href="https://twitter.com/bekahjaynex">Bekah Jane/Twitter</a></span></figcaption></figure><p>A <a href="https://www.theage.com.au/national/victoria/same-as-grenfell-tower-cladding-fears-as-fire-rips-through-melbourne-cbd-apartment-building-20190204-p50vgl.html">fire at the Neo 200 apartment building</a> in Spencer Street, Melbourne, on Monday highlighted the risk to human safety from flammable cladding and other non-conforming building products. Building quality and safety are compromised when there is no transparency about the products used. </p>
<p>Our <a href="https://vimeo.com/314639721">experimental research project</a> suggests a solution that uses sensor technology and artificial intelligence. Finding such a solution to ensure unsafe and substandard products are detected and prevented from being used in buildings is critical, given the scale of the problem in Australia. </p>
<p>In 2014, a <a href="https://www.theage.com.au/politics/victoria/docklands-owners-sue-for-24m-over-fire-as-date-to-fix-cladding-looms-20180909-p502pc.html">similar cladding fire</a> spread across multiple levels of the Lacrosse Tower in Melbourne’s Docklands. This led to an initial audit by the Victorian Building Authority. </p>
<p>In 2017, after 72 people died in the Grenfell cladding fire in London, the <a href="https://www.vba.vic.gov.au/cladding/victorian-cladding-taskforce">Victorian Cladding Taskforce</a> conducted another audit. It found at least 1,400 buildings contained cladding that was non-conforming to Australian standards and/or non-compliant with government safety regulations. Its <a href="https://www.planning.vic.gov.au/__data/assets/pdf_file/0016/90412/Victorian-Cladding-Taskforce-Interim-Report-November-2017.pdf">interim report</a> concluded:</p>
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<p>The Victorian Cladding Taskforce has found systems failures have led to major safety risks and widespread non-compliant use of combustible cladding in the building industry across the state.</p>
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Read more:
<a href="https://theconversation.com/grenfell-a-year-on-heres-what-we-know-went-wrong-98112">Grenfell: a year on, here's what we know went wrong</a>
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<h2>How could this happen?</h2>
<p>The taskforce noted 12 reasons for non-compliant use of cladding. From a systems perspective, these can be categorised as:</p>
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<li> incentive to substitute products driven by cost</li>
<li> no reliable means of independently verifying product certification </li>
<li> product labelling cannot be verified to detect fraudulent or misleading information</li>
<li> products cannot reliably be verified as being the same as those approved (and used)</li>
<li> on-site inspections are unreliable or do not take place.</li>
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<p>Essentially, the taskforce identified a problem with the system of verifying products’ conformance to standards and compliance with government regulation.</p>
<p>Substandard products can be found across a range of materials used in the building sector. These include steel, copper, electrical products, glass, aluminium and engineered wood. For example, the <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Economics/Non-conforming45th">Senate inquiry into non-conforming products</a> found:</p>
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<p>The ACCC [Australian Competition and Consumer Commission] advised that electrical retailers and wholesalers have recalled Infinity and Olsent-branded electrical cables, warning that ‘physical contact with the recalled cables could dislodge the insulation and lead to electric shock or fires’. </p>
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<p>The taskforce estimated over 22,000 homes were affected. It estimated the cost of the recall and replacement at A$80 million.</p>
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Read more:
<a href="https://theconversation.com/reach-for-the-sky-why-safety-must-rule-as-tall-buildings-aim-higher-83223">Reach for the sky: why safety must rule as tall buildings aim higher</a>
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<h2>So how can technology help?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=654&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=654&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=654&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=822&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=822&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257125/original/file-20190204-86198-vmjrnp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=822&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A QR code can tell you about this bottle of Chianti and, by matching against supply chain data, can be used to verify that the wine is genuine.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:%2213_QR_CODE_ITA_LANG_-_Chianti_DOGC_wine_bottle_code_scan_smartphone_-_qr_code_steps.png">Andrea Pavanello, Milano/WIkimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Similar problems have existed in other industries. In the wine export industry, sensor technology has been used to detect fraudulent products in our biggest market, China. This involves scanning <a href="https://en.wikipedia.org/wiki/QR_code">QR codes</a> on bottle labels to identify the manufacturer, the batch and other product details that authenticate wine products. </p>
