A CONSUMER FOCUS COLLABORATION PUBLICATION · 10 A Consumer Focus Collaboration publication10...

A CONSUMER FOCUS COLLABORATION PUBLICATION

Consumer participation inaccreditation

RESOURCE GUIDE

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CONSUMER PARTICIPATION IN ACCREDITATION

RESOURCE GUIDE

PPPPPrepared by Enduring Solutionsrepared by Enduring Solutionsrepared by Enduring Solutionsrepared by Enduring Solutionsrepared by Enduring Solutions

on behalf of the consortium involving:

Enduring Solutions Pty Ltd, Australian Council for Healthcare Standards, QualityImprovement Council, Women’s Hospitals Australasia and Children’s Hospitals

Australasia, Health Care Consumers’ Association of the ACT, National Rural HealthAlliance and Australian General Practice Accreditation Ltd.....

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22222 A Consumer Focus Collaboration publication

Consumer Participation in Accreditation – Resource Guide

©Commonwealth of Australia 2001

ISBN 0642 50357 5PA No. 2963

This work is copyright. Apart from any use as permitted under the Copyright Act1968, no part may be reproduced by any process without written permission fromAusInfo. Requests and enquiries concerning reproduction should be directed tothe Manager, Legislative Services, AusInfo, GPO Box 1920, Canberra ACT 2601.

The Commonwealth Department of Health and Aged Care has funded a range ofprojects to strengthen consumer participation in health through its Consumer FocusStrategy. These projects are overseen by the Consumer Focus Collaboration, whichis made up of consumer organisations, professional organisations, Commonwealth,state and territory health departments, and private sector representatives. TheCollaboration works to increase effective consumer participation at all levels withinthe Australian health care system.

Projects funded through the Strategy are intended to promote, integrate anddisseminate information and increase consumer involvement in health serviceplanning, delivery, monitoring and evaluation. The Consumer Focus Collaborationpublication series documents these projects.

A wide range of organisations participate in the Consumer Focus Collaboration,representing a broad range of views and interests. Consumer Focus Collaborationpublications do not attempt to reflect all of the views of the individual organisationsand jurisdictions represented on the Collaboration. However they do demonstratethe shared perspective on strategies for building a strong consumer focus for nationalaction on quality and safety.

For information on the availability of the publications, contact the InformationManager, National Resource Centre for Consumer Participation in Health,ph. (03) 9479 3614, free call 1800 625 619, web site http://nrccph.latrobe.edu.au

Commonwealth Department of Health and Aged Care

Canberra


A Consumer Focus Collaboration publication 33333

FOREWORD

Building a safe, high quality health care system means that people managing andworking in the system need to work together with consumers and the communityto achieve sustainable improvements and maintain public confidence in the system.

The Consumer Focus Collaboration publication series provides practical tools tosupport consumers and health care providers to achieve this goal. These toolshave been developed through projects funded by the Commonwealth Departmentof Health and Aged Care.

The Consumer Focus Collaboration, established in 1997, has played an importantrole in taking forward work on consumer participation at the national level. TheCollaboration is a national body with representatives from consumer, professionaland private sector organisations, and all health departments. Its aim is to strengthenthe focus on consumers in health service planning, delivery, monitoring andevaluation in Australia.

The Collaboration is taking the lead in fostering an active partnership betweenconsumers of health care and those who provide that care.

The resource guides, reports and issues papers that make up the publication serieshave been designed to provide health care consumers, service providers andmanagers with ideas and information about how to work together in partnerships.

Strengthening the voice of consumers in the health system requires a multi-prongedapproach. This publication series reflects the commitment of the Consumer FocusCollaboration to provide strategic resources in a number of areas including educationand training, building consumer capacity to participate, building provider capacityto respond to consumer need, and research into aspects of consumer involvementin health services.

Consumer Focus Collaboration

August 2001



CONTENTSCONTENTSCONTENTSCONTENTSCONTENTS

Foreword .......................................................................................................... 3How to use this guide ........................................................................................ 7Introducing the Guide ....................................................................................... 9What is in the Guide? ..................................................................................... 10Explaining some of the words we use................................................................ 11

Section 1: Accreditation – An Introduction ....................................................... 13A. The changing context ....................................................................................... 13B. Systemic benefits from involving consumers ........................................................ 15C. The role of accreditation ................................................................................... 18D. Consumer participation in accreditation ........................................................... 20

Section 2: Overview of consumer involvement in accreditation cycles ................ 21A. Introduction ..................................................................................................... 21B. Best practice for effective consumer participation in accreditation......................... 22C. Some general issues and strategies ................................................................... 24

Section 3: For accreditation agencies ............................................................... 29A. Introduction ..................................................................................................... 29B. Some strategies for involving consumers as surveyors and reviewers ..................... 33Checklist for accreditation agencies involving consumers as surveyors/reviewers ....... 44

Section 4: For facilities and services being accredited........................................ 47A. Introduction ..................................................................................................... 47B. Background to consumer involvement in quality improvement processes .............. 48C. Some good foundations for effective consumer participation ............................... 51D. Involving consumers – some practical strategies ................................................. 53Checklist for health services involving consumers on Quality ImprovementCommittees ......................................................................................................... 64

Section 5: For consumers ................................................................................. 67A. Introduction ..................................................................................................... 67B. Participating on a Quality Improvement Committee ............................................ 68C. Consumer surveyors and reviewers ................................................................... 70D. Getting involved ............................................................................................... 71E. Deciding whether to get involved yourself ............................................................ 72F. Being actively involved ........................................................................................ 73G. Staying involved ............................................................................................... 77Checklist for consumers ........................................................................................ 80

Section 6: Resources to help involve consumers in accreditation ........................ 83A. Accreditation agencies: Who are they? What do they do? ................................... 83B. Organisations which can assist with consumer participation ................................ 88C. Resources ........................................................................................................ 92

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HOW THOW THOW THOW THOW TO USE THIS GUIDEO USE THIS GUIDEO USE THIS GUIDEO USE THIS GUIDEO USE THIS GUIDE

This Guide has three audiences. They are:

� accreditation agencies;

� health services which are seeking accreditation; and

� consumers of health services who are seeking to be involved in accreditationrelated activities.

It is not essential that you read all of the Guide. We do recommend that everyonereads Sections 1and 2. Section 6 is about resources which might be useful foranyone wanting more information. Sections 3, 4 and 5 are each written specificallyfor one of the target audiences for this Guide and can be used as stand alonedocuments.

Section 3 is written for people working in accreditation agencies

Section 4 is written for people working in a health care service

Section 5 is written for consumers of health care services

Of course, if you want to read Sections 3, 4 and 5, then please do so. We hope youwill find it useful to read the advice given to everyone who is involved inaccreditation and quality improvement processes. However, if you read all threesections, you may find that there is some repetition because some of the advicecontained in the guide is relevant to accreditation agencies, health services and toconsumers.



INTRODUCING THE GUIDEINTRODUCING THE GUIDEINTRODUCING THE GUIDEINTRODUCING THE GUIDEINTRODUCING THE GUIDE

This is a Guide to involving consumers in accreditation and quality improvementprocesses. It has been developed as part of a project to assist accreditation agencies,health services and consumers to work together in monitoring and enhancing thequality of health care services. The project was commissioned by the Departmentof Health and Aged Care as part of its Consumer Focus Strategy and has beenoverseen by the Consumer Focus Collaboration.

There are many ways in which consumers can be involved in accreditation processes,including:

� helping develop standards against which health services will be accredited;

� working on the management committee of an accreditation agency;

� working on a quality improvement committee within a health service that is tobe accredited;

� providing feedback to a health service and asking that this feedback be providedto the quality improvement committee or other committee which is chargedwith overseeing the service’s accreditation process;

� being involved in consumer and community consultations which occur whenthe accreditation review is happening at a health service; or

� becoming a consumer surveyor or reviewer for an accreditation agency.

This Guide is about two of these:

� consumers as surveyors or reviewers on accreditation review teams; and

� consumers as members of quality improvement committees of the healthservices seeking accreditation.

The Guide does not deal specifically with the development of standards foraccreditation, or with consumer feedback processes such as surveys, consultationsand focus groups. These are very important roles and there is a lot of activity inthese areas overseas and in Australia (for example, see Improving health services throughconsumer participation: a resource guide for organisations1 ). The two roles covered by this

1 Consumer Focus Collaboration: Improving health services through consumer participation: A resource guidefor organisations, 2000.



Guide accept the importance of consumer experiences as users of services and thecapacity of users of services to contribute to the evaluation of quality at the ‘coalface’. It places consumer experience squarely alongside professional knowledge ascomplementary facets in the evaluation of service quality – consumers as fullpartners in the process of accreditation.

The Guide has been developed after examining the experiences of involvingconsumers in accreditation processes in Australia and overseas. A draft of theGuide was used in four pilot projects which tested out best practice in consumerinvolvement. The experience of those four pilots was used to inform and improvethe final development of the Guide as a user-friendly document for people whoprovide or use health care services and the agencies which monitor and assess thequality of those services.

What is in the Guide?What is in the Guide?What is in the Guide?What is in the Guide?What is in the Guide?

The Guide sets out some background to accreditation and its role in a continuousquality improvement cycle. It explains why consumers should be involved andsets out some best practice strategies to ensure that the benefits of consumerparticipation are maximised. It contains six sections, three of which (Sections 3, 4and 5) can be used as stand alone documents that can be photocopied and used bypeople and organisations seeking to involve consumers in their quality improvementprocesses.

� Section 1 provides some background to accreditation as part of a qualityimprovement process and explains some of the potential benefits from involvingconsumers.

� Section 2 sets out some ‘best practice’ for consumer participation inaccreditation – whether as surveyors or reviewers, or as members of qualityimprovement committees in facilities seeking accreditation. It also sets outsome general strategies for involving consumers effectively.

� Section 3 is aimed specifically at accreditation agencies. It first summarisessome of the international and Australian experience of involving consumersin the activities of accreditation agencies. It then suggests some strategies foruse by accreditation agencies that want to include consumers as part of theirreview teams. At the end of this section is a ‘check list’ of things which needto be done to effectively involve consumers.

� Section 4 is aimed specifically at health services which are seekingaccreditation and which want to involve consumers in their quality improvementprocesses. It provides some background about consumer involvement in qualityimprovement and other accreditation related activities. It then sets out some



practical strategies for organisations starting down the path of consumerparticipation in their internal quality committees. At the end of this section isa ‘check list’ of things which need to be done to effectively involve consumers.

� Section 5 is aimed at consumers who want to be involved in accreditationprocesses, either as surveyors or reviewers for an accreditation agency or inthe quality improvement processes within a health service. It summarises theways in which consumers can be involved and then sets out practical strategiesfor getting and staying involved and being effective. This section also containsa ‘check list’ to assist consumers in being and staying involved.

� Section 6 sets out some further useful resources to help accreditation agencies,health services and consumers. It includes information about the majoraccreditation agencies and some publications and organisations which can helpwith involving consumers.

From time to time in the text, there are stories and experiences retold from thosewho we interviewed as part of the project or who participated in the pilot projects.The openness with which people shared their experiences and feelings about themwas extraordinarily useful and we are very grateful for those who took the time totalk with us. We hope these stories will help others who are setting out to improveconsumer participation in accreditation. Sometimes the words used bring togetherthe experiences of more than one person, but we have otherwise tried to accuratelypresent those experiences conveyed to us.

Explaining some of the words we useExplaining some of the words we useExplaining some of the words we useExplaining some of the words we useExplaining some of the words we use

Readers may not be familiar with some of the terminology about accreditation,quality improvement, consumers and consumer participation which is used in thisGuide, so a brief explanation of how and why we use particular terms is set outbelow.

� Accreditation: A method of assessing whether health care services achieveand comply with recognised standards of service and care. It is a formalprocess, conducted by an authorised, independent accreditation agency. It is aprocess of certification that departments, functions, processes and outcomeswithin health care facilities meet specified standards both at a particular pointin time and on a continuing basis. It usually involves an accreditation agencyperiodically reviewing the standard of services provided by a health care facility.Prior to the review, the health care facility provides a self-assessment of itsservices. After the review the accreditation agency provides a report andrecommendations based on its assessment of the quality of the services,together with recommendations, to the health care facility.



� Surveyor/reviewers: An accreditation review is generally carried out by ateam of people with expertise in different aspects of health care. In this Guide,these people are referred to as surveyors or reviewers.

� Quality improvement processes: We use this term broadly to cover therange of activities within health care services that are intended to monitor andimprove the quality of care. Quality improvement processes can vary withinand between different services. The activities involved in preparing for, andresponding to, an accreditation review are seen as quality improvementprocesses.

� Consumers: We use this term broadly to cover people who use or are potentialusers of health services.

The term ‘consumer’ is often used to include a person who cares for a consumer.However, there are times in this Guide where we do use the term ‘carer’separately because at times, the experiences and perceptions of a carer maywell be different from those of a consumer. For example, a carer may havedifferent views of particular treatments because they relieve the burden ofcaring, but for consumers the side-effects of those treatments such as lack ofconcentration, lethargy or mood changes may make them unacceptable. Acarer may welcome some form of respite care, while for the consumer therespite care service may be seen as diminishing their own quality of life.

� Carer: A family member or other person who cares for a consumer who issufficiently sick or disabled to need assistance looking after themselves.

� Patient: While the Guide primarily uses the term ‘consumers’ it occasionallyuses the term ‘patient’ when referring to a person who is currently under medicalor surgical treatment within a health care facility.

� Consumer representative: A committee member whose experience of healthservices is primarily as a consumer of services and who take part in the decisionmaking process on behalf of consumers. They are committed to representinga broad range of consumers’ views, are accountable to an organisation and/orensure that they refer back to their constituency.

� Consumer participation: The process of involving health consumers indecision making about their own health care and in health service planning,policy development, priority setting and addressing quality issues in the deliveryof health services.

� Service Providers: People who are involved in the process of health careprovision, including, nursing, medical, allied health and support staff.

Review of Existing Models of Reporting to Consumers on Health Service QualitySummary Report and Guidelines


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SECTION 1:SECTION 1:SECTION 1:SECTION 1:SECTION 1: AAAAACCREDITCCREDITCCREDITCCREDITCCREDITAAAAATION – AN INTRODUCTIONTION – AN INTRODUCTIONTION – AN INTRODUCTIONTION – AN INTRODUCTIONTION – AN INTRODUCTION

A. The changing contextA. The changing contextA. The changing contextA. The changing contextA. The changing context

Around the world health care systems are under pressure. As new treatments andtherapies emerge, health systems face an increased demand for services with few,if any, extra financial resources to provide them. Governments, insurers andconsumers are demanding that services deliver better value for the health dollar.At the same time, consumer expectations about health services are changing.

In recent years a number of studies in Australia, Britain, the USA and Canada haveled to concerns about the safety and quality of health care. While it is generallybelieved that services and treatments provided in these systems are of a high quality,a number of noteworthy studies undertaken in the past two decades show that asignificant number of people are suffering avoidable injury or ‘adverse events’while receiving health services2 . Other studies are showing that the care that isprovided is not always appropriate, of high quality, or based on sound evidence ofeffectiveness. Consumers are also demanding better information about quality andcosts in order to be able to judge performance and choose their health care wisely.Health systems and services are under greater scrutiny by users and the communitythan ever before.

