Navigating Healthcare Regulations and Compliance in Australia:
Tips for Health Executives

What is regulatory compliance in Australia?

Regulatory compliance simply means obeying the law. Regulators provide rules and regulations and guidelines for organizations to follow. If you want to be regulatorily compliant, you, as an organization must obey these rules and guidelines.

Regulatory compliance in Australia refers to the observance of several rules, regulations, and standards established by governing bodies and professional associations. These laws are made to protect consumers, the environment, and the overall stability of the Australian economy by ensuring that business operations are carried out legally, ethically, and safely.

Who regulates the health system in Australia?

The health System in Australia is navigated and regulated by multiple entities, organizations and the government. For you, as a health executive to understand how Australian healthcare is navigated, here are some of the authorities and their websites you need to pay close attention to:

Australian Government Department of Health:

The Australian Government Department of Health plays a central role in the development and implementation of health policies and programs at the national level.

Therapeutic Goods Administration (TGA):

The TGA is responsible for regulating therapeutic goods, including medicines, medical devices, and vaccines, to ensure their safety, efficacy, and quality.

Australian Health Practitioner Regulation Agency (AHPRA):

AHPRA regulates health practitioners to ensure their competency, safety, and adherence to national standards. It works in collaboration with National Boards for various healthcare professions.

National Health and Medical Research Council (NHMRC):

NHMRC is Australia's leading expert body promoting the development and maintenance of public and individual health standards, guidelines, and research ethics.

Australian Commission on Safety and Quality in Health Care (ACSQHC):

ACSQHC develops and maintains national standards, guidelines, and accreditation programs to ensure safe and high-quality healthcare services.

Australian Digital Health Agency:

This agency oversees the implementation of digital health initiatives, including the My Health Record system, to improve the accessibility and security of health information.

Department of Veterans Affairs (DVA):

DVA provides support and services to veterans and their families, including healthcare services and benefits.

These regulatory authorities collectively contribute to the oversight, regulation, and improvement of the Australian health system, making sure that healthcare services are safe, effective, and of high quality. It's important to keep track of updates from these organizations for you to stay informed about changes and developments in the healthcare landscape.

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How does the healthcare system work in Australia?

One of the world's top healthcare systems nowadays is found in Australia. It offers you and your family access to high-quality, secure, and reasonably priced healthcare. It's a major factor in why Australians have one of the world's highest life expectancies. There are many different types of health care providers in Australia, including general practitioners (GPs), who offer primary care services. The Clinical Governance Standard, Partnering with Consumers Standard, and Clinical Safety Standard are the three main standards in the Primary and Community Healthcare Standards, and each of them contains a different set of implementation requirements.

National Safety and Quality Primary and Community Healthcare Standards of the Commission on Safety and Quality in Health Care. These new guidelines, which were introduced by the Minister of Health and Aged Treatment, are meant to safeguard Australians from injury and raise the grade of medical treatment provided in these facilities.

A framework can be used to apply the new healthcare standards to a wide range of healthcare services, including dental offices and allied health services. With more than a third (34%) or $63.4 billion of Australia's total health expenditure in 2017–18, the primary healthcare sector is a substantial component of the country's healthcare system.

The importance and purpose of the healthcare system in Australia.

It is essential to understand what healthcare rules are and their significance when discussing compliance with them wherever in the world. Thus, we come to appreciate the significance and aim of the Australian healthcare system, which aims to provide everyone in Australia with high-quality, secure, and inexpensive healthcare. Australians have one of the longest life expectancies in the world, and this is a major contributing factor. In Australia, there are a variety of healthcare providers, including general practitioners (GPs), who provide primary care.

Implementing the new healthcare regulations

To help healthcare providers implement the new standards and to help consumers understand what the standards mean for them, the Commission is developing substantial information. All Australian primary and community healthcare services actively engaged in patient care are encouraged to adhere to the Primary and Community Healthcare Standards.

As we can see, the new rules are being followed as independent assessments and recognition of healthcare services are made. Then, as a healthcare provider, Australians will be able to inquire about your certification and look for an accreditation badge or certificate at your healthcare facility or service website.

The Australian Government, state and territory partners, primary and community healthcare services, and community health organizations are just a few of the important parties who helped create the Primary and Community Healthcare Standards.

They comprise of three individual standards:

Clinical Governance Standard

Explains the tools, methods, rules, and regulations required to provide safe, high-quality healthcare. A key component of risk management is continuous improvement, along with ensuring that the workforce has the necessary training, expertise, and understanding to deliver healthcare.

Partnering with Consumers Standard

Outlines the measures that ought to be taken to enable patients and consumers to participate as partners in their own care. Providing the information, they require in a format they can understand to enable them to make well-informed decisions regarding their medical treatment.

Clinical Safety Standard

Discusses safety and quality hazards that are frequently present in primary and community healthcare services, such as infection control and safe communication.

What challenges does Australia face in the health system?

Currently, the Australian healthcare system

An aging population and increasing demand for health services

A rise in the population's senior adults and their demand for health care. A younger, healthier population will require many kinds of healthcare services. increased need for allied health specialists including physiotherapists and occupational therapists. We will require an adaptable and well-trained health workforce across the nation to fulfill these new and distinct requirements.

