Jessie McPherson Private Hospital is committed to ensuring patient and staff safety by minimising risk, complying with the National Safety and Quality Health Service Standards (NSQHSS), and in the continuous monitoring and improvement of services.

Jessie McPherson Private Hospital’s Quality Framework provides the governance framework to monitor, review and enhance patient safety, risk management and quality initiatives across the organisation, including strategies to meet the quality and safety requirements of external stakeholders. It helps to do this by setting out a number of key objectives:

  • Clinical Governance: clinical excellence is provided through a strong governance structure that focuses on quality and safety
  • Quality Indicators and Improvement: clinical incident and risk management drives a process of continuous quality improvement
  • Patient Experience: patient care and services lead to the best possible outcomes; consumer participation is embedded across all levels of the organisation, and the principles of health literacy are embedded into systems and processes for effective communication
  • Performance and Skills Management: staff understand their roles and responsibilities in the overall patient experience
  • Clinical Effectiveness: Robust audit processes are in place to assess, evaluate and improve healthcare delivery

Our hospital, facilities and services are all accredited with the relevant authorities.

In July 2021, Jessie McPherson Private Hospital was successfully accredited against the National Safety and Quality Health Service Standards (NSQHSs) (second edition).

Our next organisation-wide survey against the NSQHSS will occur in May 2024. To find out more about these standards, please visit
Providing feedback

At Jessie McPherson Private Hospital we welcome all feedback from patients, their carers and families as this provides us with a valuable insight into our facility and helps to inform us about how we can continue to improve our care and services. Feedback may include a compliment, suggestion or complaint about care, treatment or services provided. Any information you provide will not affect your care.

Complaints are a valuable source of feedback at Jessie McPherson Private Hospital and all patients, their family and friends have the right to make a complaint or query any aspect of their healthcare.

If you or your family have comments or concerns during your stay, please ask to speak with your nurse and/or the Unit Manager. We would like the opportunity to resolve any of your concerns as they arise.

To provide further feedback you also have the options to:

If you have tried to resolve your complaint and are still not satisfied, you may wish to contact the Health Service Commissioner. The Office of the Health Service Commissioner is an independent, impartial statutory authority and can help with seeking answers to your concerns about a health service. The service is free and confidential.

To contact the Health Service Commissioner:

  • Phone: (03) 8601 5200 or 1800 136 066
  • Email:
  • Write a letter to: Level 30, 570 Bourke St, Melbourne 3000.


Australian Charter of Healthcare Rights in Victoria
Officer of the Health Services Commissioner
Health Services Liaison Association
Australian Commission on Safety and Quality in Health Care

Patient Satisfaction Survey

Jessie McPherson Private Hospital is proud to partner with Insync in association with Press Ganey in surveying our patients upon discharge from hospital. Patients may receive a survey within 2 weeks of going home. The survey contains de-identified information that we use to monitor and measure patient satisfaction and helps inform us about any areas where we can improve.

Consumer participation

Consumer participation is widely recognised and valued as an aid to improve patient health outcomes as well as the quality of health care delivery. At Jessie McPherson Private Hospital, we have set a number of key priority areas to integrate consumer participation into every part of the organisation. These objectives support working with consumers at both a strategic and operational level, as well as supporting patient-centred care approaches with patients, families and carers at the individual level.

Our Jessie McPherson Private Hospital Partnering with Consumers in Healthcare Framework 2021-2025 demonstrates our commitment to partnering with consumers to guide the development, implementation and improvement of private health care treatment and services.

Consumer representatives are involved in the governance of our health service as well as provide input into designing and delivering care. There are many ways that consumers can play a role in improving the quality of care we provide. You can become involved at any time as a consumer representative at Jessie McPherson Private Hospital by joining our Consumer Register.

If you would like further information about how you can be involved, please email us and we would be happy to contact you to discuss this unique opportunity.

Working together

Partnering with consumers

  • We are here to help you – talk to us if you have any worries or concerns about your care and treatment
  • Make sure you know how to use your call bell to alert your nurse. Your nurse will check on you regularly throughout the day and night
  • We will introduce ourselves to you and your family members and give you the confidence to trust us with your healthcare – if someone does not introduce themselves, please ask them to do so

Preventing and controlling healthcare-associated infection

  • Hand hygiene is the single most important factor in reducing infection whilst in hospital. Please wash your hands before and after visiting the toilet and before all meals
  • All people (including staff and visitors) need to clean their hands before they touch you
  • It’s ok to ask our staff if they have washed their hands before having contact with you

Medication Safety

  • It is important that you tell us about all the medications that you are currently taking
  • Tell us if you have an allergy or you do not understand what your medication is for
  • Talk to your doctor, nurse or pharmacist about any concerns you might have about your medication
  • We will check your identification band, and ask your name, date of birth and address EVERY time you are given a medication
  • It is important that you are given information about all medications that you are going to take at home – you may be given a brochure or printed information by your nurse or pharmacist

Comprehensive Care

Preventing falls

  • Patients are at an increased risk of falling when they are in hospital
  • On admission, a falls assessment will be completed to determine if you are at risk of a fall
  • Staff will discuss with you ways to help you avoid a fall
  • Please use your call bell to call for assistance if you need to get out of bed Wear laced-up or snug-fitting shoes or slippers with rubber soles
  • If you have a walking aid, make sure it is in good condition and that it is the right size and height for you
  • Use your walking aid and do not rely on furniture for support
  • Take your time when turning around or when you are moving from a lying position to a sitting and standing position
  • We are here to help you, so please don’t hesitate to ask for support if you need it