There are also many pressures on health services to change the way they do things.Increasing numbers of consumers want to take more control of their own healthcare to be able to make truly informed choices between treatment options andproviders. Technological advances in clinical care and health informationmanagement are requiring changes to the way health care is performed.Requirements by funders of services that care is delivered efficiently and effectivelyare driving changes to the way that care is planned and delivered.

One of these changes is in the relationship between patients and the people whoprovide services. An increasing number of people want a more equal relationshipwith their health care professionals and no longer accept the traditional nature ofsuch relationships where people are treated as passive recipients of treatmentsthat are deemed to be good for them by their doctors or other health careprofessionals. They want to be more active participants in their own care – to havea partnership relationship with their health professionals – where they receive adviceand information, and make decisions in consultation with the doctor or the treatmentteam.

2 See for example the Quality in Australian Health Care Study (FN), Harvard Medical Practice Study (FN), Utah/Colorado Study (FN) and Kohn LT, Corrigan JM, Donalsdon MS eds.1999, To Err is Human: Building a SaferHealth System. Committee on Quality of Health Care in Amderica. Institute of Medicine. National Academy Press,Washington, D.C.



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The participation of consumers both in their own care and at a system wide levelis now being recognised as essential in improving the quality and accountability ofservices to the communities and governments which fund them. A growing numberof governments and health care providers are now actively seeking the views ofconsumers about health policy, planning, service delivery and evaluation.

The importance of people participating in the planning and implementation ofhealth care has been recognised in a number of international declarations. TheWorld Health Organisation (WHO), in their 1978 Declaration of Alma-Ata3 ’set outa vision for primary health care which stated that ‘people have the right and dutyto participate individually and collectively in the planning and implementation oftheir health care’. In 1986 the WHO developed the Ottawa Charter on HealthPromotion4 in which consumer empowerment was identified as a central element ofachieving improved health and well being. This was reiterated in 1997 in theJakarta Declaration on Health Promotion in the 21st century5 which recognised that healthpromotion is a process of enabling people to improve their health by increasingtheir control over it.

3 World Health Organisation, Charter for Action to Achieve Health for All by the Year 2000 and Beyond. FirstInternational Conference on Health Promotion, Ottawa, Canada, 21 November 1986.

4 World Health Organisation, The Jakarta Declaration on Health Promotion into the 21st Century. Fourth InternationalConference on Health Promotion, Jakarta, Indonesia, 1997.

5 Consumers’ Health Forum: Casemix Project Final Report; 1994.



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BBBBB..... Systemic benefits from involving consumersSystemic benefits from involving consumersSystemic benefits from involving consumersSystemic benefits from involving consumersSystemic benefits from involving consumers

The major benefit for the health system of involving consumers is the potential forimproved quality of care. Consumers see health services from a different perspectivethan the people who provide services. That perspective is one of a person usingand receiving services. The experiences of consumers can be invaluable in improvingservices and treatments because of this different perspective. They bring an extradimension to traditional ways of assessing quality which is essential to improvingthe quality of care.

Increasingly consumers judge quality not only on the competence and effectivenessof the clinical treatment provided (and that is very important) but also on the wayin which they are cared for within the health care system. For consumers, qualityincludes good communication with professionals, the provision of good informationabout services, professionals and treatments and having care which is coordinatedand holistic. It also involves treating those needing health care with dignity andrespect, including involving them in decisions about their treatments.6,7 As MaryDraper8 puts it:

how quality is defined matters …

for health service users, the health product is both process (how I get treated)and outcome (whether I benefit). The experience of quality is also about acontinuous, whole process, not just about a part of the body or what happens inthe hospital ward. It may be that my leg is ready to go home, but I am not…Whenhealth care users define quality, as opposed to health care providers, it may lookquite different.

The different perspective of consumers usually means that the questions they askand the suggestions they put forward will broaden the issues covered in the reviewprocess. While they are, of course, concerned with the technical aspects of clinicalcare, they are also concerned about other aspects of care which have not traditionallybeen considered as part of quality assurance processes or which may be given lessof a focus by some health professionals. They include issues about the coordinationand integration of care, communication, access to treatment, provision ofinformation, and respect for consumer rights. The ideas they put forward will begenerated from using services and seeing what might be improved. For example,consumers can identify where services could be improved, such as better planningand coordination of admission and discharge from hospitals. They will often have

6 Consumers’ Health Forum. Integrating Consumer Views about Quality in General Practice 1996.

7 Consumers’ Health Forum. Integrating Consumer Views about Quality in General Practice 1996.

8 Health Issues Centre: Casemix, Quality and Consumers 1992 p. 48.



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ideas about providing better information for consumers about the services offered,and the rights that consumers have while using the service. The ideas, feedbackand practical solutions put forward by consumers can have a major positive impacton the delivery of services.

It was amazing seeing what a consumer saw that I didn’t. I mean, I walked into the wardand saw good quality machinery and a well-organised ward. I saw the equipment thatwasn’t placed conveniently for an emergency. The consumer who was with me noticed that oneof the very ill patients was lying without a screen and uncovered, that there was no privacy inthe showers and that, in one ward, there seemed to be a better atmosphere, where patientswere treated better and respected. It was like seeing the same place through completelydifferent eyes – and given hospitals are after all, HUMAN services, it was a very importantperspective. (Health professional surveyor)

Many services are now encouraging consumer participation in quality managementprograms in their services. The participation of consumers has the potential to:

� provide the basis of a dialogue between services and consumers aboutimproving services;

� provide services with information about the impact of the services onconsumers and their lives;

� provide services with information about short and longer term outcomes oftreatment;

� make services aware of significant areas of dissatisfaction with care;

� provide an opportunity for joint problem solving in areas of common concern;

� give staff new insights into how people perceive aspects of their care;

� lead to fewer complaints;

� allow staff to be less defensive;

� engender consumer and community support for the service; and

� enable services to set priorities about areas of improvement that matter toconsumers.

Interviews with people who had been involved in accreditation reviews whereconsumers were surveyors/reviewers or where consumers had been involved inquality improvement activities within a health care facility seeking accreditation,spoke of the power of consumers to bring about culture change, in a way whichwas otherwise difficult.



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I came to the hospital about 18 months ago and I knew there was a lot to change. But staff– even my management team – were very resistant to change. They felt everything was prettygood. They were even resistant to the process of accreditation.It must have been hard for thesurveyors, as some staff refused to talk with them. At the conclusion of the review, theconsumer spoke from his heart about what he had seen. He talked about the lack of dignityfor people being treated here and the need for very significant change. He said things that Ihad been saying but THIS TIME, everyone listened. After that, one of the key players cameto me and asked could he go and see another facility to see what was happening in otherplaces. Once he came back, he said that he hadn’t realised how far behind the facility was,and if the consumer hadn’t talked about it, he would not have questioned his assumptionthat what they had been doing here was the best. He now is one of my best supports inbringing about the changes that are needed. (Facility Manager)



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C.C.C.C.C. The role of accreditationThe role of accreditationThe role of accreditationThe role of accreditationThe role of accreditationWith these changes has come increasing demands for more public accountabilityand external monitoring of service quality, so that consumers can includeassessments of quality appropriately in their decision-making. Funders, too, havesought some way of ensuring that the services they fund meet, at least, a minimumstandard of quality and can be acknowledged when they achieve excellence.

Accreditation is an important method of assessing whether health care servicesachieve and comply with recognised standards of service and care. It is a formalprocess by which an authorised independent body evaluates and rates a health careorganisation against specified quality criteria or standards. While it is seen as avoluntary process, many agencies which fund services require that they be accredited.For example, some state governments require that all public hospitals be accreditedas part of their funding conditions. Health insurance funds may also require thathealth facilities be accredited as part of their contractual arrangement with thoseservices.

Accreditation can play a central role in monitoring and improving the quality ofAustralian health care and community care services. It can also provide aninvaluable mechanism for assuring the Australian community and individualconsumers that the services provided by particular health care organisations orservice providers are of an acceptable standard.

Accreditation processes are generally centred around an internal assessmentconducted by the organisation undergoing accreditation in conjunction with anindependent peer-based survey team. The internal assessment and the independentreview are generally conducted every few years. Increasingly, accreditation agenciesare aiming to use this process to stimulate a cycle of continuous quality improvementrather than having the focus of accreditation being a type of examination conductedevery few years. The assessment criteria or guidelines used by accreditation agenciesare based on standards for continuous quality improvement or a framework forquality management, depending on the type of accreditation being sought.

Acute and primary health care providers currently have access to a number ofaccreditation processes to support them to improve and benchmark their qualityprocesses and outcomes. These processes include the EQuIP framework of theAustralian Council on Healthcare Standards (ACHS), the Australian Health andCommunity Services Standards which are written by the Quality ImprovementCouncil (QIC), the PriorityCare process of the Private Hospitals Association ofVictoria; and the general practice accreditation program run by Australian GeneralPractice Accreditation Ltd (AGPAL). There are also more general industry ‘qualitystandards’ which can be (and are) applied to the health sector, such as theInternational Standards Organisation ISO-9000, and the Australian Quality Council’sBusiness Excellence Awards. Contact details and brief summaries of these variousorganisations are included in Section 6 of this Guide.



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The World Health Organisation also runs an accreditation program focusing onhospitals as health promoting organisations. The International Society for Qualityin Health Care (ISQua) which is based in Australia is working internationally todevelop international standards for health care accreditation bodies through itsprogram called ‘ALPHA’ (Agenda for Leadership in Programs in HealthcareAccreditation). The purpose of this program is to provide a quality improvementframework to assist accrediting bodies in the health sector to develop and improvetheir standards and services - an ‘accreditors’ accreditor’ arrangement. There arealso other forms of accreditation for particular types of health facilites, such asthe Aged Care Standards Accreditation Agency. Particular ‘specialty’ areas alsohave accreditation programs, such as the Fertility Society of Australia’s accreditationprogram for facilities which provide assisted reproductive technology services.

In the early to mid 1990s, many concerns were raised about accreditation processes– the main criticism was that they generally focused too much on structures andprocesses and not enough on outcomes for consumers of the services. For example,review processes gave great attention to the safety of buildings, policies, proceduresand the establishment of committees, but traditionally gave less emphasis to systemsfor measuring the safety or effectiveness of the care provided. This is changingwith the broader directions of health care. Part of this change has been the growingrecognition that consumers can play a crucial role in effective accreditation.



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DDDDD..... Consumer participation in accreditationConsumer participation in accreditationConsumer participation in accreditationConsumer participation in accreditationConsumer participation in accreditation

Increasing effective participation by consumers in accreditation processes has thepotential to bring about service-wide improvements. Consumers will bring adifferent perspective to the review, asking different questions and focusing on issueswhich may not have been raised before. It has the potential to increase the consumerfocus of quality improvement activities and improve the content of accreditationfeedback to services about consumer aspects of service quality. It should alsoencourage services being accredited to increase the extent of consumer participationin all of their quality improvement activities.

It is important to remember that there are many areas of the accreditation processwhere consumers can provide valuable input. However, this Guide concentrateson consumers as members of accreditation review teams and as members of qualityimprovement committees of health services seeking accreditation.

Some consumers have already been involved in these processes. This Guide buildson their experiences and on those who worked with the consumers on review teamsor within services seeking accreditation. Many of those we spoke to in compilingthis Guide saw consumer participation as a very positive experience which is alreadyleading to significant improvements in the quality of the services. Others wespoke to identified a number of problems – these are addressed in the Guide. TheGuide is intended as a tool to ensure that consumer participation is effective: thatconsumers feel able to participate and that accreditation agencies and health servicesare able to maximise the contribution that consumers are able to make.



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SECTION 2:SECTION 2:SECTION 2:SECTION 2:SECTION 2: OOOOOVERVIEW OF CONSUMER INVVERVIEW OF CONSUMER INVVERVIEW OF CONSUMER INVVERVIEW OF CONSUMER INVVERVIEW OF CONSUMER INVOLOLOLOLOLVEMENT INVEMENT INVEMENT INVEMENT INVEMENT INAAAAACCREDITCCREDITCCREDITCCREDITCCREDITAAAAATION CYTION CYTION CYTION CYTION CYCLESCLESCLESCLESCLES

A. A. A. A. A. IntroductionIntroductionIntroductionIntroductionIntroduction

Involving consumers as surveyors or reviewers on accreditation teams or as membersof quality improvement committees of health services seeking accreditation canimprove the process and its outcomes. Our research has shown that properlytrained and skilled consumers are valuable assets for all concerned in theaccreditation process.

� Consumers and health professionals ask different questions in both processes– almost all the feedback we have received from clinicians and administratorsinvolved in accreditation has included a statement saying ‘The consumer askedgood questions, ones which I had never thought of asking!’

� There is some evidence that more junior staff also can feel more confident intalking to consumer surveyors/reviewers, rather than a health professional.Sometimes the issues raised may be a concern which needs to be addressedbut which more senior staff may overlook.

� A consumer surveyor/reviewer may relate better to other consumers who areinvolved in the facility’s quality improvement processes, or who are patientsusing the services provided by the facility.

� Most services are seeking to become more user-focused and consumer-friendly.Having consumers involved in the internal quality improvement processes canmaximise the facility’s chances of achieving this. Consumers usually see theservices provided by the facility from the perspective of a service user – theycan help identify issues and improve processes before the accreditation reviewoccurs.

However, good consumer participation does not merely involve finding a consumerand putting him or her on to a committee or in a review team. There are a numberof factors that need to be taken into account to ensure consumers are able tocontribute effectively to review processes.

This section first sets out those factors that contribute to ‘best practice’ in effectiveconsumer participation in accreditation and then discusses some strategies thatwere identified in the research for this Guide.



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BBBBB..... Best practice for effective consumer participationBest practice for effective consumer participationBest practice for effective consumer participationBest practice for effective consumer participationBest practice for effective consumer participationin accreditationin accreditationin accreditationin accreditationin accreditation

The following is a summary list of those factors that contribute to ‘best practice’for effective consumer participation in accreditation and other quality improvementprocesses. This list has been generated from the experience of consumers and peoplewho have worked with consumers in accreditation and quality improvementprocesses. The sections which follow expand on these elements of ‘best practice’and are designed to help you put them into practice. Many of them are about goodpractice generally, not just about consumer participation.

� You need to have the right person for the right job – to achieve this the rolesand expectations of consumer representatives must be clear at the time theyare recruited.

� All accreditation team and quality improvement committee members needappropriate skills and experience to effectively work together.

� All members of the accreditation team or quality improvement committeeneed to understand the role and expectations of consumer representatives andof other team or committee members.

� Participation by a consumer representative in accreditation must not be usedas a substitute for that of a health professional – consumers bring their ownexperience and expertise, as do health professionals.