<p>Scanning technology, involving complex data-matching across different data platforms, is used daily – when we use credit cards, for example. The building industry has embraced some excellent systems to collect data of importance such as <a href="https://en.wikipedia.org/wiki/Building_information_modeling">building information modelling</a> (BIM). However, BIM does not verify authenticity of products. </p>
<p>In the the case of flammable cladding, data verification to solve the use of non-conforming products is housed across a number of authorities, manufacturers and industry associations. Collaboration is needed to design a system to solve the problem. The data should be collected and stored in a manner that enables secure access by a digital verification system.</p>
<h2>What features does the system need to have?</h2>
<p>Our research focus has been on designing a system based on criteria informed by industry innovators and stakeholders. The system must be able to:</p>
<ol>
<li> collect and match product data in real time</li>
<li> verify non-conforming and non-compliant products in real time</li>
<li> maintain integrity of labelling </li>
<li> store data securely so all stakeholders can verify the status of the building, including architects, builders, site managers, inspectors, owners, investors, insurers and financiers</li>
<li> trace data (and composition) throughout the product life-cycle, to predict maintenance, recovery and repurposing.</li>
</ol>
<p>The system we suggest uses two elements, sensor technology and artificial intelligence, to do all this. </p>
<figure>
<iframe src="https://player.vimeo.com/video/314639721" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Technology to solve the problem of tracking and validating building product safety is being developed.</span></figcaption>
</figure>
<h2>How does the system work?</h2>
<p>A mobile app that can scan QR codes or “building material passports” is being developed in Europe. The label will hold relevant compliance data of the assembled product and its component parts. This includes building code compliance, and relevant assessments and certifications. </p>
<p>The product’s QR code can be scanned at any time along the supply chain and throughout the life of the building. This then enables its status to be verified via data matching. </p>
<p>Linking to a platform that uses artificial intelligence (AI) solves the problem of ensuring compliance with government regulation. CSIRO Data 61 has developed an AI software tool that enables regulation to be coded using AI algorithms to accurately determine compliance. We are working with Data 61 to test Australian regulation and ensure transparency for all. </p>
<p>The solution is designed to plug into existing technology solutions, such as BIM and <a href="https://matrackinc.com/">Matrack</a>, to trace the movement of products along the supply chain and throughout the building’s life-cycle.</p><img src="https://counter.theconversation.com/content/111073/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Usha Iyer-Raniga is Vice President, Education (ACTS). She is on advisory boards/committees such as the Property Council's Sustainability and Wellness Committee.</span></em></p><p class="fine-print"><em><span>Kevin Argus does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fortunately, no lives were lost in the latest cladding fire in Melbourne, but it’s a stark reminder of the urgent need to track and verify that building materials comply with safety standards.Kevin Argus, Lecturer, Marketing & Design Thinking, RMIT UniversityUsha Iyer-Raniga, Professor, School of Property, Construction and Project Management, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779212017-05-23T03:47:29Z2017-05-23T03:47:29ZWant to support veterans? 4 tips for finding good charities<figure><img src="https://images.theconversation.com/files/170424/original/file-20170522-7358-lkxsci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Finding a well-run veterans' charity isn't hard with some due dilligence.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/181635383?src=dIU3LaMOXxVqgiFeWWRf8w-1-17&size=huge_jpg">www.shutterstock.com</a></span></figcaption></figure><p>Many Americans donate to charities that help military veterans as a way to honor them for their service to the country. It can, however, be daunting to choose from the more than <a href="http://www.guidestar.org/downloadable-files/us-veterans-organizations.pdf">8,000 such groups</a> operating nationwide.</p>
