The ACHS Care Evaluation Program: A decade of achievement

Abstract

In 1989 the Australian Council on Healthcare Standards (ACHS) embarked on a programme to develop acute health care clinical indicators in conjunction with the Australian medical colleges. Through a carefully structured stepwise process this collaboration established a 'World first' in 1993 with the introduction of the first set of indicators into the ACHS Accreditation programme. The programme remains unique in the formal involvement of providers in the development process and in the scope of the clinical areas covered in acute health care. From the year 2000 there will be 18 sets (and over 200 indicators) from which health care organisations (HCOs) can choose to monitor the major services they provide. There remains no compulsion to address a specific number of indicators. The growth of the programme has been considerable with more than half of the nations' acute HCOs reporting their clinical indicator data (twice yearly) and it provides a reflection of the care given for the majority of patient separations in acute care. This reporting process allows HCOs to receive feedback on the aggregate results together with comparative peer group information for each indicator they address. In addition to numerous publications in peer reviewed journals an annual aggregate report, 'the Measurement of Care in Australian Hospitals' is published. It reports both qualitative and quantitative data on all indicator sets for the preceding year. Validity of the indicators is strengthened each year with a review process and reliability and reproducibility of the data can now be demonstrated. The clinical response to the indicators has been overwhelming and there is now documented evidence of numerous actions taken by HCOs to improve both the processes and the outcomes of patient care. The nation wide database can be expected to reflect trends in care over the next few years. The process of indicator refinement, however, will continue and it is likely that a reduction in the total number of indicators will occur with a core group of the more 'robust' indicators remaining. Further directions in indicator development are likely to be in the area of multidisciplinary care and in the assessment of longer-term outcomes. In addition to measures of the quality of care, hopefully, in time, health care providers will also take part in the establishment of measures of the appropriateness of that care.

Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study

“…Clinical indicator: a measure of management or outcome of care; the criterion against which such measurements can be made; an objective, quantitative measure of the process or outcome of care 3 4…”

Early Experience With Clinical Indicators in Surgery

“…4 It is possible to clearly relate actions taken after indicator monitoring with improved outcomes. 5 …”

A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]

“…Accreditation is a cornerstone of the safety and quality programs of many health care systems but it consumes considerable resources. We know little about its effectiveness beyond individual settings (through case study [ 42 ] or attitudinal data [ 37 ]). We argue that a program of research such as that proposed is required in order to provide research evidence regarding the relationships between clinical indicator performance, organisational culture, consumer participation and performance on accreditation standards, and to provide a basis for identifying strategies for improving health care delivery and informing policy.…”

“…Moreover, existing research lacks rigorous in-depth analysis of accreditation processes and the relationships between accreditation and performance. It seems logical that such relationships hold, and many stakeholders believe this [ 37 ], but beliefs rest on attitude surveys [ 38 ], anecdotal [ 39 ], conjectural [ 40 , 41 ] or case study [ 24 , 30 , 42 ] evidence rather than targetted, multi-site empirical evidence. No positive or consistent relationships between accreditation and clinical performance have been found [ 43 - 45 ].…”