� Effectively managing the diverse membership of quality improvementcommittees and accreditation review teams is a skilled task, requiring leadershipand sensitivity to the spoken and unspoken concerns of members.

� The different perspectives, experiences and skills of all team members, includingconsumer representatives, need to be acknowledged and valued by all membersof the team or committee.

� Consumer participation is enhanced by the active support of senior managerswho develop and drive a comprehensive consumer participation strategy withina service or agency.

� Consumer participation is enhanced when providers work in partnership withan accountable and representative consumer organisation.

� All members of the committee or team, including consumers, must be treatedwith respect and trust, and as equal members in the accreditation process.



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� Consumer participation needs to be supported and adequately resourced.

� Consumer representatives should be able to represent the views of a widerange of consumers, and be accountable to them through appropriatemechanisms such as consumer organisations.

� Appropriate training, orientation and information should be provided for allteam and committee members, and specific additional training or assistancefor both consumer representatives and other members should be provided asrequired to ensure the effective operation of the team or committee.

� Consumer participation needs to be a continuous process, not a one-off event.Consumer involvement in accreditation processes should be reflected in theiron going involvement in the operation of the agency or service.



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C.C.C.C.C. Some general issues and strategiesSome general issues and strategiesSome general issues and strategiesSome general issues and strategiesSome general issues and strategies

Getting the most out of the unique perspectives of consumersGetting the most out of the unique perspectives of consumersGetting the most out of the unique perspectives of consumersGetting the most out of the unique perspectives of consumersGetting the most out of the unique perspectives of consumers

The experience that consumers bring to the accreditation process is different toother members of the team or committee. For example, they may not be as familiarwith the mechanics of the health care system or with some of the technical andscientific aspects of service delivery as other team members. On the other hand,they do know what it is like to be a consumer of the sort of service seekingaccreditation, and they will look for different things in the review process.

Consumers will use their own experience, and the experience of other consumersthey talk with, to raise questions that will not necessarily occur to other teammembers with different backgrounds. For example, consumers may raise issuesabout processes for informing consumers of their rights and how to accesscomplaints processes. They may raise issues about the level of information providedto consumers, privacy and consent procedures. They may also raise issues aboutthe coordination and ‘seamlessness’ of care.

Effective participation is about ‘horses for courses’Effective participation is about ‘horses for courses’Effective participation is about ‘horses for courses’Effective participation is about ‘horses for courses’Effective participation is about ‘horses for courses’

Just as not all health professionals will be suitable to be on accreditation teams orcommittees, neither will all consumers and consumer representatives be suitable.Consumers all bring different skills and experience. Those organising qualityimprovement committees and review teams need to be aware of the skills they areseeking and what needs to be done to maximise the chances of getting someonewith the most appropriate skills and experience. In her report on consumerparticipation in hospitals, Mary Draper said:

For example, if a hospital or network wanted to get consumers on a board ofmanagement or its sub-committees as part of its strategic planning, they wouldneed to find consumers with expertise in thinking through issues from a policyperspective, and with some authority to represent other consumers. On theother hand, if a hospital ward or area was looking at improving its service delivery,it might seek to involve the relevant clinical illness consumer group, as well asconsumers who are currently or have been recently involved with that ward orservice delivery area.

9

9 Draper - see note.



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This may well mean that, just as would be the case with a health professional oradministrator, a consumer who is suitable for an internal committee may not bethe same person who would be nominated to train as a consumer surveyor/reviewer.In both cases, they will generally need to have some representative experience, aframework of understanding of the concerns of consumers more broadly and astrong understanding of his or her representative role. This can come fromexperience of sitting on a range of committees or forums, and it can be facilitatedthrough special ‘consumer training’, as occurs in the ACT Consumer Representativetraining project.10 Again this is dealt with in more detail in the next sections of thisGuide.

Building trust and overcoming fearsBuilding trust and overcoming fearsBuilding trust and overcoming fearsBuilding trust and overcoming fearsBuilding trust and overcoming fears

Consumers may not have worked in this sort of environment before, and may notbe clear about what is expected of them. Some may have had bad experiences asa patient in the health system, or have been treated disrespectfully on other occasionswhen they were working as a consumer representative.

Similarly, some members of the team or committee may not have worked on thesetypes of activities with consumers before. They may be used to thinking ofconsumers only as patients and so may not be entirely comfortable with workingwith them as colleagues. Sometimes team and committee members may not havereasonable expectations about what consumers can and cannot bring to the process.The previous experiences of health professionals with consumers on committeesmay not all have been positive and this may have left them with prejudices aboutconsumers in general.

In both cases, the relationship between consumers and other team or committeemembers may be coloured by these previous negative experiences and by uncertaintyabout the process and how they will work together. Recognising the possibilitythat issues such as these exist and working actively to overcome them is an importantrole for team or committee leaders.

A first important step is to ensure that everybody’s expectations and understandingof the roles of other members are clear from the start of the process. The nextstep is a process of long-term trust-building. Some of the mutual suspicions andfears of consumers and health professionals will probably have to be worked throughon a day-to-day basis as the committee or team progresses in their work. Sections3, 4 and 5 of this Guide include some strategies which can assist in this processand can help everybody understand and value the perspectives and contributionsof the different team members.

10 For details abut this program, please contact Health Care Consumers Association of the ACT, GPO Box1659, Canberra City, ACT 2601, ph. 02 6290 1660.



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Resource constraints for consumersResource constraints for consumersResource constraints for consumersResource constraints for consumersResource constraints for consumers

Consumer representatives on committees usually do not have the resources ofstaff and an office behind them. They are often working from home and do nothave the financial and physical resources available to other team members who areemployed within the health care system. This can, for example, limit consumers’access to electronic communication such as email and fax.

Some consumers, particularly those whose employment options may have beenlimited by chronic or serious illness, can also be affected by poverty or be relianton income support. This makes costs sometimes associated with participation oncommittees and teams, such as transport, clothing and meals out, a financial burdenfor them. Meeting these costs can thus be crucial for effective participation. Tellingconsumers and others who may be in such a situation that the specific costs will bemet and providing the means of meeting the costs before they are incurred (suchas cab vouchers) can relieve a lot of worry and embarrassment.

Adequate payment for the work done (including preparation where the workrequired is significant) is also an important principle. Other team or committeemembers may have significant earnings against which to write off their time andcosts for participation or they may be being paid to participate as part of theiremployment. By contrast, few consumer organisations are funded at all, and wherethey are funded, the funding is not sufficient to pay consumers on committees orteams. Providing payment recognises the real value to the organisation of thework being done by the consumers involved. The issue of payment should beraised with the consumer directly, but in a confidential manner, to allow theconsumer to raise issues or concerns they may have without embarrassment. Forexample, in some cases, consumers may choose (eg because of pension or otherincome support arrangements) to nominate their organisation to receive the payment.

Ensuring consumerEnsuring consumerEnsuring consumerEnsuring consumerEnsuring consumer-friendly processes-friendly processes-friendly processes-friendly processes-friendly processes

As well as resource constraints, health care consumers, by their very nature, oftensuffer from ill-health. Leaders of accreditation review teams and qualityimprovement committees need to be sensitive to this. They need to be prepared todiscuss with the consumer representative any adjustments to such things astimetables, or any ways in which they can be helped to contribute so that they arenot put under unnecessary strain with deleterious effects on their health. In somecases, consumers can work in pairs to ensure coverage of the team or committee.Both consumers are trained and the one who attends a meeting or activity undertakesto brief the other, so in the event of ill-health, the other person can be an effectivesubstitute. This may not be appropriate in all situations, but there are often creativesolutions which can be worked out collaboratively with the consumer. Ill healthshould not be a barrier to participation, because it is that experience of ill healthwhich can do so much to improve health care services.



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The processes around accreditation need to be designed to ensure that everybody’sperspective, including that of the consumers, is able to be drawn upon. Somereasonable adjustments to the way things have been done in the past may benecessary to ensure that the benefits of consumer participation are fully realised.Often these changes may be desirable for others as well (eg ensuring papers areprovided for a meeting in enough time for everyone to read them) or simply by theimplementation of recognised good practice (eg minimising the use of unnecessaryjargon and explaining frequently used acronyms), rather than making ‘specialarrangements’. These are dealt with in more detail in the next sections of thisGuide.

PPPPProper training and information for all members is crucialroper training and information for all members is crucialroper training and information for all members is crucialroper training and information for all members is crucialroper training and information for all members is crucial

All those involved in accreditation and quality improvement processes need sometraining to understand the process. Some consumers and health professionals willalso need specific training to provide the skills necessary to participate effectivelyin the processes or to enhance the skills they already have.

Often there is an assumption that consumers are the ones whose skills will beinadequate and who will need training. While this may be true in some cases, itmay also be that the consumer is more experienced and expert than other teammembers. Health professionals and administrators often have little or no trainingin the skills which are necessary for working effectively in a team. Consumer andhealth professional members may all need skills related to clear and concise reportwriting, effective communication, active listening and facilitation, group dynamicsand conflict resolution. While the range of skills may differ between consumersand health professionals at a generic level, more often than not they differ mostbetween individuals, whatever their role.

Training to develop some of these skills needs to be built into general preparatorytraining. However, some may need to be specifically tailored to the needs of onegroup or another, or to different pre-existing skill levels.

Consumer participation is an ongoing requirement for qualityConsumer participation is an ongoing requirement for qualityConsumer participation is an ongoing requirement for qualityConsumer participation is an ongoing requirement for qualityConsumer participation is an ongoing requirement for quality

Consumer participation in accreditation is not just something that should happenevery few years. The various accreditation programs outlined in Chapter 6 of thisGuide encourage the notion that their processes are not ‘one off ’ exams to achievean adequate quality ‘mark’, but rather should be part of an on-going process oforganisational quality improvement. Consumer participation is an integral part ofall continuous quality improvement, and so consumers should be participating onmany levels and across the various activities that are aimed at providing betterhealth care services and treatments.



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SECTION 3:SECTION 3:SECTION 3:SECTION 3:SECTION 3: FOR AFOR AFOR AFOR AFOR ACCREDITCCREDITCCREDITCCREDITCCREDITAAAAATION ATION ATION ATION ATION AGENCIESGENCIESGENCIESGENCIESGENCIES

A.A.A.A.A. IntroductionIntroductionIntroductionIntroductionIntroduction

This section of the Guide is aimed specifically at accreditation agencies who wantto involve consumers as surveyors or reviewers. It first summarises some of theinternational and Australian experience of involving consumers in the activities ofaccreditation agencies. It then suggests some strategies for accreditation agenciesthat want to include consumers as part of their review teams. These strategies areaimed at maximising the positive side of the experience for the accreditation agency,the consumer and the health service being accredited. The strategies cover:

� clarifying the role and expectations of consumer surveyors/reviewers;

� acknowledging the developmental process;

� recruiting consumer surveyors/reviewers;

� training consumer surveyors/reviewers;

� creating effective review teams;

� effective leadership; and

� learning from experience.

At the end of this section is a ‘check list’ of things that need to be done to effectivelyinvolve consumers.

Some models from overseasSome models from overseasSome models from overseasSome models from overseasSome models from overseas

Nationally and internationally, consumers are involved in the work of accreditationagencies in a number of ways. These include:

� having positions on the decision-making board of the accrediting agency;

� being on a consumer or community advisory group to provide advice to thedecision-making body about accreditation decisions;

� providing input into the development and review of standards; and

� acting as surveyors/reviewers for the agency.



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The philosophies of the different accreditation agencies about consumer andcommunity involvement varies significantly between countries and betweenagencies within countries. For example, many US health care agencies focus theirefforts on the ‘public interest’, with consumer bodies being established to monitorthe activities of the accreditation agency from the perspective of the ‘public interest’or ‘public’ representation being included on the board of governance. The actualwork of accreditation reviews in these cases is almost always undertaken solely byhealth professionals.

An example of both these kinds is the US Joint Commission on Accreditation ofHealthcare Organizations. The Joint Commission has six public members on its 28member Board of Commissioners, whose task is to represent the public’s interestsin the activities of the Commission. It has a separate Public Advisory Group onHealth Care Quality, which was established in 1999. The 20 member group wasformed ‘to help the Joint Commission define public expectations for quality inhealth care and offer insights for improvements in the accreditation process.’11

The United Kingdom (UK) Health Services Accreditation (HSA) organisation usesa different model for accreditation, with consumers mainly being involved instandard setting. The accreditation ‘review’ is not a single event, but rather a modelwhere different surveyor/reviewers can attend at different times to ‘attest’ thestandards. For HSA to be satisfied that the facility has achieved specified standards,two people from a specified list need to attest to its achievement. Attestationvisitors can include consumers, where they fit into one of the specified categories,but there is no separate category for service users. The ‘public interest’ approach isreflected in the use of prominent public citizens, such as the mayor, local clergymanor newspaper editor, for attestation. It is also possible that a consumer could attendas the chair or other executive member of the local community health council.This model does not really recognise the unique perspective that users of servicescan bring to the review process.

However, in some US organisations relating to accreditation for people withdisabilities, the approach is much more similar to that which we are adopting inAustralia. This approach differs from the ‘public interest’ approach outlined above,in that it accepts that consumers bring a unique understanding that is as valuableto a service, in many ways, as the perspective of an independent health professional.For example, the US Commission on Accreditation of Rehabilitation Facilities(CARF) accredits mental health, alcohol and drug programs, medical rehabilitationservices, employment and community services, adult day services and assistedliving services. People with disabilities participate in CARF as surveyors. Sometimes

11 Joint Commission on Accreditation of Health Care Organizations. The Joint Commission’s Commitment to PublicAccountability. Pamphlet JCAHO 5/00 : page 4. Further information on the work of the Joint Commissioncan be fund on its web-site: http://www.jcaho.org.



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these people also have professional skills in the services being accredited, but notalways. One of CARF’s programs also uses consumers to interview other consumersof the service to be accredited to gather information prior to the surveyors going‘on-site’. Consumers are also involved in their standard development processesand on the Board of Trustees.

Australian experiencesAustralian experiencesAustralian experiencesAustralian experiencesAustralian experiences

The introduction of consumer surveyors or reviewers in Australian accreditationagencies has generally occurred first in the area of mental health services. This hasgenerally been in response to the National Standards for Mental Health Services(NSMHS), established by the Australian Health Ministers’ Advisory Council(AHMAC) as part of the National Mental Health Strategy. The strategy has guidedpolicy in the mental health area since 1992. The standards were first published in1996.12 They stress among other things that consumers and carers of people withmental illness must be involved in the planning, implementation and evaluation ofmental health services.13

The Australian Health Care Agreements, which cover the arrangements betweenthe Commonwealth and the States and Territories include specific componentsrelated to mental health. These include the requirement that mental health serviceswill implement the NSMHS and also that the jurisdictions will maintain mentalhealth consumer advisory bodies in each state. For example, clause 85 of the ACTagreement states:

The Australian Capital Territory agrees to maintain a mental health consumeradvisory group to provide open and independent advice to the Australian CapitalTerritory Minister and the Australian Capital Territory Department on mentalhealth issues.