<p>Donor trepidation is magnified by the <a href="https://oag.ca.gov/news/press-releases/attorney-general-xavier-becerra-sues-charities-falsely-claiming-help-veterans">scandals</a> that have embroiled vets’ groups. In fact, more than 10 percent of the charities tagged as “<a href="http://www.tampabay.com/americas-worst-charities/">America’s Worst Charities</a>” by the Tampa Bay Times and the Center for Investigative Reporting in 2013 focus on veterans.</p>
<p>As a professor who researches nonprofit organizations and teaches about their finances, I have observed that while some veterans’ charities do squander donors’ dollars, others make the most of donations in meeting their mission. Fortunately, a little research goes a long way toward spotting the difference between a good cause and a lost cause. </p>
<p>The following four tips will help you vet these charities.</p>
<h2>1. Learn what exactly the charities do</h2>
<p>Be wary of vague statements about a group’s activities. While language indicating that a charity “supports” or “honors” veterans does not always signal a problem, it does mean you should seek more specific information. Many of the <a href="http://www.wrdw.com/content/news/ConsumerReports-Best-and-worst-charities-to-donate-to-402992406.html">veterans’ charities</a> that have <a href="https://www.publicintegrity.org/2013/09/06/13330/some-charities-claiming-support-veterans-spend-heavily-overhead-instead">faced criticism</a>, such as <a href="https://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=4295">Paralyzed Veterans of America</a> and <a href="https://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=7591">National Veterans Services Fund</a>, have had vague mandates to <a href="http://www.tampabay.com/americas-worst-charities/charities/national-veterans-service-fund-inc">educate the public</a> about what veterans need.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191890/original/file-20171025-25518-tw8tmb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s hard but not impossible to decide which veterans’ charities deserve a thumbs-up – and your donation.</span>
<span class="attribution"><span class="source">Reuters/Kevin Lamarque</span></span>
</figcaption>
</figure>
<p>A detailed description of a group’s mission and activities can instill confidence that veterans truly benefit from its work. An exemplary charity is the <a href="https://www.honorflight.org/">Honor Flight Network</a>, which flies veterans to Washington, D.C. to visit military monuments and honor fallen colleagues. The benefits are self-evident, as I’ve seen firsthand as a flight volunteer. <a href="https://www.fisherhouse.org/about/">Fisher House Foundation</a>, which provides temporary housing to families of veterans receiving treatment at VA facilities, is another good example. There are many ways that organizations can and do directly serve veterans. To find them, look for clear-cut programs you find meaningful and significant.</p>
<h2>2. Find out what share of the money raised for organizations actually supports them</h2>
<p>Another common pitfall: for-hire fundraisers that siphon too much of the donated funds. </p>
<p>Michigan’s attorney general determined that only 39 percent of <a href="http://www.michigan.gov/documents/ag/2016_CFS_Final_Report_557262_7.pdf">funds raised by professional solicitors</a> for charity in the state in 2016 actually supported those groups. The fundraising contractors kept the rest of the money. The picture is even more lopsided for veterans’ charities in the state, with only <a href="http://www.michigan.gov/documents/ag/2016_CFS_Final_Report_557262_7.pdf">23 percent of donations</a> making it into their coffers. The track record in Michigan is no anomaly – <a href="https://www.charitiesnys.com/pdfs/Pennies_Report_122216.pdf">New York</a>, <a href="http://www.mass.gov/ago/docs/nonprofit/professional-solicitations-reports/pro-solicit-report-2015.pdf">Massachusetts</a> and other states have found similar patterns. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/170419/original/file-20170522-7329-1w409kw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Operation Homefront, which Consumer Reports has named as one of the best veterans’ charities, clearly states on its website how much it spends supporting its mission.</span>
<span class="attribution"><a class="source" href="https://operationhomefront.wordpress.com/tag/jim-knotts/">Operation Homefront</a></span>
</figcaption>
</figure>
<p>Professional solicitation is not inherently problematic – but outsourced fundraisers keeping most of the money raised for a charity is a real concern. The federal government does not track this information but most offices of state attorneys general maintain databases that indicate how the organizations raising funds in their states stack up.</p>