Preventing pressure injuries

  • Pressure injuries are caused by unrelieved pressure, shearing or friction resulting in pain and damage to skin and sometimes underlying tissue
  • In hospital, patients are at risk when they are lying or sitting on a chair
  • On admission, an assessment will be completed to determine if you are at risk of developing a pressure injury
  • To help prevent a pressure injury, try and keep moving – even in bed. Change your position as much as possible to reduce pressure
  • Keep skin clean and dry – moisturise very dry skin
  • Alert your nurse or doctor if you notice any areas on your skin showing changes or if there are areas that are painful
  • We are happy to help you change position and can provide a special mattress or cushion for support

Communicating for Safety


  • We will regularly check your identification to ensure we give you the right care
  • Tell us if any of your personal information is wrong or needs updating
  • Always wear your identification band on your wrist or leg
  • Tell us if you have any allergies you will be given a red identification band.

Handing over patient information

  • All staff looking after you need up to date information about your condition and treatment
  • The sharing of information between staff involved in your care is known as “clinical handover”
  • You can expect that staff will involve you in handover information on a regular basis to keep you informed and ensure that your needs are being met
  • If you have any worries or concerns about your treatment, please let us know

Using blood products safely

  • Some patients may require a blood transfusion during their hospital stay
  • If you do require a blood transfusion, the nurses will ask you to tell them your name, address and date of birth and you will be required to sign a consent form
  • If you object to having a blood transfusion, it is important that you discuss this with your doctor and that your wishes are recorded in your medical record

Detecting changes in your health condition

  • Our staff are trained to detect changes in your health
  • You and your loved ones can help by letting staff know if you do not feel well, if you think that your health condition has changed, of if you think that something does not feel ‘right’
  • Your nurse may contact your doctor on your behalf if you have any worries or concerns
Point of Care Goals

Safe patient care is our number one priority and we are committed to ensuring that processes are in place to prevent patient harm that might inadvertently result from care. Our Point of Care Goals were developed from a range of input from staff and consumers about what constitutes safe and quality care at Jessie McPherson Private Hospital. Our goals reflect our understanding of what patients value about healthcare access and delivery and how this translates into providing exceptional care, for every person, every time.


We will provide a safe, clean and peaceful environment for our patients and staff.
Our staff will have access to equipment, stock, resources and processes to enable efficient care delivery.


We will provide best practice care and services.
Through clinical effectiveness, we will promote healthcare that is appropriate, effective and consistent.
Our quality and safety performance data, policies and procedures, and audit processes will guide service delivery and improvement.


We will strive to serve each patient and other members of the healthcare team in a positive and supportive manner.
We will introduce ourselves to our patients and given them the confidence to trust us with their healthcare.
We will communicate with and inspire our staff to embrace our vision.


We will seamlessly collaborate with our colleagues to achieve the required outcomes.
Through a coordinated approach, we will work with all members of the health care team to ensure a smooth transition across all aspects of the health care journey


We will deliver care that is respectful of, and responsive to, the needs and values of our patients and consumers.
We will care about the person and involve the patient and their family in all aspects of their care and treatment.


We will strive to plan and prepare activities effectively to ensure continuity in the delivery of our care and services.
We will continue to build and improve resilience in order to deliver a stable and secure workforce.

Click here for printable version of Jessie McPherson Point of Care Goals

Monitoring and managing risks

At Jessie McPherson Private Hospital, we monitor and manage risks across many areas of the organisation, such as operational, financial, and clinical risks. This is to ensure we continue to keep our patients, staff and visitors safe and free from harm.

Monitoring our risks means that we encourage all staff to report on any and all incidents using our incident reporting system. This enables us to monitor the effectiveness of our risk controls and develop strategies to prevent incidents from occurring. Our incident management system enables us to be notified as soon as an incident occurs, so that it can be followed up in a timely manner.

Despite our efforts to minimise risks, unfortunately incidents can occur. When they do, Jessie McPherson Private Hospital supports open disclosure – this is the process of providing open communication with patients and their carers/families following an incident that has resulted in unintended harm.

Open Disclosure

Please refer to the Jessie McPherson Private Hospital Open Disclosure procedure:

JMPH Open Disclosure (PDF Download)

Child Safety Standards

Jessie McPherson Private Hospital is a child safe organisation and complies with the current Victorian Child Safe Standards which are in effect from 1 July 2022. We are committed to:

  • Keeping all children safe and ensuring our actions and decisions relating to children support this. We have zero tolerance towards child abuse.
  • A culturally safe environment for Aboriginal children and young people, and a culturally safe environment for children and young people from CALD backgrounds.
  • A safe environment for children with a disability and for those who are unable to live at home, and lesbian, gay, bisexual, transgender and intersex children and young people.
  • Empowering children, young people, their families and communities to be involved in decisions affecting themselves and ensuring they are informed about their rights.
  • The protection of children from abuse, including complying with relevant legislation which supports the safety and wellbeing of children.
  • Provision of training and education to staff to support the achievement of these commitments.

The Jessie McPherson Private Hospital Child Safe Policy is available for viewing by clicking here.

Contact Us

You can contact Jessie McPherson Private Hospital on 03 3534 2776 or send us a message below.

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