Why is it important?:Accreditation is a process, usually voluntary, through which a recognised external body assesses the extent to which a health care organisation meets applicable quality standards. Quality standards typically address issues such as: governance of the organisation, management of safety issues such as infection control, handling of care processes such as discharge planning, general management issues such as human resource management, quality of the physical infrastructure, and issues such as handling of patient complaints. Assessments often result in recommendations for action. The assessment outcome may also be reported publicly in a summarised form. The services accessed by Aboriginal and Torres Strait Islander peoples should be able to demonstrate a comparable level of quality when compared with other health services in Australia. While accreditation status is a broad measure, it provides one measure of the capability of services, based on their skills and knowledge, to provide quality health services to Aboriginal and Torres Strait Islander peoples.
In Australia, there are well developed accreditation systems for hospitals and general practice. Most hospitals are accredited by the Australian Council of Healthcare Standards (ACHS) Evaluation and Quality Improvement Program (EQuIP), although other accreditation systems are used by hospitals such as the Quality Improvement Council (QIC). Overall, 87% of hospitals accounting for 97% of hospital beds have achieved some form of accreditation (AIHW 2010a). Most large hospitals are accredited. Accreditation is less common for small hospitals located in regional and remote areas. Achieving accreditation generally requires a considerable ongoing investment of time and resources which is not always easy for smaller hospitals. It is not possible to draw conclusions about the quality of care in hospitals that do not have accreditation.
Accreditation in general practice involves assessment against standards set by the Royal Australian College of General Practitioners (RACGP) in five key areas: practice services, rights and needs of patients, quality assurance and education, practice administration, and physical factors for workplace health and safety (Royal Australian College of General Practitioners 2006). There are two registered accreditation providers: Australian General Practice Accreditation Limited (AGPAL) and General Practice Accreditation Plus (GPA+). Most general practices are accredited by AGPAL. The RACGP standards indirectly address issues for Aboriginal and Torres Strait Islander peoples. For example, in assessing whether patient care is effective, accreditation assessors ask GPs if they ‘can access guidelines for specific clinical care of patients who self-identify as Aboriginal and Torres Strait Islanders’.
Findings:For the jurisdictions in which Indigenous identification in hospital patient data are considered adequate, 94% of episodes for Aboriginal and Torres Strait Islander peoples occurred in accredited hospitals, which was similar to episodes for other Australians. The percentage of both Aboriginal and Torres Strait Islander patient episodes and other patient episodes treated in accredited hospitals is higher for hospitals located in outer regional (98%) and inner regional (95%) areas.
In 2009–10, an estimated 87% of registered general practices were accredited through AGPAL or GPA+. Accreditation was highest (89%) for practices in areas where Aboriginal and Torres Strait Islander peoples make up 2–3% of the population.
In 2008–09, of the 130 Aboriginal and Torres Strait Islander primary health care services that employed a GP 65% (85) were accredited.
As at June 2009, of the 72 services that were included in the Healthy For Life program and reported information on accreditation, 65% (47) of services were accredited, 1.4% provisionally accredited (1), and 14% (10) were undergoing accreditation.
The 2007–08 Federal Budget committed $36.9 million over four years for the A Better Future for Indigenous Australians — Establishing Quality Health Standards (EQHS) Measure. This Measure was funded to support eligible Indigenous health organisations become accredited under Australian health care standards. As at November 2010, 137 Aboriginal and Torres Strait Islander primary health care organisations employing a general practitioner were eligible for support under the EQHS measure. In addition there were 71 eligible Indigenous health service organisations without general practitioners including Substance Use Services, Link Up, Bringing Them Home, Social and Emotional Well Being and Advocacy Groups.
Implications:Most accreditation processes do not specifically address the needs of Aboriginal and Torres Strait Islander peoples in either quality or safety of care. Accreditation processes do not address capacity to provide culturally specific skills and knowledge to address the health needs of Aboriginal and Torres Strait Islander peoples. Little research into the appropriateness of accreditation processes for the health needs of Aboriginal and Torres Strait Islander peoples has been undertaken (Otim et al. 2002).
The Commonwealth has sought to progress the debate around the nature and value of accreditation of health service delivery to Indigenous Australians by establishing the Indigenous Health Service Accreditation Advisory Committee in 2007 and funding accreditation-specific research and information projects throughout the Aboriginal and Torres Strait Islander community controlled health sector.
The Aboriginal and Torres Strait Islander Health Sector Accreditation and Quality Standards Project (CRCATSIH 2008) comments on the following aspects of accreditation: the nature of accreditation standards that could be applied to the Aboriginal and Torres Strait Islander community controlled health sector; the most feasible approach to implement accreditation against those standards; and the support needed in order to achieve such accreditation.
A related project being undertaken by the Quality Improvement Council is investigating the extent to which accreditation processes can be streamlined in order to minimise the administrative burden on health service providers, especially in cases where multiple accreditation might apply.
Figure 179 – Proportion of hospital admitted patient episodes in accredited hospitals, by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008
Source: AIHW analysis of National Public Hospitals Establishment Database
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Figure 180 – Proportion of general practices accredited(a) by Divisions of General Practice, by proportion of the population that is Indigenous(b), 2009–10
(a) Indigenous proportions are based on ABS population estimates used in the Annual Survey of Divisions of General Practice
(b) GPA+ data is for the period 2009–2010. AGPAL data is as of February 2010
Source: AIHW analysis of AGPAL and GPA+
Text description of figure 180 (TXT 1KB)