The AHMAC National Mental Health Policy Working Group has determined thatthe implementation of the standards is to be confirmed by external review andthat the criteria for such external reviews are:

� a review process should include a broad consultation strategy which includesfeedback from consumers, carers, staff, stakeholders and management;

12 National Standards for Mental Health Services 1996 Australian Government Publishing Service (AGPS) Canberra.

13 Commonwealth Department of Health and Family Services. National Standards for Mental Health Services –Supporting Quality in mental health care in Australia. Pamphlet undated - see section 3 under Summary.



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� review personnel are critical to the outcome of the review and mental healthservices should only be surveyed by a team with appropriate mental healthexpertise; and

� consumer surveyors/reviewers should be included on review teams.

In some jurisdictions, the State or Territory Mental Health Units have indicatedthat the external review is to be conducted as part of any accreditation processwhich the service is undertaking.14

Two of the major accreditation agencies in Australia, the Australian Council onHealthcare Standards and the Quality Improvement Council, have introducedconsumer surveyors into their survey teams for in-depth mental health servicereviews. Some organisations which accredit specialised clinics also involveconsumers as surveyors. In compiling this Guide we talked to some of thoseconsumers, other survey team members, and staff from facilities which have beenaccredited in order to draw out the lessons from these experiences. Use of consumersurveyors in the broader health care accreditation environment is expected to followin the near future.

14 Australian Council on Healthcare Standards. External Assessment of the National Standards for MentalHealth Services Using the Australian Council on Healthcare Standards(ACHS) Evaluation and QualityImprovement Program (EQuIP).



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BBBBB..... Some strategies for involving consumers asSome strategies for involving consumers asSome strategies for involving consumers asSome strategies for involving consumers asSome strategies for involving consumers assurveyors and reviewerssurveyors and reviewerssurveyors and reviewerssurveyors and reviewerssurveyors and reviewers

Clarify the role and expectations of consumer surveyors/Clarify the role and expectations of consumer surveyors/Clarify the role and expectations of consumer surveyors/Clarify the role and expectations of consumer surveyors/Clarify the role and expectations of consumer surveyors/reviewersreviewersreviewersreviewersreviewers

An accreditation agency needs to be very clear about the role it sees consumersurveyors fulfilling and how this complements the role fulfilled by other surveyors.This allows the agency to:

� identify the sort of skills and experiences which would be useful for theconsumer surveyors/reviewers to have;

� work out the kind of training which may be required;

� clearly advise the consumer surveyor about their role and to clarify expectationsregarding this role;

� educate other team members about what the role of the consumer surveyors/reviewers; and

� work out the appropriate remuneration and reimbursement of expensesassociated with being a surveyor/reviewer.

Clarification of roles and expectations of the agency is an important first step,because it will shape much of what occurs. Consumers are not being asked tobecome ‘pseudo-health professionals’ with similar expertise as the healthprofessional surveyors/reviewers. They are on the team because they have a differentperspective and bring different things to the process. Identifying what thesedifferences are can help in the recruitment process and in the ultimate success ofthe accreditation process. It can reduce the risk of recruiting consumers who maynot be suitable to the role. If a consumer knows ‘up front’ what is expected, thenthey may well self-select out of the process. So far as remuneration andreimbursement is concerned, the agency needs to work out what its policies arebefore recruiting of consumers begins, because these should be seen as one of theterms of engagement.

The following are some of the questions an agency needs to address in clarifyingthe role and expectations of a consumer surveyor or reviewer.

� What exactly do you want the consumer surveyor or reviewer to do - take fullor a partial responsibility for surveying various aspects of the standards? Writereports? Present oral information? Look closely at written material as part ofvalidation? Facilitate consumer or community groups? Liaise with clinicalstaff ? Liaise with management?



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� Do you see them as an advocate for the consumers using the facility, or as anexternal person seeing whether the service measures up to certain standards?

� In relation to compliance with standards, do you want the consumer surveyorto identify detailed breaches of standards, get an overall ‘feel’ for the facilityor both?

� What skills and experience would help a consumer in the role you see forthem?

� What other expectations do you have - the hours of work? attendance at socialevents? standard of clothing? cultural issues and understanding?

� What time commitment will be required for training?

� What time commitment will be expected on an on-going basis?

� Which expenses associated with the accreditation review process should youmeet – travel? accommodation? meals? clothing allowance? luggage allowance?child or other respite care?

� What remuneration will be payable – the rate? When will it be payable? Willpreparation time and report writing time be included? What hours are expected?

� Will expenses or remuneration vary with the person’s other income sources orplace of employment – if the consumer depends upon income support? is self-employed? has to take unpaid leave to do accreditation reviews? works for anagency which operates on a financial shoe-string?

� Are there any conditions which may actually preclude consumer involvementin accreditation and are there ways around the problems seen by the accreditingagency?

In the last case, it may initially be that an accreditation body may consider someonewith a particular disability such as blindness, deafness or mobility problems maynot be suitable. However, if the agency works with a consumer resource groupwith an understanding of the adjustment needs of people with this disability, theymay in fact be able to find ways around the barriers they at first think areinsurmountable. This may be particularly important for facilities which providespecialist services relating to particular disabilities.

When identifying roles and expectations, it is important to look critically at yourideas. Sometimes what seem like central requirements are merely ‘nice to haves’or may simply reflect an intention to make it easier for the organisation. It maymean you are not recruiting for the core requirements and are therefore setting upunnecessary barriers to effective and broad consumer participation in the process.



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Just as professionals bring different skills to the survey team in addition to theircore skills, so too, can consumers. Try not to be too broadly prescriptive or you arelikely to narrow your recruitment field too much.

Acknowledge that this is a developmental processAcknowledge that this is a developmental processAcknowledge that this is a developmental processAcknowledge that this is a developmental processAcknowledge that this is a developmental process

Including a consumer as a surveyor or reviewer is not as simple as just placinganother person on the team. The consumer is there because he/she will bring anextra dimension to the work of the group because of their different perspective onhealth services.

Bringing that extra dimension can be a new and exciting development. Theexperience in Australia in the mental health area has shown there can be significantbenefits for the health service which is being accredited, as well as for the qualityof the accreditation agency’s activities. However, it does require that the agencyputs time and resources into making the development one that is worthwhile, andwhich captures the extra benefits that consumer involvement can bring.

A consumer surveyor or reviewer should not become a substitute for a healthprofessional or other member of the team. Each brings their own areas of specificskill and expertise. They are an extra surveyor or reviewer. Experience thus far hasshown that where a consumer is substituted for a health professional, more workloadshifts to the other team members who are health professionals and this can lead toheavy workloads for these surveyors and resentment.

Because consumer surveyors and reviewers are a new experience for everyone, theaccreditation agency needs to be prepared to put time and some financial resourcesinto developing the process. Effective consumer participation will not happenovernight, or by just including a consumer as a surveyor or reviewer. It will needsome reorientation of training and briefing of the team, and a recognition that thisis a learning process for all involved. Time will be needed for everyone – the agency,the health professionals and the consumers – to develop the role and to learn fromthe practical experience gained by involvement in the reviews.

As an accreditation agency, it is important to remember that you are building abody of knowledge to draw on in designing and conducting future reviews.Therefore, you need to ensure you are collecting on-going evaluative information,so that you can refine your processes. Some of this might feed into your standardsdevelopment. For example, it may provide an opportunity to develop a requirementfor focus groups of consumers and carers, and the opportunity for broader communityinput through a public meeting in appropriate cases. Others may lead to modificationin the training provided to surveyors or reviewers or to different administrativeprocesses for reviews.



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Learning from the experienceLearning from the experienceLearning from the experienceLearning from the experienceLearning from the experience

Accreditation agencies which involve consumers as surveyors/reviewers are alsostarting to build up a body of consumer expertise in undertaking reviews whichwill be able to be drawn on in the future. Proper evaluation and refinement of theprocesses will allow you to be more efficient and direct your expenditure at the‘right place’. For example, one of the biggest costs of accreditation are the airfaresand accommodation costs of surveyors and reviewers. It may be that costs arereduced once a sufficient number of consumers are trained as surveyors or reviewersto allow consumers who live close to the facility but are not service users, toundertake reviews. Funds thus saved may be able to be used to meet consumercosts in other areas.

Including consumers as surveyors and reviewers is a developmental process.Therefore, it is important that an evaluation framework is in place at the start ofthe exercise. The accreditation agency and everyone involved in it is embarking ona new process, and it is important that lessons learned and knowledge gained isapplied to future processes. In designing the evaluation process make sure that theviews of the consumer surveyors/reviewers and the consumers of the servicewhich was accredited are sought separately.

Recruiting consumer surveyors and reviewersRecruiting consumer surveyors and reviewersRecruiting consumer surveyors and reviewersRecruiting consumer surveyors and reviewersRecruiting consumer surveyors and reviewers

Once an agency has clarified the role and expectations of the consumer surveyors/reviewers, and answered the questions above, they are likely to be in a good positionto specify a ‘job’ description for those they want to recruit. It is important toacknowledge that not all consumers will automatically have all the skills andexperience you may consider appropriate and some may require additional assistanceto be ready for the role you see for them. However, having worked out what youdo expect and questioned what your expectations are, you will need to find thepeople.

There are many sources of consumers. Some starting points are:

� seeking nominations from established consumer advocacy groups;

� seeking suggestions from other policy agencies, such as consumer advisorybodies; and community committees relating to health or related fields;

� using networks to identify people to approach individually; and

� public advertising.



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In the last case, there is a need to ensure that the person is actually a consumer ofhealth services with an understanding of the need to represent the interests ofconsumers more broadly, rather than a ‘prominent citizen’ who may have nounderstanding of such a role. It usually helps if a consumer actually has formal orinformal links to other consumers through such things as membership of a consumerorganisation, or being part of a consumer advocacy network. Public advertisingcan be a less focussed way of obtaining a broader field of potential applicants.This is covered in more detail on p. 51 in Section 4.

When seeking nominations ensure that the ‘job’ description has been circulated toall those who may be interested in nominating. This will ensure that consumersunderstand what is involved and the sort of skills that are needed. You may alsoconsider asking a representative of a consumer organisation to be involved in theselection process. This will help to ensure that the people selected to be surveyorsand reviewers do have a broad consumer perspective and are able to consider theinterests of consumers in the review process.

TTTTTraining consumer surveyors and reviewersraining consumer surveyors and reviewersraining consumer surveyors and reviewersraining consumer surveyors and reviewersraining consumer surveyors and reviewers

Accreditation agencies have an important role to fulfil in training their review teammembers. Proper training can allow the surveyors or reviewers to do the best jobthat they can, on behalf of the accrediting agency and the health service beingaccredited.

Some of the training needs of consumer surveyors and reviewers will be the sameas that required for all surveyors and reviewers. These include:

� an understanding of the accreditation process of the accreditation agency andtheir role as a surveyor or reviewer;

� the role of the consumer surveyor;

� a general understanding of types of organisations that will be reviewed andthe way they function;

� what to expect to receive before the accreditation site inspection starts andwhat to do with it;

� what to expect when the surveyors/reviewers are on site;

� a broad understanding of the agency’s standards;

� a general understanding of the philosophy and practice of modern qualitymanagement;



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� how feedback is provided to the service being accredited;

� what is expected of surveyors/reviewers in the process; and

� administrative issues such as timeframes for receiving information prior to thereview, timeframe and process for submitting reports, reimbursement ofexpenses, booking of accommodation and travel, etc.

It is always important to remember the ‘other’ people with an interest in accreditation– the funders and users of services who rely on the accreditation status of a healthservice to decide whether it is a quality service. In that way, all surveyors orreviewers - consumers and health professionals alike – have a broader ‘publicinterest’ responsibility, which relies on their independence and their integrity indetermining whether or not a health service is meeting the established standards.These are special elements of the surveyor/reviewer’s duty which need to formpart of the accreditation agency’s training.

In addition to this general training, some consumers and health professionals mayneed additional training. It is important to recognise that other new, non-consumersurveyors and reviewers have probably worked in health care services which havesought accreditation, and will therefore have knowledge of what an accreditationreview involves. Consumer surveyors and reviewers may not have had this detailedexperience of being involved in an accreditation review. They may therefore needextra training over and above that provided to all new surveyors and reviewers.Consumers may also need assistance with various skills which may be required forthe accreditation process. These may include:

� report writing using clear and concise expression;

� effective communication with health professionals, senior management andother stakeholders;

� management of documentation;

� strategies for coping with the big workload and long working hours;

� validation skills to ensure what people claim is actually happening;

� interview skills;

� group facilitation; and

� providing feedback that is constructive.



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Some consumers will have these skills as will some health professionals. However,it should not automatically be assumed that these skills are held by either consumersor health professionals. It will depend a great deal on their prior experiences, eitherin paid or unpaid positions.

Rather than assuming that any surveyor/reviewer trainee (whether healthprofessional or consumer) has these skills, it may be worthwhile asking them toidentify their skills and training needs at an introductory session, which covers thebasics. Once their training needs are identified, the accreditation agency can lookat ways of assisting trainee surveyor/reviewers to gain the necessary skills. Analternative approach can be to place them on review teams where there are othersurveyors or reviewers who have the skills the trainee person has identified thatthey are missing, but where the team can make use of the other skills that thetrainee person can bring to the task.

For consumers there are the additional skills required of them as ‘representatives’.Some consumer organisations are able to provide basic training for people whorepresent them. This will usually involve such things as meeting procedures,advocacy and conflict resolution, as well as issues such as consumer rights andquality improvement.

Consumer representative training often also emphasises the need to maintain aconsumer perspective and provides skills on how to work as a representative witha capacity to listen to and reflect a broad range of consumer experiences, ratherthan simply ‘pushing a barrow’ from their own experiences. This training does notdiscount the importance of the individual experience of consumers. Rather ithelps consumers to translate and integrate their own experiences into a broaderunderstanding of consumer issues in the health sector. It helps consumers tounderstand the systemic lessons which can be learned from the experience ofindividual consumers and to focus a proportion of their energies on systemic change.Accreditation agencies might want to include some of this training in their ownsurveyor or reviewer training or to make arrangements for consumer surveyors andreviewers to undertake this kind of training with an appropriate consumerorganisation.

Consumer surveyors/reviewers may also benefit from having access to a range ofdocumentation and other material about people’s experiences of being in hospitalas a patient. Accreditation agencies could usefully prepare an information kit, ora reading list of literature about consumers’ hospital experiences which theirconsumer surveyors/reviewers could use as part of their orientation and training.

Accreditation agencies could also consider linking a new consumer surveyor/reviewer with an experienced surveyor, with whom the new surveyor can spendtime, or be available to answer questions or provide advice during their trainingand orientation period.



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Creating effective review teamsCreating effective review teamsCreating effective review teamsCreating effective review teamsCreating effective review teams

Survey teams are made up of diverse people from different backgrounds, withdifferent skills and different experiences. In many cases members of the team maynot have met, or worked with each other before. The people who lead these teamsneed to have excellent leadership skills and a good understanding of humanrelationships and group dynamics. This is even more important when perceived‘outsiders’ such as consumers are introduced into review teams. Unless this processis well-handled, the dynamics in the team may be tarnished by mutual suspicionsor even hostile attitudes.