Increasing rates of chronic disease

Managing chronic conditions is another challenge Australian healthcare faces. The rise in many chronic conditions such as skin cancer, Chronic Obstructive Pulmonary Disease (COPD), Arthritis, Asthma Alzheimer's Disease and other dementia to name a few. There is an increasing demand for flexible, person-centered treatment models to address this, you as a health executive should adhere to the government-approved national approach to coordinated care in your health plans and policies, including GP-led team-based care for patients with chronic and complex conditions. We, at Medfuture continue to work on ways to improve sharing of health and medical information between providers.

Making the best use of emerging health technologies and medical research

The way healthcare is provided will be drastically altered by advances in medical research. For instance, genomic testing will assist doctors in making earlier diagnoses of health issues and diseases, as well as in offering people better options for both prevention and therapy. However, these innovations come at a high cost and with some challenging moral and legal questions that must be resolved.

From digital health technology to automated health and diagnostic services, new technologies have an impact on health and medical services as well. These developments improve the healthcare system, but they could also have an effect on patients and medical staff as a whole. The Australian government is sponsoring technological and medical advancements through the Medical Research Future Fund in an effort to address some of these problems. As a result, more concepts will be developed, examined, and made available to Australians in all sectors of healthcare. With thorough data, you can improve health policies, programs, and services. As a result, it is essential to our job that diverse types of health information are connected throughout the healthcare system.

Other challenges

Australia shares other health system challenges with countries around the world — the rising cost of the health system, being able to respond to new health issues, inequality in access to health services and hospital waiting times. For this reason, we see that most of the medical practices offer a 15-minute consultation time.

Strategies for navigating healthcare regulatory uncertainty

An integrated approach to growth

In the healthcare industry, fee-for-service is no longer the standard. As a result, settlement models are increasingly value-based, aiming to improve the health of patients as a whole. Meanwhile, unions and acquisitions, alliances, and joint ventures are all growth paths to gain the scope and scale of services and infrastructure capabilities needed to compete and succeed in this environment.

But if you want to scale the new value-based model, it's crucial to choose the right next actions that will serve as a guide. Among them are focusing on the ideal strategic outcome or competitive edge, identifying the weaknesses or risk areas in the current products or services, using financial and operational metrics to determine the best organizational and financial models, and weighing all the relevant factors, such as potential partner organizations, the next strategic move, and the optimal organizational and financial model for all parties involved.

Consumption and information technology

Healthcare firms may now change how they conduct business, who they work with, and how they relate to patients thanks to technology. Organizations must coordinate cost, quality, patient involvement, and customer experience if they want to succeed in the rapidly evolving digital health environment.

The patient is at the core of this technological upheaval because they are more connected, involved, and empowered than ever. They want a comparable experience in their health and wellness with straightforward, well-coordinated interactions because they are accustomed to technology making their lives easier.

Those who embrace and acknowledge the impact of the digital and technical future on the patient experience will emerge as winners.

Cost optimization

Rather than seeking to cut costs, leading companies must focus on cost optimization, which allows organizations to reduce expenses in areas that affect patient care the least while making investments that can achieve better and more sustainable outcomes in the long term.

A variety of tactics are used to build more effective, efficient, and long-lasting care delivery models as part of the optimization of cost and experience. This method ensures optimization throughout the whole spectrum of care delivery by tightly integrating an organization's operational, clinical, and IT teams.

Hospitals can achieve a level of financial stability that enables them to look beyond the here and now and engage in prospects for growth and advancements in value-based care by switching to a cost-optimization approach.

Excellence in Compliance

Every healthcare business must integrate forward-thinking compliance efforts into their daily operations. The explanation is straightforward: while regulatory compliance has a high cost, the cost of non-compliance is much higher.

Leading healthcare companies have mastered the art of anticipating and preparing for regulatory inspection. Stakeholders, members, and regulators are more confident because of integrated compliance capabilities. With the confidence to venture into unfamiliar ground, this proactive strategy gives leaders the tools they need to expand their healthcare organizations.

Transforming from a react-and-respond approach to a proactive stance does more than protect an organization’s assets and reputation: it enables growth. (Faig, 2017)  

Steps to ensure complete healthcare compliance in Australia

Step 1: Stay informed

First and foremost, healthcare organizations should seek to learn and understand the right practices and standards in order to stay on top of regulations. The Department of Health has established numerous standards for Australian healthcare. The Therapeutic Goods Administration, the Aged Care Quality and Safety Commissioner, and the Private Health Insurance Ombudsman are a few of the health executives and regulators who support the Department of Health. By monitoring healthcare compliance in a number of areas, these authorities seek to protect the general public.

It is vital to know the regulations that apply to your organization in order to develop company policies and procedures that comply with them.

Additionally, regulations are ever-changing. You should constantly keep up with the adjustments and new implementations to stay compliant.

You can do this, among other things, by keeping an eye on updates on the websites of governmental and regulatory organizations and by going to important industry conferences and meetings. These techniques will make sure you receive the most recent information and keep you informed of any recent or upcoming regulatory changes for the sector. Then, you'd be better equipped to respond to changes.

