The New Zealand Health Strategy

Full text version

Date of publication: December 2000This is the full text online version of this document. You can also download this publication in PDF format.

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Chapter 5:
Ensuring Quality Services

This chapter focuses on the need to ensure that the performance of health services and the health system as a whole are of the highest quality within available resources.

In particular, health services should meet people’s needs and be clinically sound, culturally competent and well co-ordinated. They should also be efficiently delivered. Budgets are capped and distributed through the population-based funding formula. The health sector will need to ensure limited resources are used in the best way possible to achieve these aims.

Quality health services

Quality is the cornerstone of a high-performing public health and disability support service. High quality care is about performance and patient and consumer satisfaction: the right thing is done for the patient in the right way, the right result is obtained, care is delivered efficiently, and adverse events are minimised.

Health care and disability support services in New Zealand are generally safe and of good quality. However, things do occasionally go wrong.

It is acknowledged that not all risks can be eliminated; services are deemed safe when components and systems are in place that reduce risk to levels which are considered acceptable according to recognised and, where appropriate, international standards.

A quality system

The New Zealand Health Strategy commits to the development of a health and disability support sector that embraces a culture of continual quality improvement in the delivery of health and disability services, which:

• is system-wide

• uses a risk-management approach to reduce preventable harm

• fosters consistency of practice through shared learning, benchmarking and clinical governance within a standards framework

• takes account of community and health service users’ views on quality of care.

Already there are mechanisms at all levels in the health and disability support sector that are designed to assure the safety and quality of care.

These include:

• regulation to ensure safety of services, by setting and enforcing minimum standards of facilities and participation and competency of the health workforce; and
• hospital ownership by the Crown to promote the provision of hospital services at certain standards, including clinical review, as part of regular business planning.

In addition, individuals have certain rights within the health system (see the following section).

These mechanisms will be strengthened by initiatives designed to support clinicians and managers of health and disability support services in quality assurance and improvement activities. Initiatives under way include:

• the Health and Disability Services (Safety) Bill – the Bill, now in its final parliamentary stages, will modernise the way standards are set, audited and enforced. Providers will develop, and sign up to, standards for their services, which will then be subject to independent audit

• reportable events – a proposal currently out for consultation is that health and disability service providers must report defined serious or significant incidents and show that there has been a systematic investigation of what went wrong and why

• credentialling – the proposal, currently out for consultation, is that doctors (and in future other health professionals) will be assessed to determine what, where and with whom they can practise

• modernisation of the health professional regulations, to provide for ongoing competency assurance and increase consumer representation

• introduction of a ‘balanced scorecard’ for public hospitals to look more widely than just financial performance and encompass performance on customer satisfaction, internal processes, and organisational learning. This can be extended to the whole of District Health Boards and other public health agencies.

Most of the progress will come from the teams of health professionals working and learning together to establish agreed clinical protocols and processes and share best practice initiatives.

The health professionals must be enabled and supported to do so by their colleagues, the District Health Boards, the Ministry of Health and other central agencies.

The Ministry of Health will complete a fundamental review of the quality framework for the sector, to assess how high performance is rewarded and where further support and development is required in terms of: clarifying roles and accountabilities; monitoring and information provision; people systems and resources. Key improvements include:

• District Health Boards’ accountability arrangements, which will have explicit performance targets based on the New Zealand Health Strategy’s goals and objectives. Performance will be benchmarked and publicised, and achievements rewarded

• funding agreements between the Minister of Health and District Health Boards, and service level agreements between District Health Boards and providers, to set quality standards and delivery expectations

• monitoring by the Ministry of District Health Boards’ performance against quality expectations, and District Health Boards’ monitoring of the performance of the providers it has service level agreements with

• in recognition of the Code of the Health and Disability Services Consumers’ Rights, each District Health Board will have in place accessible and robust complaints procedures

• the New Zealand Health Knowledge Strategy will encourage the use of comparative information by health providers and others for quality improvement and learning purposes, and enhance the role of patients and health service users through better information and other ways of increasing the consumer’s voice. (For more information, see Appendix 2.)

Individual rights

Individuals have fundamental rights within a quality health care system. They include rights under the Privacy Act 1993 and those recognised in legislation through the Health and Disability Commissioner Act 1994.

The latter Act covers:

• the right to be treated with respect

• the right to freedom from discrimination, coercion, harassment and sexual exploitation

• the right to dignity and independence

• the right to services of an appropriate standard

• the right to effective communication

• the right to be fully informed

• the right to make an informed choice and give informed consent

• the right to support

• rights in respect of teaching or research

• the right to complain.

Improved co-ordination

For health services to address the needs of local communities and individuals, more co-ordinated and complementary ways of working across the sector need to be established. Competition between providers or professional groups has inhibited the development of services oriented to the needs of individuals and communities.

In many parts of the country initiatives have been developed to overcome these barriers. These include initiatives designed to meet the needs of specific population groups (such as Maori, Pacific peoples, youth, children and their families, or older people), or specific groups of patients or health service users (such as people with diabetes or those requiring elective services). Most of these initiatives have been developed by local communities, health organisations or providers. Much can be learned by studying such initiatives.

It is important for District Health Boards to look at how they can foster well co-ordinated initiatives that are oriented towards improving health outcomes for individuals and communities and eliminating health inequalities. District Health Boards will need to consider:

• ongoing relationship development within the health sector and between health and other sectors

• specific funding earmarked for the support of local initiatives to reduce health inequalities and improve health outcomes

• learning from successful initiatives in other District Health Board areas (for example, through dissemination of information, site visits and secondments)

• working with other government agencies locally, particularly with respect to intersectoral initiatives such as Strengthening Families, the prevention of drug-related harm, the prevention of youth suicide, road safety, injury prevention and health promotion in schools

• working with local government to support regional and local policies and programmes that will have a positive impact on the health of local communities and will reduce health inequalities.

The Government expects District Health Boards to ensure service providers in their districts work with each other to maintain and develop well co-ordinated programmes to improve the health of communities and individuals (across public health, primary care, community-based care and secondary/tertiary service sectors).

District Health Boards will need to work with each other to ensure access for their populations to regional and national services. This is particularly important for public health and mental health services, where regional planning and networking is imperative