Prejudices can exist in both health professionals and consumers. Leaders of teamsneed to be sensitive to these and to discuss them with team members, as necessary.They also need to be able to recognise their own preconceptions about what aconsumer is, or what they can do. Many of these prejudices can be borne of fearsor from a single ‘bad experience’. While some of these concerns may be alleviatedthrough exposure to different and better experiences, it may be that, where a surveyoror reviewer has a real issue of this kind, some specific training may be necessary toexpand their understanding and address their fears.

Effective leadershipEffective leadershipEffective leadershipEffective leadershipEffective leadership

The leader of the review team can be critical to ensuring the effective involvementof consumers. It is important that the accreditation agency ensures that the teamleader understands that they and other members of the team are taking part in adevelopmental process and that they will need to take this into account in leadinga team which includes consumer surveyors or reviewers. It is likely that this‘supportive role’ will reduce over time as the consumer surveyors/reviewers becomemore experienced, but it is an important role which needs to be recognised by theaccreditation body in its timetabling and costings.

An effective leader can help to make sure that the consumer is comfortable in theirrole, and work through any problems that arise for them. The team leader shouldcontact the consumer surveyors/reviewers prior to the site visit to talk throughthe process and identify any areas where the consumer may need special assistanceor support. They should also contact other members of the survey team and discussany issues or fears they hold about the inclusion of consumer surveyors/reviewerson the review team.



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The leader should also keep an eye on the group dynamics throughout the review,to check that the consumer and the other surveyor/reviewers are working welltogether, and that tensions and conflicts are not developing. They should also ensurethat the consumer surveyors/reviewers feel able to raise a range of issues, includingissues about clinical care, and that the matters that are raised are dealt withsensitively and appropriately by all team members.

If the consumer surveyors/reviewers have extra responsibilities (such as extrainterviews or convening meetings of consumers of the service being accredited)the leader needs to be aware of this, to ensure that the workloads are manageableand that assistance is available to the consumer if needed. This could be bynominating another, experienced surveyor/reviewer, who is briefed by the teamleader to work with the consumer surveyors/reviewers. This arrangement must, ofcourse, have the agreement of the consumer themselves.

Supporting consumer surveyors and reviewersSupporting consumer surveyors and reviewersSupporting consumer surveyors and reviewersSupporting consumer surveyors and reviewersSupporting consumer surveyors and reviewers

During the course of any review, difficult issues can arise for any surveyor orreviewer. Some agencies recognise that it is important for surveyors and reviewersto have available a colleague who is not a member of the review team to talkthrough these issues. For example, the Australian Council on Healthcare Standardshas a team of ‘preceptors’ available to discuss issues with health professionalsurveyors. These preceptors are health professionals or administrators whounderstand the issues facing the surveyors because they have the same professionalbackgrounds.

Similar support needs to be available for consumer surveyors/reviewers. It maynot always be appropriate or useful for them to talk through an issues with a healthprofessional because their perspectives may be different. In Australia there are anumber of very experienced consumer representatives who may be prepared to actas ‘preceptors’ or just be available to talk to consumers who are involved in reviewsand who are facing an issue which has arisen in the review, and need some assistancein dealing with it. Approach an established consumer organisation to seek theirhelp in providing a confidential support system for consumer surveyors andreviewers, approach some more experienced surveyors or reviewers to play thisrole, or discuss appropriate means of support directly with the consumer surveyors/reviewers when they are appointed.

Sometimes consumer surveyors/reviewers may feel it necessary to raise issuesrelating to the standard of clinical care. They may wish to discuss this with anappropriately qualified person who is outside of the survey team. This couldpossibly be through access to those who are currently available to act as a sourceof advice – but training in working consumers may be needed for those ‘preceptors’.



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Informing surveyors about patients’ perspectives on theInforming surveyors about patients’ perspectives on theInforming surveyors about patients’ perspectives on theInforming surveyors about patients’ perspectives on theInforming surveyors about patients’ perspectives on theserviceserviceserviceserviceservice

The experience of involving consumers as surveyors/reviewers so far suggeststhat the work of survey teams can be enhanced by getting better feedback fromconsumers to the surveyors/reviewers. Some surveyors are happy to interviewpatients who are using the service at the time of the accreditation review. However,we suggest that accreditation agencies develop some protocols for interviewingpeople who are ill, and who may not be prepared to be interviewed at short notice.Those protocols could include questions which are designed to ‘test’ the standardsagainst which the services is to be accredited.

Services being accredited could also be asked to organise focus-groups of patientswho have used the facility in, say the last year, and who have thus had time toreflect on their experience and to provide valuable feedback. These focus groupswould be attended by the consumer surveyor, and possibly other team members.This process has already been used in specialised mental health facility surveysand reviews.

Services seeking accreditation could also be asked to notify consumer representativeson their committees and Boards of the presence on the survey team of consumersurveyors/reviewers, and organise a meeting between the representatives and thesurveyor/reviewer.

Commit the funds to make it workCommit the funds to make it workCommit the funds to make it workCommit the funds to make it workCommit the funds to make it work

Involving consumers as members of review teams is bringing an extra dimensionto assessments of quality. There will be some extra costs which you need to allowfor in the costs of the reviews. They include:

� recruitment;

� training, including both special training and revision of existing trainingprograms;

� costs of participating in the process, including travel, accommodation,remuneration and other expenses, particularly for people on low incomes; and

� costs involved for a consumer ‘preceptor’ or other consumer supportmechanisms.

The provision of payment to consumers is an important principle in recognisingthe skills and expertise they bring and the time they devote to the work. However,it is something that will need to be discussed with each consumer as, like health



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professionals, their individual circumstances can influence their views about thenature and appropriateness of support they receive. For example, for someone setup with a home office and a computer but who works for themselves, a time-basedfee, or sitting fee may be appropriate. For someone who is dependent upon means-tested income support, the offer of access to a computer and reimbursement ofinternet connection and running costs might be a preferred option. In some cases,where a consumer has other means of support, they may want to have the sittingfees paid to their consumer organisation.

Where consumers are dependent on income support or are in a low income situation,it may be appropriate to make additional assistance available for clothing or luggageor other direct costs associated with their participation. The issue of suitable clothinghas been one that has caused considerable embarrassment and discomfort for someconsumers. There is an expectation among many surveyors and reviewers that theircolleagues should be dressed to the same standard as themselves. However, manyconsumers are forced to live on low incomes because of their illness. They simplycannot afford the range of clothing available to people in the workforce. They maynot have clothing that would be considered acceptable attire for say, working in anoffice or surveying a major health care facility. Accreditation agencies should dealwith this by clarifying their expectations about dress standards, and providing somepractical assistance to consumer reviewers who live on low incomes.

It is a matter which you will need to raise directly with consumers, but in a mannerwhich suggests that you are trying to provide the assistance that suits the consumerbest, rather than to simply ‘save the organisation money’. Consumers are like manyothers – raising the issue of reimbursement or payment may be difficult andembarrassing for them, particularly where their needs may be greatest. Anaccreditation agency requiring their services should be proactive and help theconsumer to feel comfortable about it. A page with some payment options whichis given to consumer surveyors/reviewers as part of the recruitment informationpackage is a useful strategy.

It is also important to educate other team members who may have higher incomeabout the issues associated with living on a low income. Discussions with consumersurveyors/reviewers and consumer committee representatives identified significantignorance among many health professionals to these issues and it can make lifevery difficult for a consumer.

Sometimes not having much money makes me feel like a real outsider. The accreditationagency pays our costs, which is great and we get paid afterwards. But it can still be reallydifficult – I was in a cab with other surveyors one day, and they all got out first. The cab-driver looked at me to pay the fare, and I knew that if I paid the fare, I wouldn’t eat for therest of the week. It was no help at all knowing that I could get reimbursement. What could Ido? In the end, I think one of the team realised what was happening and came up and said‘I’ll pay.’ I still don’t know what I would have done, if he hadn’t looked around and seenme looking stricken (Consumer surveyor)



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CCCCCHECKLISTHECKLISTHECKLISTHECKLISTHECKLIST FORFORFORFORFOR AAAAACCREDITCCREDITCCREDITCCREDITCCREDITAAAAATIONTIONTIONTIONTION AAAAAGENCIESGENCIESGENCIESGENCIESGENCIES INVINVINVINVINVOLOLOLOLOLVINGVINGVINGVINGVING CONSUMERSCONSUMERSCONSUMERSCONSUMERSCONSUMERS ASASASASAS

SURSURSURSURSURVEYVEYVEYVEYVEYORSORSORSORSORS/////REVIEWERSREVIEWERSREVIEWERSREVIEWERSREVIEWERS

PPPPPrior to recruiting consumer surveyors/reviewersrior to recruiting consumer surveyors/reviewersrior to recruiting consumer surveyors/reviewersrior to recruiting consumer surveyors/reviewersrior to recruiting consumer surveyors/reviewers

� Develop a role and description.

� Identify the skills and experiences which would be useful for consumersurveyors/reviewers to have.

� Decide on appropriate remuneration and which expenses will be paid for. Aflexible policy for implementing this will help, given the various circumstancesof consumers.

� Work out the kind of training which may be required.

� Consider particular strategies to support consumer surveyors/reviewers, eg aconsumer ‘preceptor’.

� Develop strategies to educate other team members about the role of theconsumer surveyors/reviewers.

� Develop strategies for informing and educating organisations about the roleof the consumer surveyors/reviewers.

Recruiting the consumer surveyors/reviewersRecruiting the consumer surveyors/reviewersRecruiting the consumer surveyors/reviewersRecruiting the consumer surveyors/reviewersRecruiting the consumer surveyors/reviewers

� Develop draft ‘job’ description and ‘selection criteria’.

� Identify and contact consumer organisations, consumer advisory councils etc.

� Discuss the job description with them.

� Seek their help in recruiting consumer surveyors/reviewers and agree on anappropriate selection process.

� Discuss training programs for consumers.

� If there are no consumer organisations, set up selection process and advertise.



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WWWWWorking with consumer surveyors/reviewersorking with consumer surveyors/reviewersorking with consumer surveyors/reviewersorking with consumer surveyors/reviewersorking with consumer surveyors/reviewers

Have discussion with consumer surveyors/reviewers to:

� Provide initial briefing.

� Assess their information needs.

� Agree a process for payment of remuneration and out-of-pocket expenses.

� Assess any particular needs such as electronic or hard copy of papers, specialdietary needs, special training needs etc.

TTTTTraining for consumer participationraining for consumer participationraining for consumer participationraining for consumer participationraining for consumer participation

� Include in your training programs a discussion about the roles and expectationsof different surveyors/reviewers (including consumer surveyors/reviewers).

� Include in your training program a discussion of the ‘public interest’ role .

� Organise any special training which may be necessary for consumer surveyors/reviewers or other team members.

� Develop an information kit or reading list about consumers experiences ofbeing in hospital as a patient.

Including consumers on review teamsIncluding consumers on review teamsIncluding consumers on review teamsIncluding consumers on review teamsIncluding consumers on review teams

� Brief the team leader about the consumer surveyors/reviewers’ role and theimportance of fostering effective consumer participation through supportingand mentoring.

� Ask team leader to contact the consumer surveyors/reviewers prior to thereview to introduce themselves, to talk through the process and identify anyareas where the consumer may need special assistance or support.

� Ensure all team members are introduced and are informed about each others’backgrounds and particular roles.

� Ensure team meets informally prior to undertaking review tasks.

� Ask the facility being accredited to provide the review team with a means ofobtaining feedback directly from patients or ex-patients.



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Learn from the experienceLearn from the experienceLearn from the experienceLearn from the experienceLearn from the experience

� Develop an evaluation strategy.

� Ensure that the consumer is involved in the development of that strategy.

� Apply the lessons learned to future work.



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SECTION 4:SECTION 4:SECTION 4:SECTION 4:SECTION 4: FOR FFOR FFOR FFOR FFOR FAAAAACILITIES AND SERVICES BEINGCILITIES AND SERVICES BEINGCILITIES AND SERVICES BEINGCILITIES AND SERVICES BEINGCILITIES AND SERVICES BEINGACCREDITEDACCREDITEDACCREDITEDACCREDITEDACCREDITED


This section of the Guide is aimed specifically at health services which are seekingaccreditation and which want to involve consumers in their various qualityimprovement processes, particularly the preparation for accreditation. It firstprovides some background about consumer involvement in quality improvementand other accreditation related activities. It then sets out some practical strategiesfor organisations starting down the path of involving consumers in their internalquality improvement committees. It covers:

� clarifying expectation, roles and conditions;

� recruiting consumers;

� financial and physical support;

� providing information and orientation;

� setting the process up to succeed;

� running effective meetings;

� training and team development issues;

� handling conflict and different perspectives; and

� confidentiality and trust.

At the end of this section is a ‘check list’ of things which need to be done toeffectively involve consumers.



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BBBBB..... Background to consumer involvement in qualityBackground to consumer involvement in qualityBackground to consumer involvement in qualityBackground to consumer involvement in qualityBackground to consumer involvement in qualityimprovement processesimprovement processesimprovement processesimprovement processesimprovement processes

Involving consumers on quality improvement committees is not a new concept atall - there are many good examples of consumer involvement in these forums at alocal, state and national level. Consumers can be very influential in these forums,ensuring that health professionals and administrators are properly focussed on theinterests of the users of health services.

The importance of consumer involvement in quality and safety activities in healthcare was emphasised in the Final Report of the National Expert Advisory Groupon Safety and Quality in Australian Health Care in 1999, where the first nationalaction that it endorsed was to support methods to enable increased consumerparticipation in health care. That Report said:

The Expert Group believes that all organisations and people involved in the healthcare delivery process should be encouraged to involve consumers in key elementsof health care planning, delivery and evaluation. ... At a State level, a number ofhealth departments have established high level safety and quality organisationsthat have consumer involvement and a consumer focus. Models exist in someStates of action plans and frameworks for safety and quality that have a significantconsumer participation aspect. ... The Expert Group believes that incorporationof consumer perspectives in the development of strategies relating to all othernational action areas is an integral part of a national approach to safety and qualityimprovement.15

In its 1996 Report to Australian Health Ministers’ Advisory Council, the Taskforceon Quality in Australian Health Care stressed the need to ensure that consumerswere involved in quality management at the institutional level. Consumerinvolvement in defining, managing and monitoring the safety and quality of healthcare was a key theme in the Taskforce’s recommendations. The Report went on tosay:

Consumers should be active participants in the broader quality managementprocess. The Taskforce also supports consumer involvement in the machineryof quality review in all institutions and organisations. Consumer focused carerequires that consumers be represented and participate in quality management.

16

15 National Expert Advisory Group on Safety and Quality in Australian Health Care. Implementing Safety andQuality Enhancement in Health Care – National Actions to support quality and safety improvement inAustralian health care. July 1999 : pages 6-7. This report can be found on the Internet at: http://www.health.gov.au:80/hsdd/nhpq/pubs/qualsyn/neagsyn.htm

16 Australian Health Ministers’ Advisory Council. The final report of the Taskforce on quality in Australian healthcare. June 1996 (Taskforce Report): see para. 4.39, page 36. This report is available on the Internet : http://www.health.gov.au:80/pubs/hlthcare/toc.htm.