It can be challenging to read and understand the acts, regulations, and rules, despite their importance. Healthcare organizations could be short on resources and experience.

Then it would be advisable to consult with qualified and knowledgeable legal counsel who could analyze the rules and let you know when operational modifications are necessary. As an alternative, you may create an internal professional team to monitor regulatory changes.

Step 2: Implement policies and procedures

After understanding what you have to comply with, the next step is to implement the policies and procedures that healthcare providers have to abide by.

Create your policies and procedures while closely adhering to the regulations. They should be simple to understand for your staff.

To generate buy-in, you will need to communicate and educate employees on the implemented measures. Employees need to be aware of the significance of ensuring healthcare compliance as well as the rationale behind some rules and regulations.

Additionally, you may involve your staff in the formulation of policies and procedures. The policies and procedures that employees have a voice in and have contributed to are more likely to be followed by them.

Infractions of compliance should also result in penalties or fines. Employees would be discouraged from disobeying rules and regulations as a result.

Step 3: Conduct internal compliance audits

When it comes to healthcare compliance, employees may overlook regulations or take advantage of loopholes.  This is where an internal compliance audit comes into play.

A compliance audit examines how you adhere to regulatory requirements. In this process, compliance officers or outsourced professionals measure compliance, identify bottlenecks and gaps in current practices, and treat noncompliance.

First, the auditors would perform a risk assessment to identify processes with potential or existing risks in the healthcare organization. They then prioritize the processes based on the likelihood of their risks occurring and the significance of the risks’ impact on organizational goals.

Thereafter, the auditors develop an audit plan. The plan would document the details of each risk-causing process so you could determine which high-risk areas to address. They would also schedule internal audits regularly throughout the year.

Finally, the auditors execute the plan and obtain findings from it. In order to better accomplish healthcare compliance, healthcare management should study the report and determine whether any changes to current policies and processes are necessary.

With internal compliance audits, healthcare organizations can ensure they are staying compliant with regulatory requirements. Employees would also be less likely to breach the regulations when checks are in place.

Step 4: Adopt compliance tools

Healthcare compliance can be extremely overwhelming. Your organization will need to constantly fork out resources to maintain it, which eventually increases operational costs. Fortunately, the adoption of compliance tools can help mitigate these negative effects.

The goal of compliance tools is to automate and streamline risk identification and mitigation. This takes away the burden on employees to monitor the changing regulations and compliance levels in the organization. They also aid in developing policies and procedures that align with the regulations and support compliance training and education. There is no one-size-fits-all or all-in-one compliance tool. Consider what is suitable and necessary for your healthcare organization. Here are some tools we recommend:

Visitor management system

Adopting an effective visitor management system helps to ensure compliance with COVID-19 regulations such as social distancing and health declarations. It controls the number of visitors entering the healthcare facility and restricts people who are not allowed in the vicinity. You can also freely adjust the parameters based on the regulations at your healthcare facilities to stay compliant.

Furthermore, the visitor management system allows you to track footfall and gain visitor insights so that you can better allocate your resources.

Billing compliance software

Billing and coding regulations are some of the most complex requirements to meet for healthcare compliance. Billing compliance software will help keep personal and sensitive information secure and ensure compliance with the Privacy Act.

This software also captures any billing or coding errors and flags them before employees take any further action. Hence, you will achieve compliance coupled with greater efficiency.

Vaccination management system

With vaccination gradually becoming mandatory for most Australian healthcare and aged care workers, it is critical to ensure your healthcare organization quickly adapts. Instead of performing manual checks on your workers’ vaccination statuses, you can adopt a vaccination management system.

Vaccination management systems help to automate the sign-ins of your workers, approving only those who are vaccinated. Workers simply need to upload their vaccination evidence onto the system and have it verified. The system also stores the information securely to enable faster check-ins in the future.

Additionally, the system monitors and updates itself on changing state regulations, enabling the automatic adjustment of entry policies and requirements.  Hence, you can be assured that your healthcare organization stays compliant with the vaccine mandate.

Stay on top of government regulations by following the guidelines and referring to the official Australian healthcare websites. Most definitely, you should adapt them and implement other tools and processes to suit your organization’s needs.

An effective healthcare compliance strategy is one that will achieve 100% compliance and minimize costs.

Lastly, ensuring complete healthcare compliance in Australia is tedious and complex; being non-compliant is even more devastating. So, you should make compliance one of the key priorities in your organization.

How can Medfuture Help You?

Medfuture specializes in empowering Health Executives across Australia in their job search journey. We meticulously screen clinics and hospitals to present our clients with top-tier opportunities. With unparalleled access to the best job offers in the industry, we ensure that executives have a comprehensive view of their options. Our expertise lies in precisely matching candidates to their ideal roles, considering their unique skills, preferences, and career aspirations. At Medfuture, we're dedicated to helping Health Executives seamlessly transition into their next fulfilling role in the dynamic healthcare landscape of Australia.

Look for your next job be it as a Healthcare Executive or a medical professional when you visit the Medfuture website, today.