<p>Since national campaigns also show up in these databases, even if your own state doesn’t make all the details easily accessible, you can use the online tools other states offer to evaluate different charities. <a href="https://www.charitiesnys.com/pfcmap/">New York’s</a> database is especially user-friendly.</p>
<h2>3. Check out IRS 990 forms</h2>
<p>OK. I know perusing IRS forms is not everyone’s favorite activity. But it’s the best way to discover how donor dollars are actually spent. Finding a charity’s tax form is easy, even if groups don’t post them on their own websites, thanks to databases like Propublica’s <a href="https://projects.propublica.org/nonprofits/">Nonprofit Explorer</a> and the Foundation Center’s <a href="http://990finder.foundationcenter.org/">990 Finder</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=698&fit=crop&dpr=1 600w, https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=698&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=698&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=877&fit=crop&dpr=1 754w, https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=877&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/170398/original/file-20170522-7337-vk6jrz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=877&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Semper Fi Fund 990 form from its 2016 fiscal year suggests that the group does not spend an excessive amount of money on fundraising and administration.</span>
<span class="attribution"><a class="source" href="https://semperfifund.org/wp-content/uploads/2016/12/FY-2016-Form-990-Public-Inspection-Copy.pdf">Semper Fi Fund</a></span>
</figcaption>
</figure>
<p>If you do check out a 990 form, be sure to go to page 10. That’s where nonprofits classify their <a href="https://www.irs.gov/pub/irs-pdf/f990.pdf">expenses</a>, both by function and type. There, you can see where donated money primarily goes. If the organization has a stated focus on providing financial assistance to veterans, for example, you should see lots of grants to individuals on line 2, and not so much in the way of advertising, travel and postage listed on the other lines. </p>
<p>Consider how the <a href="https://semperfifund.org/about-us/financials/">Semper Fi Fund</a>, a group that provides financial and other aid to injured and ill post-9/11 veterans and their families, stated its functional expenses for its 2016 fiscal year. The numbers indicate that the group spends over 90 percent of its funds on its mission. Three-fourths of that mission spending is direct grants to individuals – a good sign.</p>
<h2>4. Inquire about donor privacy policies</h2>
<p>When you make charitable donations, you give away both money and personal information. What charities do with your personal data is part of the picture and how they handle this information varies widely.</p>
<p>Consider how the <a href="https://www.woundedwarriorproject.org">Wounded Warrior Project</a>, among the nation’s most visible veterans’ organizations, has handled donor data. The group came under fire in 2015 and 2016 for alleged <a href="http://www.cbsnews.com/news/cbs-news-investigates-wounded-warrior-project-spending/">waste</a>, as well as routinely selling <a href="http://www.thedailybeast.com/articles/2015/06/08/vet-charity-s-new-fight-to-waste-your-cash">personal information culled from its donors to other nonprofits</a> and defending this practice. The controversy resulted in a <a href="http://www.cbsnews.com/news/wounded-warrior-project-michael-linnington-ceo-cbs-news-investigation-inspires-reforms/">shakeup at the top</a>.</p>
<p>Other groups do a better job of protecting donor privacy. <a href="https://www.fisherhouse.org/about/faqs/">Fisher House Foundation</a>, which clearly states a policy of not sharing or selling donor lists, offers a good example of how to do this. If an organization doesn’t state its privacy policy on its website, take the time to ask.</p>
<p>When it comes to vetting charities, a little work goes a long way. These four steps should help you find veterans’ charities with goals that match your own and that you can trust to make the most of the money you give away.</p><img src="https://counter.theconversation.com/content/77921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Mittendorf has no formal affiliation with any charities mentioned in this article but he has served as a volunteer guardian for Honor Flight Network.</span></em></p>Some veterans’ charities make the most of their donors’ dollars, while others squander that money. Vetting these groups will help ensure your money is well-spent.Brian Mittendorf, Fisher Designated Professor of Accounting, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/545612016-03-20T19:28:19Z2016-03-20T19:28:19ZNo-one should get dud hospital care – it’s time to lift our game on quality and safety<figure><img src="https://images.theconversation.com/files/115400/original/image-20160317-30211-5g2aov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some hospitals have substantially higher costs. Others have higher rates of death. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-141478693/stock-photo-writing-on-clipboard-with-patient-in-background-in-hospital.html?src=mCMExOTXOnVDqrAEYkstyA-1-108">racorn/Shutterstock</a></span></figcaption></figure><p>In 2013-14, <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129552833">Australian governments spent A$105 billion on health</a>; A$44 billion of that was on public hospitals. </p>
