Safer Care Victoria

In 2022-23, Safer Care Victoria worked with Albury Wodonga Health, Albury Wodonga Private Hospital and Insight Private Hospital to contact around 2,000 patients who had a colonoscopy performed in the region since 1 January 2018.

An investigation had found that some colonoscopies performed in the region were incomplete, which may have affected the accuracy of the resulting diagnoses.

Many affected patients underwent a repeat colonoscopy as a precautionary measure.

The Duty of candour is a new legislative requirement for Victorian health services, which came into effect on 30 November 2022.  

The Duty of candour builds on existing elements of open disclosure as outlined in the Australian Open Disclosure Framework and encourages open, honest communication when a patient has suffered a serious adverse patient safety event while receiving care.    

Sometimes things go wrong in healthcare, which can result in a patient being harmed. In these cases it’s important for the health service to:

• understand what happened
• understand how it happened
• make recommendations to reduce the chance it will happen again.

Learning from these events is a powerful tool to prevent harm going forward.

This page provides information on Safer Care Victoria’s role and the actions health services take when things have gone seriously wrong with patient care.

Our Just Culture resources support health services to strengthen their safety culture and improve patient experiences and outcomes.

What is Just Culture?

Just Culture is part of a safety culture that applies a systems perspective when developing organisational processes, including the review of adverse patient safety events. It enables a workplace where employees feel safe to report adverse patient safety events. It promotes the concept of shared accountability between the organisation and the people in the system, supporting a fair (‘just’) approach.

The Safewards model and associated interventions identify the causes of behaviours in staff and consumers that may result in harm - such as violence, self-harm or absconding - and reduce the likelihood of this occurring. Independent evaluations of three trials of Safewards within Victoria, across three different healthcare settings, demonstrate that Safewards can be effective at reducing conflict where mental health consumers require care.