National Safety and Quality Health Service Standards

From 1st January 2013 hospitals and day procedure services across Australia will be required to participate in accreditation against the National Safety and Quality Health Service (NSQHS) Standards, writes Amy Winter.
In September 2011, Australian Health Ministers took a significant step in improving Australia’s health system by endorsing the Australian Health Service Safety and Quality Accreditation Scheme (AHSSQAS).
This new system will come into effect from 1 January 2013 when hospitals and day procedure services across Australia will be required to participate in accreditation against the National Safety and Quality Health Service (NSQHS) Standards. The Australian Commission on Safety and Quality in Health Care (the Commission) developed the ten NSQHS Standards to improve the quality of health service provision in Australia.
The NSQHS Standards provide a nationally consistent and uniform set of measures of safety and quality for application across a wide variety of health care services. They propose evidence-based improvement strategies to deal with gaps between current and best practice outcomes that affect a large number of patients.
The Standards address the following areas:
1. Governance for Safety and Quality in Health Service Organisations
2. Partnering with Consumers
3. Preventing and Controlling Healthcare Associated Infections
4. Medication Safety
5. Patient Identification and Procedure Matching
6. Clinical Handover
7. Blood and Blood Products
8. Preventing and Managing Pressure Injuries
9. Recognising and Responding to Clinical Deterioration in Acute Health Care
10. Preventing Falls and Harm from Falls
National Accreditation Scheme and Standards Development Process
The AHSSQA Scheme is essentially a clarification of the responsibilities of five inter-related groups which each has a role in the process of accreditation. The roles of each are broadly as follows:
1. Health Ministers endorse the NSQHS Standards and receive information about the health systems performance against the Standards.
2. The State, Territory and Commonwealth governments determine which health services are to participate in accreditation processes
using the NSQHS Standards. They receive data on the outcomes of accreditation of health services and determine the regulatory response for health services that do not meet the requirements of the NSQHS Standards.
3. The Health Service Organisations implement action to meet the Standards and select an approved accrediting agency that assesses their compliance in meeting the Standards. Contracts between accrediting agencies and health services recognise that accreditation data will be provided to regulators and the national coordination program for reporting and review.
4. The Approved Accrediting Agencies assess health service organisations against the Standards. They may also offer to assess against a range of other standards.
5. National Coordination by the Commission involves:
• Developing and maintaining the NSQHS Standards
• Advising Health Ministers (from time to time) on the scope of accreditation on which health services being accredited and annually on the progress of national accreditation
• Approving accrediting agencies to assess against the Standards, and
• Undertaking ongoing liaison with health departments on opportunities to streamline accreditation processes and support implementation of the Standards.
Critical to the accreditation scheme was the development of the NSQHS Standards, which occurred over two years following substantial consultation and collaboration with key stakeholders including regulators, technical experts, health service organisations, accrediting agencies and consumers.
Flexible Transition Arrangements
In 2013, flexible transition arrangements for a national accreditation system will commence for hospitals and day procedure services. Under the new arrangements, health services will use the NSQHS Standards to focus their quality improvement programs.
For health services that are already accredited, accreditation process will be coordinated and supported by the Commission and assessment will be to the NSQHS Standards. Health service will continue to select their accrediting agency from a list of approved agencies.
Because of the variable size, structure and complexity of Australian health services a degree of flexibility is required in the application of the Standards, therefore a set of core and developmental items have been identified.
• Core actions are critical for safety and quality. All core actions must be met before a health service organisation can achieve an accreditation award against the NSQHS Standards.
• Developmental actions are areas where health service organisations should focus their future efforts and resources to improve patient safety and quality. Activity in these areas is still required, however the actions do not need to be fully met in order to achieve accreditation. It is required that 100% of core actions are to be met in order to achieve accreditation to the NSQHS Standards.
In some circumstances a Standard, criterion or action may be considered ‘not applicable’. Not applicable actions are those which are inappropriate in a specific service context or for which assessment would be meaningless.
Implementation Support
The Commission is supporting health services implement the NSQHS Standards. Accreditation Workbooks have been developed for  hospitals and day procedure services that provide useful information on the process, checklists and tools needed for self assessment, and possible examples of evidence.
The target audience for the Accreditation Workbooks is quality managers responsible for managing the process of accreditation. The Commission has also developed Safety and Quality Improvement Guides. There is one Guide for each Standard. The Guides will help health services focus their quality and improvement activities within the framework set by the NSQHS Standards.
The Accreditation Workbook and the Safety and Quality Improvement Guides can be found at http://www.safetyandquality.gov.au/our-work/accreditation/.
An Advice Centre has also been established to provide information and support. If required mediation between health services and surveyors during surveys is available. This service can be accessed by telephone within Australia on 1800 304 056, via email on accreditation@safetyandquality.gov.au
The Advice Centre is also establishing networks of similar health services offering regular meetings via telephone, access to information about resources, support and expert input for day procedure services preparing for accreditation during 2013.
More information about the NSQHS Standards can be found at the Commission web site at http://www.safetyandquality.gov.au/our-work/accreditation/ or by contacting accreditation@safetyandquality.gov.au