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For a long time, many services viewed accreditation as a one-off process whichonly happened once every few years. They were not seen as part of the managementof quality or as part of a quality culture within an organisation. In the TaskforceReport in 1996,17 as well as criticising the closed nature of most accreditationprocesses and their lack of publicly available information to help consumers choosebetween facilities, the following criticisms were made:

At present, accreditation surveys are scheduled events which are carefullyprepared for by the hospital concerned. Conditions and processes within thehospital at the time of the survey are not necessarily those which are routinelyin force. Surveys focus on structure and process within the hospitals and healthservices, rather than on assessing whether these structures and processes areeffective in delivering safe, high quality care.

18

The Taskforce’s recommended alternative was radically different:

Indicator and accreditation information from individual institutions should bepublicly available. Accreditation should be a continuous process, with regularreview of the functioning of the entire organisation supplemented by a seriesof unannounced smaller surveys which assess the routine operation of systemsin specific parts of the institution.

19

Accreditation processes in Australia are now moving generally more towards thecontinuous quality improvement approach and greater consumer involvement. Thismeans that some health services use their Quality Improvement Committees asthe forum for their preparation for accreditation. Consumers are quite often alreadyinvolved in these committees. Other facilities still establish specific committees toprepare for accreditation. The form of the committee and its scope varies fromfacility to facility, and the overall membership of the committee often depends onlocal factors. Where involving consumers is a new step for an organisation, it canbe a daunting prospect.

With the growing recognition of the positive impact of greater consumerparticipation in health care planning, delivery and evaluation, these committeesare also seeking to have consumer members. In some cases, this is required by theirpurchase contracts or broader governance frameworks.20

17 Taskforce Report – see note 16: paras 3.27-3.37, pages 18-20.

18 Taskforce Report – see note 16: para.3.27, page 18.

19 Taskforce Report - see note 16 : para. 3.29, page 18.

20 In the ACT, the purchaser/provider agreement includes requirements relating to consumer representation oncommittees. In NSW, the Quality Framework requires consumer membership on Area Quality Councils(Appendix D – page 67) and the performance measures for Area Health Service Boards include demonstratedevidence of consumer involvement in assessment of feedback about service delivery as well as broaderconsumer and community participation (Appendix B – page 55).



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Bringing consumers in to these processes has involved opening up a process, whichwas previously very internal and closed. However, it is increasingly recognisedthat consumers involved in such committees can head off problems and embedconsumer-focussed quality into the organisation.

Unfortunately, there are still few statutory requirements to make information gainedfrom accreditation processes publicly available. No doubt, a consumer cansometimes be placed in a difficult position where they are bound by confidentialityrequirements of the organisation and they become aware of significant problems.This issue is dealt with later in this section.

Involving consumers need not be difficult – much of it is about good practice inorganising committees. It requires thought and possibly some adaptations to whathas become normal practice in your organisation.



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C.C.C.C.C. Some good foundations for effective consumerSome good foundations for effective consumerSome good foundations for effective consumerSome good foundations for effective consumerSome good foundations for effective consumerparticipationparticipationparticipationparticipationparticipation

Experience of consumer participation, particularly from the trials which formedpart of the project on involving consumers in accreditation, demonstrated someimportant foundations for successful consumer participation. The trials clearlydemonstrated that effective consumer participation involves much more than simplyfinding a consumer and placing him or her on a committee. There are a range ofprocesses and strategies that appear to maximise the likelihood that consumerparticipation in a quality improvement committee within a health care facility willget past ‘first base’.

None of these are complicated – it is ‘hardly rocket science’ as one senior managersaid. However, we found the following three features to be strong foundations forsuccessful consumer participation. This is not to say that effective consumerparticipation is not possible without these. Rather, if you want to have the bestchance for long term success in implementing consumer participation across yourorganisation, particularly in the core areas associated with quality improvement,these three ‘‘features’’ can really help.

Strong and active commitment from the CEO of the serviceStrong and active commitment from the CEO of the serviceStrong and active commitment from the CEO of the serviceStrong and active commitment from the CEO of the serviceStrong and active commitment from the CEO of the service

Consumer participation in your service will be enhanced if there is strongcommitment from the CEO. Such commitment sends a strong signal throughoutthe organisation that consumer participation is valued at the highest level. TheCEO’s commitment can be demonstrated through a number of means, including acommitment to regular meetings with consumer representatives in order to heardirectly from them about their concerns and the work they are doing within theorganisation.

A senior staff person responsible for developing, drivingA senior staff person responsible for developing, drivingA senior staff person responsible for developing, drivingA senior staff person responsible for developing, drivingA senior staff person responsible for developing, drivingand coordinating a consumer participation strategy withinand coordinating a consumer participation strategy withinand coordinating a consumer participation strategy withinand coordinating a consumer participation strategy withinand coordinating a consumer participation strategy withinthe servicethe servicethe servicethe servicethe service

The presence of a senior staff person with responsibility for developing and drivinga consumer participation strategy within the service is another essential ingredientin having effective consumer participation. This is the person who can makeconsumer participation happen, and make it a positive experience for everyone.This person can provide leadership to staff, and support and encouragement forconsumers. They can coordinate consumer participation activities within the facility,and can be a source of help and advice if problems arise.



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A relationship between the service and an accountableA relationship between the service and an accountableA relationship between the service and an accountableA relationship between the service and an accountableA relationship between the service and an accountableand representative consumer organisationand representative consumer organisationand representative consumer organisationand representative consumer organisationand representative consumer organisation

Having a relationship with a good consumer organisation will strengthen consumerparticipation within your facility. They can help you to recruit and train appropriateconsumers, and provide support and advice to you and to the consumerrepresentatives. They may be able to help you themselves, or to nominate anappropriate consumer organisation in your area. If you do not know of any consumerorganisations in your area, seek advice from one of the organisations listed inSection 6 of this Guide.



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DDDDD..... Involving consumers – some practical strategiesInvolving consumers – some practical strategiesInvolving consumers – some practical strategiesInvolving consumers – some practical strategiesInvolving consumers – some practical strategies

Clarifying expectations and rolesClarifying expectations and rolesClarifying expectations and rolesClarifying expectations and rolesClarifying expectations and roles

Being clear about your organisation’s expectations of consumer participation isthe first step in a successful partnership with consumers. Check whether yourexpectations are reasonable, and that the role the consumer(s) is expected to playis clear. You can do this by discussing it with a local consumer organisation or withexperienced consumer representatives. You may also want to talk to other servicesthat have involved consumers in their activities.

Think about the qualities and skills that will be needed for consumers to be able toparticipate in accreditation and other quality improvement processes. Participationat this level is not something that will come easily to all consumers, particularlythose who have not had much experience at participating in committees. Workingas a consumer representative to help health care organisations identify and act onopportunities for improvement can be a demanding process, and some broadknowledge of how health services work as well as basic skills and experience atworking on committees will be helpful.

Develop clear statements about the role of the committee and the consumerrepresentative. These can take the form of terms of reference for the committee,a role description and selection criteria for the consumer representative(s).

Think about whether you want more than one consumer on your committee. Thereare added benefits for the organisation in including at least two representatives. Itis very hard for one consumer to represent all consumers. The lone consumerrepresentative tends to shoulder an enormous amount of responsibility and a verylarge workload because virtually all the business coming before your committee isof critical importance to his/her constituency. Having more than one consumermeans that they can provide support and help to each other while working in anenvironment which may be completely new to them.

Prior to starting the recruitment process make a decision about whether and howto pay a consumer representative for the work they do. It is important that you dothis before recruiting begins, because it must be seen as one of the conditions ofrecruitment. This is discussed further in the section in Financial and physical supporton page 57.



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Another key question to consider when deciding what you want from a consumeris whether or not you want to involve someone who is actually a user of yourservice. There can be arguments in both directions. Being a user of the servicecan mean the consumer really understands your service ‘from the inside’. However,a downside can be the difficulty for that consumer in acting independently incriticising the service, if they are dependent on it. If both the consumer and theirtreating health professional are on the committee, it may be difficult for them tochange their ‘roles’ from provider/patient to colleagues in a joint enterprise.

Once you are clear about the role and your expectations and the conditions underwhich you expect consumers to participate, you can start the recruitment process.

Recruiting consumersRecruiting consumersRecruiting consumersRecruiting consumersRecruiting consumers

The first step in a recruitment process is understanding who a consumer is. Aconsumer is simply a person whose primary experience of health services is fromthe receiving end. Of course everyone is a health consumer at some time in theirlife. However, people who work as service providers or health serviceadministrators often find it difficult to divorce themselves from their training andsee things the way that ‘ordinary’ consumers see them.

Consumers are not a homogeneous group. They are as diverse as the Australianpopulation and have as many differing attitudes and views. This means that it isessential that you find consumers who are able to represent a range of views, notjust their own.

Some health care consumers have links with a range of other consumers. This canbe through a consumer or self-help organisation, or by being part of a support and/or advocacy network around a particular service. Many consumers become familiarwith other people’s experiences through involvement in informal networks withother people who are using the same services or who participate in support groupsfor particular conditions.

Some consumers are members of a consumer organisation. These groups haveoften been formed by people who want to share with others their commonexperiences or circumstances, or because they want to talk with and learn fromother people with similar problems.

Consumers who are linked in to a range of other consumers are generally able todevelop a broader view than that of a consumer who does not have that contact.For this reason they are better able to represent the views of a range of consumers.This ability to bring the views of a range of people to the table generally makesthem a better ‘representative’. As individuals they will bring their own views to thetable but these are usually informed by the views of those they ‘represent’. If that



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person is a ‘representative’ of a group of consumers, then in turn he/she may beaccountable to that group for the consumer views put forward in the accreditationprocess. Accountability to a consumer constituency helps the consumerrepresentative to maintain their consumer focus, and ensure that the views theybring forward are not just his/her own, but are those of a range of people.

The role you have described for your consumer representative will lead you toidentify if there is a formal constituency you want the consumer to represent. Formost large health services which provide treatments for a range of consumers aformal constituency would be found in a broad-based consumer group rather thana specific interest or illness-focussed group. Some national and broad basedconsumer groups are listed in Section 6 of this Guide.

Those services which specialise in treatments for particular illnesses or disorderssuch as mental illness, cancer, diabetes etc will be able to locate consumers whocan represent other people with similar problems by approaching support groupsfor the condition the service specialises in treating. Alternatively, one of the broadlybased consumer organisations listed in Section 6 will probably be able to help youlocate a suitable support group.

When you approach a consumer organisation or support group, don’t ask for orexpect to be given nominees immediately. The organisation will probably havetheir own internal processes for nominating or appointing representatives. A clearstatement of the role and criteria for the consumer representative(s) will assistthem to find a suitable person. As Improving health services through consumer participation:a resource guide for organisations21 (p. 73) says:

Be clear about your selection process and criteria before you approach anyoneand consult with the key people in the agencies you approach. Give them yourcriteria and selection process and leave them to use their own organisation’sprocesses to select a nominee(s) if they decide they want to.

Improving health services through consumer participation: a resource guide for organisations22

(see Section 6) also gives the following good advice if you are unable to locate anappropriate organisation or network:

you may need to advertise using local newspapers, letter box drops, communityservice radio announcements or what ever seems most likely to reach thepopulation you are after. Remember you are looking for someone who will havegood links to the population you want represented. Let everyone know the cutoff date for nominations. Provide one person to handle all inquiries for the

21 Consumer Focus Collaboration. Improving health services through consumer participation: A resource guide fororganisations, June 2000.

22 Consumer Focus Collaboration Improving health services through consumer participation: A resource guide fororganisations June 2000.



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position. Ask intending nominees to contact that person first so that they canexplain the process to them. Alternatively, interested people can be invited toattend an information session. Provide them with a copy of your ‘job description’and ask them to explain in writing why they believe they should be taking therole.

You will then need to set up an appropriate process to cull the applications and tomake a selection. Try to involve a consumer in the selection process – they willhave a useful perspective on who would be an appropriate representative toparticipate in quality improvement within your service. Alternatively, you can seeksome advice and assistance from a consumer organisation.

PPPPProvision of information and orientationrovision of information and orientationrovision of information and orientationrovision of information and orientationrovision of information and orientation

Provision of orientation and information – both for the consumer and for othermembers of the committee – is basic good practice for successful involvement inan organisation or committee.

Consumers have, by and large, not participated in accreditation processes in thismanner before. Participation in this process will therefore be a new experience forthe consumer(s) who is joining your committee. They will be joining a committeewhich is made up of people who either work in the service or are familiar with it inways which the consumer is not. They will be the ‘outsider’ joining a committeemade up of ‘insiders’, so it is especially important to ensure they are comfortableand that meetings operate in an inclusive way.

Also, other people in your service may not have worked with consumers in thisway before. They may have unrealistic expectations of who or what a consumerrepresentative is, or what they can bring to the process. They may not understandwhat a consumer can contribute or why their perspective is necessary. They mayworry that the consumer will be critical of the services they work so hard to provide.

You can help your consumer representative to ‘settle in’ by providing some basicinformation and orientation about the organisation and issues they will be dealingwith. Orientation may involve having a briefing meeting with the consumer,clarifying questions about their role and the expectations of them, and giving thema briefing about the service and its quality management and improvement historyand processes. It could also involve a brief tour of the facility and introductions tosome of the senior staff. An organisation chart is often helpful, as is a briefdescription of the services you provide.

Offer to provide a range of information for consumer representative(s). This mayinclude the results of patient satisfaction surveys, reports on any focus groupswith consumers that have been held or data about complaints. It may be helpful for



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them to be provided with information which is not necessarily made available tothe committee to assist them to more fully understand your organisation and tohelp them to make a valuable contribution. They may also be interested in talkingdirectly with other consumers who have participated in some way in accreditationor quality improvement processes. Such information helps to orient them, and tofocus on the needs of the consumers who use your service.

You will also need to orient the other members of your committee to working withconsumers, particularly if this is the first time a consumer has been involved ininternal quality improvement processes. Explain to them why consumers areparticipating, and what benefits the organisation can expect as a result of thatinvolvement. Ask for their help in providing briefings and any relevant informationto the consumer. And ask if they have any concerns about the consumer’sparticipation so that those concerns can be addressed before the committee startsit work. Finally, remind other committee members that the consumer is not an‘insider’ to the service, and that they should avoid using acronyms and jargonwhen talking to them, or in conversations where they are present.

FFFFFinancial and physical supportinancial and physical supportinancial and physical supportinancial and physical supportinancial and physical support

In Section 2 we pointed out that consumers often do not have access to the financialand physical supports which are available to other members of your committee orgroup. Other members may have offices with staff who support them throughanswering phone calls, printing off documents which have been emailed, makingappointments, etc. Through those offices they also have access to computers,printers, paper and stationary and the like.

