New health service standards to improve safety and quality at healthcare facilities

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New National Safety and Quality Health Service Standards have been introduced to drive the implementation and use of safety and quality systems. The Australian Commission on Safety and Quality in Health Care provides some guidance on how to meet the new criteria.

Healthcare in Australia is delivered in a variety of settings. The majority of health consumers receive quality care and achieve good outcomes. Harm does occur, however, and patients don’t always receive the quality of care required.
Evidence suggests a significant correlation between the governance system of a health organisation and the level of performance achieved within that organisation1. It is also recognised that patients have a unique position and perspective that can help to identify opportunities for improvement at an individual and organisational level, which otherwise might not have been identified2,3.
The great challenge in improving quality and safety in healthcare lies in improving systems. Effective systems support clinicians and improve patient experiences. A systematic approach identifies the people responsible and accountable for action in the health service organisation. It focuses on risk, quality and patient safety.
The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC) to drive the implementation and use of safety and quality systems and provide a nationally consistent statement of the level of care consumers should be able to expect4.

EMBEDDING SAFETY AND QUALITY
The commission developed two NSQHS Standards that set overarching requirements for the effective application of the standards as a whole:

  1. NSQHS Standard 1: Governance for Safety and Quality in Health Services Organisations, which requires a governance framework to ensure accountabilities and clear responsibilities for keeping patients safe, and
  2. NSQHS Standard 2: Partnering with Consumers, which requires the engagement of consumers in the processes of developing and reviewing health services.

Good governance and engaging with consumers is vital to improving safety and quality of healthcare services. The NSQHS Standards provide direction and guidance for health services organisations to embed these approaches into practice.
Many health service organisations will already have strategies and systems in place that address NSQHS Standards 1 and 2. The purpose of the NSQHS Standards is not to replace good systems, but to set out minimum standards for safety and quality, and provide quality assurance guidelines and improvement mechanisms to achieve them.
Following is an overview of the criteria required to be met by health service organisations in NSQHS Standards 1 and 2. There are also some practical points for considering how a health service organisation might go about meeting the criteria in the context of their organisation.

NSQHS STANDARD 1
The aim of NSQHS Standard 1 is to create integrated governance systems that maintain and improve the reliability and quality of patient care and improve patient outcomes. It provides the framework for safety and quality by setting reporting and accountability structures, and describing processes of a safe organisation.
For health services organisations to meet the requirements of NSQHS Standard 1, they must be able to demonstrate that:

  • governance and quality improvement systems are in place to actively manage patient safety and quality risks
  • care provided by the clinical workforce is guided by the best current practice
  • managers and the clinical workforce have the right qualifications, skills, and approach to provide safe, high quality care
  • patient safety and quality incidents are recognised, reported and analysed, and this information is used to improve safety systems, and
  • patient rights are respected and their engagement in their care is supported.

In determining what is appropriate to meet the criteria, health service organisations may wish to consider the following in relation to governance:

  • Is there a positive organisational culture that values performance and promotes continual inquiry? In other words, have we got a system? Is it a good system?
  • Are systems of care well designed and is performance being monitored?
  • Are there systems to ensure people with the necessary skills and competencies are appointed and supported at all levels of the organisation?
  • Are the right facilities and supports available?
  • Are risks identified and managed appropriately?
  • Is there documented evidence to support governance systems?
  • Is focus directed to systems; for example, setting up policies and processes, clarifying accountability and responsibility, providing a structure for good clinical practice, determining reporting and monitoring, specifying workforce requirements, and setting the framework for ensuring patients’ rights?

Good clinical governance draws from experience in other sectors and industries – the principles of delegation, responsibility, quality management, accountability and risk management are the same.

NSQHS STANDARD 2
NSQHS Standard 2 is focused on partnering with consumers in governance. Health services organisations need to listen to and use consumer knowledge, skills and experience in a systematic way to make the care that is delivered better.
For health services organisations to meet the requirements of NSQHS Standard 2, they must be able to demonstrate that:

  • governance structures are in place to form partnerships with consumers and/or carers
  • consumers and/or carers are supported by the health service organisation to actively participate in the improvement of the patient experience and patients’ health outcomes, and
  • consumers and/or carers receive information on the health service organisation’s performance and contribute to the ongoing monitoring, measurement and evaluation of performance for continuous quality.

In determining what is appropriate to meet the criteria, health service organisations may wish to consider the following in relation to partnering with consumers:

  • Are there jurisdictional requirements in the area that will determine the nature of processes for partnering with consumers?
  • What methods for partnering with consumers have been considered? For example, a board representative; a consumer advisory committee; holding planning days, forums or workshops with consumer participants; joint consumer and staff workshops; focus groups; waiting room discussions; informal meetings; and meetings with community and consumer organisations?
  • What sources of information about the views of consumers have been considered? For example, patient experience surveys, real-time feedback forms, review of complaints and compliments, and providing information publicly and inviting comment?
  • How will the systems and processes used to partner with consumers be documented? For example, documentation from committee meetings, policies, consultation processes, training, project plans, reports of feedback obtained and file notes of discussions?

NSQHS IMPLEMENTATION
For many health service organisations the introduction of the NSQHS Standards may mean building on or adjusting existing arrangements. For others, the process of implementation may be entirely new and require an overhaul of existing safety and quality systems.
In approaching implementation of the NSQHS Standards, health services organisations may find value in making links with established organisations (for example, professional organisations) or networking with health services with similar characteristics, issues or exemplar performance. For example, public hospitals can gain support through Local Hospital Districts or Networks and day procedure services may wish to stay in contact with the Australian Day Hospital Association or the Australian Private Hospitals Association.
Change can require effort, resources and focus. The NSQHS Standards provide the focus and framework to achieve improvements in safety and quality in healthcare, starting with the overarching requirements of NSQHS Standard 1 and 2.

References
1. S Michel. Putting quality first in the boardroom. The King’s Fund. 2010. Available at: www.kingsfund.org.uk/publications/putting_quality.html.
2. LJ Donaldson. ‘Put the patient in the room, always’. Quality and Safety in Health Care 2008;17(2):82-83.
3. R Iedema, S Allen, K Britton, TH Gallagher. ‘What do patients and relatives know about problems and failures in care?’ BMJ Quality & Safety 2012;21(3):198-205.
4. Australian Commission on Safety and Quality in Health Care. Windows into Safety and Quality in Health Care 2010. Sydney: ACSQHC, 2010.

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