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3.19 Accreditation

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. Public and private hospitals are accredited against the National Safety and Quality Health Service Standards (NSQHSS). Accreditation is provided by a number of bodies, including the Australian Council of Health-care Standards Evaluation and Quality Improvement Program, and the Quality Improvement Council. There are currently 1,352 public and private hospitals and day procedure services in Australia eligible to be assessed against the NSQHSS. Of these health service organisations, 57% (770) are in the public sector and 43% (582) are in the private sector. In 2013, 750 health service organisations were assessed against the Standards (Department of Health unpublished).

In 2012–13, 93% of public hospitals, accounting for 98% of public hospital beds were accredited (AIHW 2014f). 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 2011 and June 2013, 99% of public hospital separations for Aboriginal and Torres Strait Islander peoples occurred in accredited hospitals (as did 99% of public hospital separations for non-Indigenous Australians). Rates were similar across remoteness areas.

Since 1998–99, the proportion of care provided to Indigenous Australians in accredited public hospitals has increased significantly (by 59%) for jurisdictions with adequate data for time series (Qld, WA, SA and the NT combined). In the same period, the proportion for other Australians increased by 19%.

In 2012–13, an estimated 94% of general practices registered for accreditation were accredited through AGPAL or GPA+. The proportion of practices that were accredited ranged from 92% for practices in areas where Aboriginal and Torres Strait Islander peoples make up 10% or more of the population to 95% in areas where 4–10% of the population is Indigenous.

As at July 2014, of the 185 Australian Government-funded Aboriginal Community Controlled Health Organisations surveyed, 77 (42%) had achieved organisational accreditation and a further 85 (48%) were pursuing this accreditation (Department of Health unpublished). Of the 129 Australian Government-funded Aboriginal Community Controlled Health Organisations employing a GP, 119 (92%) achieved clinical accreditation under the RACGP Standards for General Practices (Department of Health unpublished).

Implications

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.

The Australian Government continues to implement activities to raise awareness of the value of accreditation and promote uptake and achievement of accreditation for services delivering care to Indigenous Australians. In 2014–15 the following dedicated supports were available to eligible organisations to achieve clinical or organisational accreditation under mainstream services.

  • Accreditation facilitation services: Funding is available for accreditation facilitators to provide ongoing expert support and advice to organisations to help them achieve first time clinical and/or organisational accreditation.
  • Gap assessments: Organisations can receive a gap assessment undertaken by a licensed assessment agency at the start of their accreditation process to assist them in identifying any essential barriers to achieving accreditation.
  • Sector support: Funding is provided to the National Aboriginal Community Controlled Health Organisation and its state and territory affiliates to provide accreditation support to organisations.

Figure 3.19-1 Proportion of hospital separations in accredited public hospitals, by Indigenous status, Qld, WA, SA and NT combined, 1998-99 to 2013-14
hospital separations in accredited public hospitals

Figure 3.19-1 shows a the proportion of hospital separations for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians which occurred in accredited public hospitals between 1998-99 and 2013-14. Data are presented for Qld, WA, SA and the NT combined (jurisdictions with adequate data for time series). The data show that since 1998–99 the proportion of care provided to Indigenous Australians in accredited public hospitals has increased significantly (by 59%). In the same period the proportion for other Australians increased by 19%. Current rates are around 99% for both Indigenous and non-Indigenous Australians.

Source: AIHW analysis of National Hospital Morbidity Database and National Public Hospitals Establishment Database

Figure 3.19-2 Proportion of hospital separations in accredited public hospitals, by Indigenous status and remoteness, Australia, 2011-12 to 2012–13.
hospital separations in accredited public hospitals

Figure 3.19-2 shows a the proportion of hospital separations for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians which occurred in accredited public hospitals between July 2011 and June 2013 by remoteness area. The data show that 99% of hospital separations were in accredited public hospitals for both Indigenous and non-Indigenous Australians. Rates were similar across remoteness areas (ranging from 96% to 100%).

Source: AIHW analysis of National Hospital Morbidity Database and National Public Hospitals Establishment Database

Figure 3.19-3 Proportion of general practices accredited through AGPAL and GPA+, by proportion of the population that is Indigenous, 2012–13
general practices accredited through AGPAL and GPA+

Figure 3.19-3 shows the proportion of general practices accredited through AGPAL and GPA+, by proportion of the population that is Indigenous in 2012–13. The figure shows that 94% of general practices registered for accreditation were accredited through AGPAL or GPA+. Accreditation was highest (95%) for practices in areas where Aboriginal and Torres Strait Islander peoples make up 4–10% of the population.

Source: AIHW analysis of AGPAL and GPA+ data