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 of quality 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 accreditation systems for both hospitals and general practice. Most hospitals are accredited by the Australian Council of Healthcare Standards Evaluation and Quality Improvement Program, 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 2010b). 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; safety, quality improvement and education; practice management; and physical factors (RACGP 2010). 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.
Findings:Between July 2008 and June 2010, 96% of episodes for Aboriginal and Torres Strait Islander peoples occurred in accredited hospitals, which was similar to episodes for non-Indigenous Australians (97%). The proportion of Aboriginal and Torres Strait Islander patient episodes treated in accredited hospitals is highest for hospitals located in inner regional areas (99%) and lowest in very remote areas for Aboriginal and Torres Strait Islander patients (90%). Since 1998–88 the proportion of care provided to Indigenous Australians in accredited hospitals has increased significantly.
In 2010–11, an estimated 71% of general practices registered for accreditation were accredited through AGPAL or GPA+. Accreditation was highest (84%) for practices in areas where Aboriginal and Torres Strait Islander peoples make up 4–10% of the population.
In 2010–11, of the 147 Aboriginal and Torres Strait Islander primary health care services that employed a GP 82% (121) were accredited. As at June 2010, of the 79 services that were included in the Healthy For Life program and reported information on accreditation, 66% (52) of services were accredited, and 18% (14) were undergoing accreditation.Top of Page
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 Australian Government continues to implement activities to raise awareness of the value of accreditation of health service delivery to Indigenous Australians and promote uptake and achievement of accreditation by services.
The 2011–12 Federal Budget allocated $35 million over four years for the Establishing Quality Health Standards in Indigenous Health Services continuation (EQHS–C) measure to continue the work undertaken through the original 2007–08 EQHS measure ($36.9 million over four years). This Measure was funded to support eligible Indigenous health organisations to become accredited under Australian health care standards. As at May 2012, 133 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 66 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.
The Australian Government established the Indigenous Health Service Accreditation Advisory Committee in 2007, and funded accreditation specific research and information projects throughout the Aboriginal and Torres Strait Islander community controlled health sector. The committee supported the development of RACGP and QIC interpretive guides to assist in the application of mainstream healthcare standards to Indigenous health services. The Indigenous Health Service Accreditation Implementation Group replaced the committee in 2009 and provides advice to the Australian Government on the rollout and national direction of accreditation across the Indigenous health sector and supports the uptake of mainstream accreditation across the sector.
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'. Under the RACGP standards, practices are required to demonstrate that patient information records routinely record Aboriginal and Torres Strait Islander status in active patient health records. This information is important in ensuring Aboriginal and Torres Strait Islander peoples receive the most appropriate care. Top of Page
Figure 194—Proportion of hospital admitted patient episodes in accredited hospitals, by Indigenous status and remoteness, July 2008 to June 2010
Source: AIHW analysis of National Public Hospitals Establishment DatabaseTop of Page
Figure 195—Proportion of general practices accredited through AGPAL and GPA+, by proportion of the population that is Indigenous, 2010–11
Source: AIHW analysis of AGPAL and GPA+ unpublished dataTop of Page