<p>The Commonwealth government is increasingly concerned with the size of the health budget and has acted to reduce the <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/mbsreviewtaskforce">inappropriate use of Medicare benefits</a>. But the Commonwealth government has less influence on public hospitals because the state and territory governments control their expenditure. </p>
<p>State governments are facing tighter budgets as <a href="https://federation.dpmc.gov.au/increased-demand-leading-rising-health-expenditure">demand for heath care increases</a> due to an ageing population, greater rates of chronic disease and more service use generally. </p>
<p>The collection and analysis of data on the performance of our health-care system can be used to improve the quality of health services and maybe also reduce costs.</p>
<p>At a national level, the clinician-led <a href="http://www.choosingwisely.org.au/">Choosing Wisely campaign</a> is developing lists of specific tests, treatments and procedures that may be unnecessary and sometimes harmful for individual patients. Recommendations include reducing use of CT scans in the emergency department and <a href="https://theconversation.com/antibiotics-for-colds-x-rays-for-bronchitis-internal-exams-with-pap-tests-the-latest-list-of-tests-to-question-56007">not ordering x-rays</a> for patients with uncomplicated acute bronchitis. </p>
<p>But while improving the decisions made by individual doctors is important, there remain other causes of substantial variation in the safety and quality of care provided in Australian hospitals. This needs to be addressed. </p>
<h2>Varied quality and safety</h2>
<p>Efforts to improve the quality of care in hospitals have traditionally been left to individual hospitals and their managers. But we now have the data to compare different hospitals. We can identify the best and worst performers and, most importantly, determine how to boost the performance of the stragglers. </p>
<p>Identifying and intervening to improve low-quality care requires financial investment. But there are significant potential long-term savings, due to improved efficiency and better patient outcomes. </p>
<p>In New South Wales, the <a href="http://www.bhi.nsw.gov.au/publications/the_insights_series/30-day_mortality_in_nsw_for_five_clinical_conditions">Bureau of Health Information</a> has developed and tested methods for comparing the death rates within 30 days of treatment for heart attacks, strokes, pneumonia and hip fracture surgery. </p>
<p>For stroke patients, ten hospitals had noticeably higher-than-expected death rates for these conditions. An additional 16 deaths were observed in every 100 patients treated at a low-performing hospital compared to a high-performing hospital. </p>
<p>Clinical auditors and review panels should investigate differences in the care provided at the high- and low-performing hospitals and approaches to improve care quality. </p>
<p>Other data show the costs of treating similar conditions varies dramatically. A <a href="http://grattan.edu.au/wp-content/uploads/2014/03/806-costly-care.pdf">Grattan Institute analysis</a> shows the average cost of performing a hip replacement at different hospitals ranges from under A$10,000 to more than A$30,000. </p>
<p>Further investigation may find the higher costs are due to the use of more expensive prostheses and to keeping patients in hospital for longer after surgery. Assessments can then be made about whether more expensive prostheses or extended lengths of stay produce better patient outcomes, which justify the additional costs. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115412/original/image-20160317-30247-28754r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The average cost of hip replacement varies from A$10,000-30,000.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-158329520/stock-photo-midsection-view-of-hands-in-surgical-gloves.html?src=gvoBG1_Kks4jT_O4ZlgKJw-1-52">XiXinXing/Shutterstock</a></span>
</figcaption>
</figure>
<p>We have <a href="http://www.publish.csiro.au/paper/AH15101.htm">analysed hospital data</a> to <a href="https://youtu.be/4B18R5vkeDs">compare costs, outcomes and the care pathways</a> of patients treated for similar conditions at the main public hospitals in South Australia.</p>
