Cancer services pilot accreditation program in New South Wales
When a diagnosis of cancer is made, the patient and their loved ones face a journey that will change their lives and priorities. In these circumstances, the health professional team works with the patient and their carers to provide the best treatment and the best chance of long-term survival. Thus, high-quality care and optimal treatment should be the usual standard of care.
by Mark Anns, Matthew Mikus-Wellings, Robyn Thomas. Cynthia Lean, Sue Sinclair, Jim Bishop
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Background
The development and piloting of the Cancer Services Pilot Accreditation Program (CSPAP) in 2007 was an important step in identifying the very best approaches that will support optimal outcomes for cancer patients in NSW. This report on the pilot of a CSPAP provides an opportunity to increase our understanding of the challenges and contribute to the discussion on the best methods for further improving the quality of NSW cancer services.
The Cancer Institute NSW is continuing to investigate appropriate indicators. Monitoring systems and standards systems that will contribute to further improving the care provided throughout NSW.
Objectives
To determine the impact a cancer service accreditation program might have on cancer services.
Methods
In March 2007, the Cancer Institute NSW commissioned Communio to undertake the development of a cancer services specific accreditation program. The CSPAP was pilot tested by Communio across eight cancer services from October to December 2007. The program was based upon a quality improvement cycle, and involved:
- the development of 12 draft accreditation standards
- a pilot of the standards across eight cancer services in NSW
- an external evaluation of the CSPAP as piloted.
Results
The development of the evaluation framework allowed the pilot to be assessed on nine criteria. Based on the evaluation report, two of the drafted standards were not supported: credentialing and scope of practice; and population health.
The evaluation found that further work on the meaning and wording of the proposed standards is required to ensure consistency in ratings between external and internal evaluators.
There were mixed views about the degree of overlap in the CSPAP and existing accreditation systems. This aspect will require further examination if a cancer service accreditation program is introduced in NSW.
The evaluation found that additional infrastructure will be required to support data systems before the effectiveness criteria could be fully utilised, as existing data reporting systems do not provide the required level of detail to monitor clinical outcomes.
The evaluation identified that clinicians have concerns about the utilisation of resources for an accreditation program when the evidence that such a program will impact on clinical outcomes is slight. This view is confirmed in the international literature. This aspect alone requires a step back from directly moving towards implementing a CSPAP in NSW, until systems are in place that can demonstrate that an accreditation process will have an impact upon cancer control and patient outcomes.
Conclusions
In November 2008 the NSW Report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals (Garling Report) was released. The NSW Government official response to the Garling Report supported recommendations that will allow clinicians across the state to have access to information upon which to base decisions and improved control over their local work. A greater response on monitoring of clinical performance including outcome and appropriateness of treatment is highlighted in the Garling report and the NSW Government response. A Bureau of Health Information will be created to support transparency in health data and allow greater local control of information analysis. The Bureau will undertake public reporting, performance monitoring, ad-hoc data supply and analysis, evaluation and research. In addition, chief executives will publish budget, performance and care status down to ward level staff, so that improvements can be made locally. The NSW Government response also emphasised that the NSW Clinical Excellence Commission will become the primary body responsible for safety and quality within NSW Health.
The Cancer Institute NSW is currently reviewing the findings of the CSPAP evaluation and will conduct further investigations to identify additional research and models that monitor the effectiveness of cancer services in NSW. This will allow the Institute to work closely with the new Bureau of Health Information and the NSW Clinical Excellence Commission, to develop additional mechanisms to ensure the further improvement of the quality and effectiveness of NSW cancer services.
In summary, while there is support for a cancer service accreditation model, further work is required on the most appropriate model that would impact upon patient outcomes and hence cancer control in NSW.