Trust in Standards

9 June 2005

The stakes are always high in health. Our sector is driven by the twin demands of constant innovation and best practice. The outcomes affect all areas of New Zealand life. Standards,  and the systematic approach they represent, are a vital part of this double act.

ACC has long been involved in standards development. Over the past five years we have sponsored standards in many areas,including:

  • Accident and Medical Clinics
  • Day Surgery
  • Rooms-Based Procedures
  • Home and Community Care
  • Allied Health Services Sector
  • Primary Healthcare Practice Management Systems

We have also increasingly commissioned our own clinical guidelines, with documents published on treating back, shoulder, ankle, and knee injuries. Burn treatment and brain injury guidelines are in the pipeline.

Our reasons for this support are straightforward,and go right back to the purpose of the corporation.

ACC’s mandate is to quickly and effectively rehabilitate injured people back to work or independence. This mandate requires ACC to purchase the best treatment and care from a wide range of providers. Where we can demonstrate that doing things in a certain way gives better results, we want all providers to understand how and why they should change their practice.

In other words, we constantly search for nationally applicable healthcare standards that encourage or support best practice. And we have consistently demonstrated that these standards correlate with improved outcomes.

The Accident and Medical Clinic Standard requires that a nurse is present to triage all new arrivals. Emergency trained doctors must provide clinical supervision. These and many other requirements are in place because they clearly improve the level of service offered by providers. More widely, we have seen that a systematic approach to health management – undertaking customer satisfaction audits, work to put effective processes in place, and getting serious about active improvement mechanisms – results in better health.

Standards development in New Zealand runs in parallel to our own ACC guideline creation: while Guidelines are a standard for individual practitioners and providers, SNZ Standards are the wider standards for the service delivery environment.

Both guidelines and standards are enormously benefi cial, and minimize the effort required by individuals or organizations to identify best practice.

While there is inevitably tension about the cost of compliance, in the vast majority of cases ACC believes that standards define what a provider should already be doing. We don’t as a rule fund training and education, we fund providers to deliver appropriate service. When we do require meeting of standards, we try and ensure funding matches these criteria. Further, if we get treatment right at the front end, we reduce long-term disability, hence reducing our overall scheme costs.

As we endorse standards, we realize compliance is challenging. But decisions providers make are clearly relevant to outcomes, and those decisions must be informed by up-to-date expectations. We can’t afford to purchase healthcare as it was 20 years ago, because healthcare outcomes are now so different.

Healthcare never stops evolving. New, better methods are always coming online, and health providers need to reflect this with their own continuous quality improvement. Along with setting initial benchmarks for performance, standards give a framework for advancement – far from a static prescription, standards actively drive innovation.

The challenge of compliance is really the challenge of effective care and a strong health sector that people trust.

That trust is the overall mandate of standards use. We want efficient treatment and recovery of injuries. We want the economic and social gains of people working unhampered by long-term health problems. Standards are a foundation of a strong, thriving sector that is constantly evolving, toward best practice and ultimately healthy New Zealanders.