Other committee members probably will also be being paid for the time that theyare involved in the quality process because this is seen as being a part of their job,and the organisation which employs them is willing to support them in this activity.

By contrast, consumer organisations usually have very few resources, and are unableto provide payments to consumers to sit on committees. Neither are they usually/always able to provide support through their offices, if they have one.

It is very important that your consumer representatives are not disadvantaged interms of their participation because they lack access to support. It is also veryimportant that they are able to participate fully and on an equal basis to the othermembers of the group.

Payment of a sitting fee is good practice, both because it demonstrates that yourorganisation values the participation by the consumer, and because it puts theconsumer on an equal footing with other members of the group. It also enables



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them to pay for the expenses involved in doing the job, such as childminding,travel, printing etc. Some health care organisations are concerned that if they paya sitting fee to a consumer representative it will reduce their independence. This isnot often seen as a limitation for health professionals and, in many ways, is simplyan excuse for not paying. Taking care with selecting a good consumer representativewho is part of, and accountable to, a formal constituency will ensure that he/shemaintains a consumer focus.

Given the range of circumstances of consumers, there is a need within this generalprinciple that payment policies allow a range of options which might suit a consumer.For example, people who receive means-tested income support may prefer somein-kind assistance eg provision of a computer and internet connection/runningcosts, rather than money, as the receipt of income may result in a reduction in theirpensions or benefits. In other circumstances, people may prefer that the sitting feesare paid to their organisation. The best thing is to discuss these options directlywith the consumer with the intent of best meeting their needs in this area.

At the very minimum the consumer’s costs that are involved in participating inyour committee need to be met by your service. Such costs can include:

� costs of travelling to and from meetings (petrol, wear and tear on car, bus ortrain fares, taxis;

� meals or refreshments;

� parking fees;

� child or respite care;

� use of internet;

� printing;

� stationary and postage; and

� telephone calls.

Your consumer representative(s) may be on a low income and may not be able toafford to pay for such expenses. Nor should they be expected to pay the costs upfront and then seek reimbursement. They may not have enough money to do this,and it can lead to considerable embarrassment and discomfort if they find theyhave to pay out what to them are large amounts of money.



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As soon as the consumer is appointed, discuss arrangements for meeting expenseswith them. Suitable arrangements may include issuing some cab vouchers in advanceof travel, paying a travel allowance before the travel is undertaken and provisionof a parking voucher or fees.

Setting up the process to succeedSetting up the process to succeedSetting up the process to succeedSetting up the process to succeedSetting up the process to succeed

The secret to success in setting up any committee is in good preparation and ingood processes. You will get the best out of your consumer representative if youset the process up to ensure that everyone is informed and willing and able tocontribute – and if all members of the committee are working together as a teamwith a common understanding of their task and purpose.

Make the committee a worthwhile experience for all its members, one which theyenjoy and where they know and respect the people they are working with, andwhere they have a sense of common purpose. It helps if everyone starts with acommon information base and a shared understanding of the task before them.So, once you have appointed your committee, start its work by holding a jointinformation session to provide the necessary background information, answerquestions and consider draft terms of reference.

Make sure that the consumer representative(s) knows something about the othermembers of the committee. This should include information about their positionwithin the organisation. Remember that the consumer may be the only person onthe group from outside the service and won’t know the other people. Make surethe other committee members are properly introduced, and that they all know whythe consumer(s) is there and what is expected of them. Name badges can be veryuseful, as can stand-up ‘name plates’ to go in front of people at meetings.

At the first formal meeting ask members to agree on the final terms of reference,the scope of the work of the committee, outcomes the committee seeks to achieve,and business rules for the operation of the committee.

Ensure that there is some space in the agenda for committee members to interactinformally eg over a meal or afternoon tea so that they can get to know each other.Ensure that the consumer representative is comfortable and able to mingle withother members of the committee. Remember that he/she can be a stranger, and assuch will appreciate some support in meeting people and navigating his/her way ina different environment. Don’t forget to tell them basic information, such as wherethe toilets are or where the coffee machine is. If people normally get up and helpthemselves, let the consumer know that it is normal practice.



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If your consumer representative(s) is joining a committee which is already inexistence and has been meeting for some time, you will need to ensure that theyhave a briefing on the role and work of the committee so far. Make sure that theyknow who else is on the committee, and where those people are from.

Running effective meetingsRunning effective meetingsRunning effective meetingsRunning effective meetingsRunning effective meetings

The first step in running meetings, where your consumer representative is able toparticipate effectively, is to make sure that everyone has the papers well in advanceof the meeting. This ensures that they can read them, and have time to think aboutdifficult issues prior to coming to the meeting.

Consumers often do not have access to an office to support them, so ensure thatyour processes for distributing papers and for communication among team membersare agreed with the consumer representative. As we increasingly rely on email forcommunication and distribution of large amounts of information, it is easy toforget that consumers may not have a computer, or if they do, that printing offlarge amounts of information is expensive and time consuming. There are simpleremedies for many of these problems – such as agreeing to provide hard copy ofmeeting papers or providing the consumer representative with some equipmentand office supplies for the duration of the committee’s work.

Remember that the consumer representative will probably not be familiar with allthe acronyms and jargon used by other people on the committee. Minimise the useof acronyms or jargon in the agenda or papers – and make sure they are explainedin plain English, and that the reason they are on the agenda is clear. Ask the chairof the meeting to ensure that acronyms and jargon are not used in the discussion orthe minutes.

TTTTTraining and team development issuesraining and team development issuesraining and team development issuesraining and team development issuesraining and team development issues

As the work of the committee progresses keep an eye on the group dynamics. Aswith any group of people coming together around a particular task, some will copebetter than others. Participation in a group or committee which is working well willbe an positive experience for all – where they will learn from each other so that thework they do for your service will be enhanced. Participation in a good committeecan be seen as a quality improvement process in itself because it enhances theknowledge and understanding of key personnel.

Training or support may be needed for various team members over the life of thecommittee. In particular, keep an eye on the consumer representative, check withhim/her that they are comfortable in that environment and that they are able tocontribute. Make them feel comfortable to request some help – like some extra



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briefing, or some training. They may feel overwhelmed by the level of what theysee as expertise around the table – and not value their own ‘expertise’ as much.

You could provide your consumer representatives with one of the handbooksdesigned to help consumers participate. One is the Guidelines for ConsumerRepresentatives published by the Consumers’ Health Forum (see section 6). Anotheris the Little Purple Book of Consumer Rep-ing (see section 6). These provide valuableinformation and advice for consumer representatives.

Handling conflict and different perspectivesHandling conflict and different perspectivesHandling conflict and different perspectivesHandling conflict and different perspectivesHandling conflict and different perspectives

When any group of people come together tensions can arise from having differentperspectives, different working styles, and the pressure of having to meet deadlines.There may also be some conflict arising from the presence of a new participantwhose presence is resented or not understood.

Conflict can be very fruitful if handled well. If it is ignored, it has the potential toderail processes, misuse the energies of committee members, and distract thecommittee from its task.

When the committee starts meeting, be up front about the possibility of conflictarising and suggest that you need to develop simple and clear processes for dealingwith conflict should it arise. Your organisation may already have a conflict resolutionprocess in place. If so, make sure all committee members are aware of it and askthem to use it. There are a number of community organisations which may be ableto provide some simple principles for handling conflict. Such organisations includeRelationships Australia, conflict resolution centres and adult learning and trainingorganisations.

Confidentiality and trustConfidentiality and trustConfidentiality and trustConfidentiality and trustConfidentiality and trust

Trust between members of a committee is very important. The development oftrust requires time and opportunity to develop, and a shared understanding of thecommittee’s rules or requirements around confidentiality is a crucial foundationfor this.

Confidentiality policies need to be worked out before problems arise and spelledout when they do, particularly where a consumer may have obligations to reportback to their consumer organisation. It is probably equally as inappropriate thateverything be treated as ‘secret’ as it is for there to be nothing which is confidential.The problem for a consumer can be that sometimes there will be an assumption ofsecrecy, which may not be obvious to a consumer. If the consumer talks of thematter and is seen as indiscreet, this can undermine trust.



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At the same time, it is not appropriate to expect someone who is a consumerrepresentative to ‘hide’ something which requires action in the interests of one ormore consumers. Good consumer representatives are always aware of theirresponsibilities to other consumers and in their eyes this may well take precedenceover loyalty to the organisation. They will want to see problems about the qualityof services addressed constructively so that consumers are not harmed by receivingpoor quality services.

There needs to be a balancing solution determined before the situation arises. Forexample, sometimes there may be an adverse event which results in significantpatient harm that comes to the quality committee. While it may be appropriate toseek confidentiality for the material discussed, a protocol needs to be worked outso that the consumer can then be assured that preventative and ameliorative actionis taken to assist the harmed consumer as well as to prevent it occurring again.

Keeping consumers involvedKeeping consumers involvedKeeping consumers involvedKeeping consumers involvedKeeping consumers involved

Remember that involving consumers is not a one-off process. It is about participationin a cycle of continuous quality improvement. This can happen in many ways andin many parts of your organisation. The National Resource Centre for ConsumerParticipation in Health has developed a consumer participation audit tool for healthcare organisations (see Section 6). Use this audit tool to identify opportunities forinvolving consumers, and discuss them with other relevant people in yourorganisation. This tool can also provide a useful first step for the quality improvementor accreditation committee to see what consumer involvement there is in a facilityat the start of the process and as a benchmarking tool afterwards.

Evaluating the processEvaluating the processEvaluating the processEvaluating the processEvaluating the process

Make sure that the committee process, including the process and effect of consumerparticipation is evaluated, so that your whole organisation can learn some lessonsabout what you have done. A proper evaluation will tell you what you did well,and what improvements could have been made. Make sure that you have input tothis evaluation by the consumer who participated on your committee, and fromconsumers and consumer organisations in your area.



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Reporting on the accreditation reviewReporting on the accreditation reviewReporting on the accreditation reviewReporting on the accreditation reviewReporting on the accreditation review

The accreditation review visit and report is not an end – it is the start of a newcycle of quality improvement (as well as the formal recognition of the things youhave done well). Don’t let the quality improvement process end when you hangthe accreditation certificate in the foyer.

The Department of Health and Aged Care, through its Consumer Focus Strategy,has commissioned a project to review existing models for reporting to consumerson health service quality. The report of that project is referred to in Section 6.

Think about how you can disseminate the findings of the accreditation process tokey stakeholders for your service – including consumers and consumer organisations.Also consider enlisting their help to improve the service even more.



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CCCCCHECKLISTHECKLISTHECKLISTHECKLISTHECKLIST FORFORFORFORFOR HEALHEALHEALHEALHEALTHTHTHTHTH SERSERSERSERSERVICESVICESVICESVICESVICES INVINVINVINVINVOLOLOLOLOLVINGVINGVINGVINGVING CONSUMERSCONSUMERSCONSUMERSCONSUMERSCONSUMERS ONONONONON

QQQQQUUUUUALITYALITYALITYALITYALITY I I I I IMPROMPROMPROMPROMPROVEMENTVEMENTVEMENTVEMENTVEMENT C C C C COMMITTEESOMMITTEESOMMITTEESOMMITTEESOMMITTEES

PPPPPrior to recruiting consumersrior to recruiting consumersrior to recruiting consumersrior to recruiting consumersrior to recruiting consumers

� Identify which committees should include a consumer representative.

� Clarify the role you think a consumer representative should play.

� Decide whether there will be one or two representatives on the committee.

� Identify the skills and experiences which would be useful for the person tohave.

� Identify what costs might be incurred by the consumer.

� Decide whether to pay a sitting fee.

� Consider a strategy to inform and orient the consumer representative(s).

� Develop strategy to educate other team members about the role of theconsumer representative.

Recruit the consumer(s)Recruit the consumer(s)Recruit the consumer(s)Recruit the consumer(s)Recruit the consumer(s)

� Develop draft ‘job’ description and ‘selection criteria’.

� Identify and contact consumer organisations, consumer advisory councils etc.

� Discuss the job description with them.

� Seek their help in recruiting consumer(s) and agree on an appropriate selectionprocess.

� Discuss training programs for consumers.

� If there are no consumer organisations advertise in the local media.

� Nominate one person in your organisation to be the contact person to answerinquiries.

� Set up a selection process, and, if possible, involve a consumer in itsimplementation.



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PPPPProvide information and orientationrovide information and orientationrovide information and orientationrovide information and orientationrovide information and orientation

� Have discussion with consumer representative to:

– provide initial briefing about the service, the task of committee they willjoin and the members of the committee

– agree on extra information which can be provided

– agree a process for meeting out-of-pocket expenses and any remuneration

– assess any particular needs such as electronic or hard copy of papers, trainingneeds, etc

– organise a joint information session for the whole committee to providebackground information, discuss terms of reference, answer questions andallow members to get to know each other.

Running effective meetingsRunning effective meetingsRunning effective meetingsRunning effective meetingsRunning effective meetings

� Brief the chair about ensuring that the consumer representative is welcomedand included in discussions.

� Ensure that agenda papers minimise the use of acronyms or jargon, and thatthese are fully explained in plain English if they must be used.

� Circulate agenda and papers at least one week before the meetings.

� Get the committee to agree on a process for resolving conflicts.

� Get the committee to develop and agree on a confidentiality protocol.

Reporting on the accreditation reviewReporting on the accreditation reviewReporting on the accreditation reviewReporting on the accreditation reviewReporting on the accreditation review

� Devise and implement a strategy for circulating the report of the accreditationreview to consumers.

Keep improving qualityKeep improving qualityKeep improving qualityKeep improving qualityKeep improving quality

� Evaluate the process and implement any necessary changes.

� Do an audit of consumer involvement in your service.

� Keep consumers involved on all relevant committees.

� Have regular meetings with consumer organisations.



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SECTION 5:SECTION 5:SECTION 5:SECTION 5:SECTION 5: FOR CONSUMERSFOR CONSUMERSFOR CONSUMERSFOR CONSUMERSFOR CONSUMERS


This Section of the Guide is aimed at consumers who want to be involved inaccreditation processes, either as surveyors or reviewers for an accreditation agencyor in the quality improvement processes within a health service. It summarises theways in which consumers can be involved and then sets out practical strategies forgetting and staying involved and being effective. At the end of this section is a‘check list’ to assist consumers in being and staying involved.

Accreditation of a health service involves a periodic assessment of the quality ofthe service by a team of independent surveyors or reviewers from an accreditationagency. The assessment is made against a set of criteria or standards developed bythe accreditation agency and which are made available to the health service.

Consumers can make a big contribution to improving the quality of services bybeing involved in the accreditation process. Because consumers bring theperspectives of people who use health care services, they are likely to ask differentquestions and look for different things. During our research for this Guide, peoplewho provided services would often tell us how useful those different questionswere – and how they would never have thought of asking them themselves.