<p>After adjusting for differences in the types of patients presenting at emergency departments with chest pain, seven in every 100 patients presenting at a particular hospital were readmitted or died within 12 months. This compared to four to five patients at the other hospitals. </p>
<p>The same hospital spent up to A$669 more on each patient than the other hospitals. Over one year, these additional costs amount to almost A$1 million.</p>
<p>Analysis of the care pathways showed that the hospital with the highest rates of re-admission, premature death and costs, discharged more patients from the emergency department. This hospital also kept patients who were admitted to an inpatient bed in hospital for longer than the other hospitals. </p>
<p>This suggests some patients may have been inappropriately discharged home from the emergency department, while other patients could have been discharged earlier.</p>
<p>Further investigation might look more closely at how and why decisions are made to admit patients from the emergency department and at what might be causing admitted patients to stay longer in hospital.</p>
<h2>Investing in improvement</h2>
<p>State governments are increasingly interested in improving quality. The Queensland government has set up an <a href="https://www.health.qld.gov.au/clinical-practice/innovation/integrated-care/default.asp">Integrated Care Innovation Fund</a> to invest in initiatives to improve efficiency and value. NSW set up a similar <a href="http://www.health.nsw.gov.au/ohmr/Pages/trgs.aspx">Translational Research Grants Scheme</a>. In South Australia, the <a href="http://transforminghealth.sa.gov.au/">Transforming Health</a> initiative aims to improve the quality and consistency of health care across all metropolitan public hospitals.</p>
<p>But while individual efforts to improve quality may have some effect, it is more likely that co-ordinated, systematic approaches will have a greater impact. </p>
<p>Data should be analysed across hospitals on an ongoing basis to identify areas of clinical activity with the greatest potential for improvement, such as the examples above. Findings that quality could be improved should be fed back directly to hospitals. </p>
<p>Specialist teams should be set up to work with hospitals to further investigate areas of concern and to develop and implement improvement strategies. </p>
<p>Rather than going back to the drawing board on health reform, governments need to improve what we’ve already got and bring the poor performing hospitals and departments in line with their better performing peers. </p>
<hr>
<p><em><strong>This article is part of our series <a href="https://theconversation.com/au/topics/hospitals-in-australia">Hospitals in Australia</a>. Click on the links below to read the other instalments:</strong></em></p>
<ul>
<li><p><strong><a href="http://theconversation.com/the-problems-with-australias-hospitals-and-how-can-they-be-fixed-54248">The problems with Australia’s hospitals – and how can they be fixed</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/infographic-a-snapshot-of-australias-hospitals-56139">Infographic: a snapshot of Australia’s hospitals</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/from-triage-to-discharge-a-users-guide-to-navigating-hospitals-54658">From triage to discharge: a user’s guide to navigating hospitals</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/how-much-seeing-private-specialists-often-costs-more-than-you-bargained-for-53445">How much?! Seeing private specialists often costs more than you bargained for</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/why-do-we-wait-so-long-in-hospital-emergency-departments-and-for-elective-surgery-54384">Why do we wait so long in hospital emergency departments and for elective surgery?</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/heres-how-to-boost-hospital-funds-and-end-the-blame-game-54247">Here’s how to boost hospital funds and end the blame game</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/what-are-better-public-or-private-hospitals-54338">What are better, public or private hospitals?</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/do-you-really-need-to-go-to-hospital-time-to-recentre-the-health-system-54406">Do you really need to go to hospital? Time to recentre the health system</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/hospitals-dont-need-increased-funding-they-need-to-make-better-use-of-what-theyve-got-54815">Hospitals don’t need increased funding, they need to make better use of what they’ve got</a></strong></p></li>
</ul><img src="https://counter.theconversation.com/content/54561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Karnon receives funding from the National Health and Medical Research Council. </span></em></p>There is substantial variation in the safety and quality of care provided in Australian hospitals. The data can tell us why.Jonathan Karnon, Professor of Health Economics, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.