On March 11 2004, 44 people attended a roundtable discussion about the framework and the best way to implement it. Participants were nominated leaders in patient safety and represented a wide cross section of organisations from every state and territory in Australia. Professor Duncan Neuhauser, a patient safety and quality expert from Case Western Reserve University USA was special guest speaker and facilitator.

There was agreement that the framework should be designed to help create a health care system where:

• every worker in the system can speak up when something is wrong
• patients can also speak up
• every worker understands their individual responsibility for patient safety and at the same time is able to work effectively in a team
• leaders take a hands-on role in ensuring patient safety and quality
• patients play an active role in their own care and in ensuring their own safety.

Some suggestions were made about the framework and its implementation:

• safety should be integrated into the curriculum for all health care workers, rather than something that is taught separately—it should be the 'background' to everything that is taught
• the more ways of teaching quality and safety the better
• health workers should receive more training in teams, not in separate groups e.g. nurses and doctors training together as students, from the beginning of their training—this will teach teamwork
• collect and make better use of data e.g. realtime data
• public reporting has been shown to work and agreed-upon benchmarks can improve practice and reduce error by creating commitment to change
• improve the uptake of evidence-based therapies to improve patient outcomes—doctors and other health workers need to learn about risk-benefit ratios
• provide more information to patients and involve patients actively in their own care
• involve CEOs and professional bodies—registration should be conditional on awareness of patient safety
• introduce testing and credentialing—the framework can provide the basis for workers' duty statements with performance criteria that can be measured
• move towards standardisation across the health sector
• change cannot be left to individuals; policies are needed at the federal level to drive change right across the system
• rural and remote areas are a special case and specific policies and strategies need to implemented to overcome the barriers e.g. providing properly trained and prepared workers and information to patients who cannot read or speak English
• find ways to partner with indigenous service providers to ensure the strategies are also relevant to indigenous health workers and patients
• choose language for the framework carefully; be aware of the negative connotations of some terms and avoid use of confusing jargon
• the framework should take full account of the organisational learning needed to reshape culture and policy: 'training the system'
• cultural change is needed as much as curriculum development
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