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BBBBB..... PPPPParticipating on a Quality Improvementarticipating on a Quality Improvementarticipating on a Quality Improvementarticipating on a Quality Improvementarticipating on a Quality ImprovementCommitteeCommitteeCommitteeCommitteeCommittee

For a health service to achieve the standard required for accreditation, there is alot of preparation and ongoing work which must be done. Large services will usuallyeither set up a special committee to lead and coordinate the preparations, or givethe responsibility to an existing committee within the service, such as a QualityImprovement Committee. Consumer participation in these sorts of committees isessential.

Often, though not always, there is a process of internal self-assessment, where thehealth service looks at how it is performing. As the actual accreditation reviewgets closer, the accreditation agency requests the health service to produce a numberof reports and other documents explaining how the service has performed againstthe criteria. If there has been a previous accreditation review and there were problemsidentified in it, then there may well be some specific questions raised in theseareas. There may also be ‘in-depth’ reviews in some parts of the facility, for examplein the mental health service area or a specific clinic, which are in addition to thenormal accreditation processes. This may be because of other requirements byfunders.

The review team then visits the health service and interviews a cross section ofpeople who can include managers, clinical staff, patients in the hospital andconsumer and community representatives in order to assess the quality of theservices and validate the claims made by the service in their documents. This canbe a very busy time for the service and the quality improvement committee membersmay have an active role in many parts of the accreditation visits.

The internal committee which is charged with leading and coordinating theaccreditation activities usually oversees the production of reports and other materialrequired by the surveyors or reviewers. They also ensure that the whole organisationis ready for its assessment, and that staff and others are available to talk to thereview team. The review team will probably want to talk to some consumers ofthe service seeking accreditation, carers of service users and even members of thewider community.

The full assessment happens only every few years. Because of this there has beena tendency for services to treat the accreditation process as a one-off ‘exam’ whichthey need to pass. Activity needed to ‘pass’ this ‘exam’ has therefore been focussedmore on preparing for the ‘exam’ rather than on real processes of continual qualityimprovement.



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Accreditation agencies are now reorienting their standards and processes to ensurethat accreditation really is part of a process of continuous quality improvement(CQI) rather than something that happens every few years. They do this by bothhaving regular reviews of the service and by looking at the documented effort,progress and outcomes over time, rather than focussing on the ‘snap shot’ on thedays of the accreditation review. For example, there might be documentary evidenceof long-standing problems with food services. The accrediting team is more likelyto want to find out what was done over time, rather than being impressed thatwhen they are visiting the food seems excellent. Equally, if complaints have beenreceived over a long period or service users tell of making such complaints, evenif the documentation is missing, then remedial action at the time, rather than justprior to accreditation will be what the surveyors and reviewers are looking for.

Consumers can help the organisation to focus on continual improvement by viewingtheir own role as being part of the cycle of quality improvement and encouragingand helping the service to involve consumers in all its quality improvement activitiesthroughout the whole quality improvement cycle particularly the periods betweenreviews.



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C.C.C.C.C. Consumer surveyors and reviewersConsumer surveyors and reviewersConsumer surveyors and reviewersConsumer surveyors and reviewersConsumer surveyors and reviewers

Accreditation agencies are now interested in involving consumers on the reviewteams. Traditionally membership of these teams has been drawn from people whowork in health services, including doctors, nurses and managers. Members are oftendrawn from other parts of Australia because it would not be suitable to use peoplewho have worked in a service to review that service. Recently some accreditationagencies have included a consumer as a member of some review teams. This hasgenerally been in the mental health arena, because the National Working Groupwhich is overseeing the implementation of the National Mental Health Standardshas stated that consumer surveyors or reviewers must be included in external reviewteams.

Members of review panels usually receive some training from the accreditationagency. That training typically lasts for two days and focuses on the standards andthe processes of accreditation. Once this initial training is complete, consumersand other surveyors or reviewers do an observation review, where they are involvedin learning ‘on the job’.

The accreditation agency draws on its pool of trained surveyors or reviewers tomake up review teams which visit the service to be accredited. They can spend upto five days at that service, if it is a large, acute care hospital. They will usuallyspend less time in smaller services. There may be as few as two and as many as 12surveyors or reviewers on a team, depending upon the size of the facility. Prior tothe visit, the accrediting agency requests a number of reports from the service ondifferent aspects of the services activities. These are supplied to the surveyors orreviewers in advance of the actual site visit.

During the visit team members will look at different aspects of the service. Theymay inspect some of the physical facilities, interview staff, and inspectdocumentation. Some panel members will also seek to talk to consumers of theservice about their experience of the care provided. They may hold focus groupsor one-on-one discussions. They may seek to verify claims made in thedocumentation by looking at internal reports or papers.

During and after the site visit the team consider together the documentation andthe things they observe each day during the site visit. Teams mostly meet everynight of a survey and sometimes in the morning before starting, to ensure they arefollowing up everything which needs to be addressed. They compile a report onthe quality of the service against their criteria or standards and make a series ofrecommendations aimed at improving quality. Much of this report may be writtenduring the review, although the surveyors or reviewers will often need to completethe report after the review.



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Different accreditation processes have cycles of accreditation of different duration.Sometimes accreditation is provisional, and depends on the service making changeswhich are considered necessary for it to meet basic standards of care. In a smallnumber of cases, accreditation is withheld until the service demonstratesimprovements in its standards of care.

DDDDD..... Getting involvedGetting involvedGetting involvedGetting involvedGetting involved

You can get involved in a number of ways. You could contact the health servicesin the area you live in and tell them of your interest. If you are involved in aconsumer group or a support group in your area, you could suggest to them thatthey should try to work with the services in that area. This could involve talking tothe health services about why they should involve consumers in qualityimprovement processes. You could work with the health service to write a roledescription for a consumer representative, and then help the service to findconsumers who could effectively participate.

Consumer organisations and groups could also contact the accreditation agencies(addresses and phone numbers are in Section 6 of this Guide) and offer to helpthem by nominating consumers who would be suitable for work on review teams.They could assist with the training of the consumers and of the other surveyor/reviewers.



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E.E.E.E.E. DDDDDeciding whethereciding whethereciding whethereciding whethereciding whether to get involved yourselfto get involved yourselfto get involved yourselfto get involved yourselfto get involved yourself

Think carefully about getting involved in the accreditation process. Factors youneed to take into account include:

� Time commitment: Accreditation and quality improvement processes canbe time consuming. Check out with the agency or the service just how muchtime may be involved, when meetings and other events will happen, and howlong they will last.

� Your own skills and experience: Your experience as a consumer is crucialfor you to be able to do this job. However, other skills or experiences will helpyou. Involvement in accreditation and quality improvement processes can bequite demanding. If you have had experience at working on committees thiswill help. If you have had some training as a consumer representative this willalso help. You may bring other useful experiences from your working life orfrom other voluntary activities in which you have been involved.

� Your health: Being ill can give you a very detailed view of how a health caresystem operates and all its frailties. However, it can make it difficult for you tobe sure you will be able to participate. If you are currently ill, it may be useful,if you are interested in being involved in accreditation or quality improvementactivities, to find someone who can ‘pair’ with you. This means if you can’tmake it, they can attend. You need to keep each other well-briefed andcommunicate about what is happening on a regular basis for this to work. Youmay need to discuss the need to work this out with the accreditation body orthe health service – as each consumer is likely to have a range of skills thatwill impact on the activities they are invited to participate in.



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FFFFF..... Being actively involvedBeing actively involvedBeing actively involvedBeing actively involvedBeing actively involved

If you do get involved in accreditation and quality improvement processes thereare some strategies that will help you.

VVVVValue your own experiences and expertise as a consumeralue your own experiences and expertise as a consumeralue your own experiences and expertise as a consumeralue your own experiences and expertise as a consumeralue your own experiences and expertise as a consumer

It is precisely because you are a consumer that your presence is needed in theaccreditation process. The experiences which you have as a consumer are thosewhich will help you look for things that other team members won’t. They will helpyou frame different questions, and suggest strategies which would not occur toother team members.

Be involved with, supported byBe involved with, supported byBe involved with, supported byBe involved with, supported byBe involved with, supported by, and represent a range of, and represent a range of, and represent a range of, and represent a range of, and represent a range ofconsumersconsumersconsumersconsumersconsumers

It will help if the experiences and perspectives you bring to the review are not justyour own, but are shared by other consumers. You can do this by being involved ina consumer organisation or a support group, and/or by being a part of a networkof consumers.

Make sure you talk to other consumers about what you are doing, and activelyseek their views. Make sure you have a way of reporting back to them about thework that is being done. Talk to other consumers who have been involved incommittees and panels because they can often provide you with advice based ontheir own experiences and suggest practical strategies that will help you as you getinvolved in an area that may not be used to working with consumers.

Be clear about your roleBe clear about your roleBe clear about your roleBe clear about your roleBe clear about your role

Talk to the agency or service you will be involved with. Ask them for a clearstatement or explanation of your role, and make sure that you are comfortablewith this role. Discuss the role with the agency or service, and make sure that theirexpectations are reasonable. Ask them to clarify your role with other members ofthe team who may not be used to working with a consumer, and who may haveunreasonable expectations of why you are there.

Talk to other consumers and their organisations about what your role is, so thattheir expectations of what you will contribute to the process are reasonable.



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Identify where you might need some helpIdentify where you might need some helpIdentify where you might need some helpIdentify where you might need some helpIdentify where you might need some help

Talk to the agency or service you are going to be working with about the sort ofwork that will be required of you.

Accreditation agencies provide training for all members of their review teams –explore with them what that training involves, and then assess whether that willmeet all of your needs. If it doesn’t, then talk to the agency and some consumergroups about extra training and advice that may be available.

If you are going to be involved in the service being accredited, explore with them,and with your local consumer group, the training and advice that is available toyou.

And remember, just talking with other people who have been, or still are, consumerrepresentatives can be very helpful. They will be able to give you advice based ontheir experiences, as well as being able to lend a sympathetic and supportive ear ifnecessary.

Some of the publications listed in Section 6 will also help you. Two of these: theGuidelines for Consumer Representatives published by the Consumers’ Health Forumand the Little Purple Book of Community Rep-ing are both basic handbooks for anyonewho represents consumers. They contain lots of helpful hints, advice and strategiesfor identifying and solving problems.

Get oriented and informedGet oriented and informedGet oriented and informedGet oriented and informedGet oriented and informed

Orientation to a task and the physical location in which tasks are carried out isvery important, but is often overlooked by busy managers.

If you are participating in a quality improvement committee within a health serviceit will be helpful if you are familiar with the services it provides, their physicallocations and the names and responsibilities of some of the senior staff. This willgive you a context for some of the discussions you will participate in. Don’t beafraid to ask the chair of the committee or the head of the secretariat to provideyou with some orientation of this nature.

Be active in seeking information which will be helpful to you. Some informationwhich may be helpful includes:

� results of patient satisfaction surveys;

� reports of focus groups with consumers which may have been conducted bythe service;



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� data about the number and nature of complaints;

� data on adverse events suffered by consumers of the service and otherperformance measures; and

� how the service informs consumers of their rights.

If you may need some assistance with interpreting some of the data – ask forassistance from the service.

Ask the service to put you in touch with or arrange meetings with consumer supportgroups or networks which relate to the services provided by the facility. Ask tospeak to any patient advocates employed by the service.

Check out what to do about expenses and paymentsCheck out what to do about expenses and paymentsCheck out what to do about expenses and paymentsCheck out what to do about expenses and paymentsCheck out what to do about expenses and payments

There are always costs associated with involvement in a committee or as a surveyoror reviewer. They can include costs of travelling to and from meetings, parkingand child or respite care. These costs should be covered by the committee in whichyou are participating. Ask the accrediting agency or the committee secretariat aboutarrangements for covering expenses. For example, will they supply cab vouchers,or do they want you to pay the costs up front and then reimburse you? These issuesare important for many consumers, particularly those on low incomes who cannotafford to pay the costs and then wait for reimbursements. It is reasonable to askthat your expenses be met at the time they are incurred – or even in advance.

Sitting fees are paid for participation in some committees and by most accreditingagencies. You should inquire whether sitting fees are paid. If they are not, you maywant to ask why, and suggest that they should consider paying a fee. Most of theother people on the committee will be receiving a salary or some form of paymentbecause it is part of their job. Sometimes, consumer representatives are the onlypeople on the committee not being paid for their time. The organisation whichhosts the committee may never have thought of this before, or they may worrythat paying you will somehow compromise your independence. You can reassurethem about this by stressing that your accountability is to consumers, not to theservice.



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Evaluate the processEvaluate the processEvaluate the processEvaluate the processEvaluate the process

It is always good practice to make sure that evaluation of a process happens.Evaluating a process means that problems are identified and lessons are learnedfrom the experience and can be applied to future activities. It also means that thosethings that worked well are understood and valued. A good evaluation processalso provides a good means of de-briefing for all team members, so that they areable to identify what they have learnt and apply those lessons to other things theydo.

If your committee or group does not have a process for evaluating its own work onthe agenda, ask that this be added. Get involved in designing the evaluation –because it is important that the questions and issues that consumers raise are acentral part of any evaluation of activities in health care. Make sure that the viewsand experiences of consumers who have contributed to the process are sought aspart of that evaluation.

Report back to consumersReport back to consumersReport back to consumersReport back to consumersReport back to consumers

Anyone who represents consumers needs to report back to their constituency.Bearing this in mind also helps you to maintain your focus on issues of concern toconsumers. Reporting back will help other consumers to learn from your experience,to appreciate some of the highs and lows involved in being a consumerrepresentative, and to understand what you thought you have achieved, and whatturned out to be too hard, and why.

Discuss the most appropriate means of reporting with the consumer group.Reporting back can be as simple as a written report or article which can be publishedin a newsletter. It can also be an oral presentation given at one of the group’smeetings – or it can be both.



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GGGGG.....Staying involvedStaying involvedStaying involvedStaying involvedStaying involved

Sometimes, involvement in the improvement of quality of a service through beingon a quality improvement committee can be long term. Equally, if you train to bea consumer surveyor or reviewer, you may well wish to keep doing this over thelonger term. One of the difficulties with long term commitment to any work ofthis kind can be ‘burn-out’ and a loss of connection with your reason for beingthere. Maintaining your energy and your consumer perspective are crucial to longer-term involvement.

Looking after yourselfLooking after yourselfLooking after yourselfLooking after yourselfLooking after yourself

Participation in accreditation and quality improvement processes can be physically,mentally and emotionally demanding. It is very important that you look after yourself.

As part of your preparation for the process, check out the timetable and workloadsyou are expected to undertake. If you feel that the workload and working hours aregoing to be too physically or mentally demanding for you, take action before itbecomes a problem. Don’t feel guilty, bad, or inadequate, about it. Many consumerrepresentatives suffer from ill-health – it’s what gives you your unique perspectiveas a user of services and what makes you such a valuable member of the team.

You can discuss the possibilities of a more reasonable timetable and workloadwith the chair of the committee or the leader of the review team. By negotiatingmore reasonable working hours you will be doing a favour for other members ofyour committee or panel. Alternatively, you can suggest that another consumer beavailable to act as your proxy, while you take a much needed and well earnedbreak. This would mean that the person who is your proxy would need to alsoparticipate in training and orientation activities with you.

It is also important that you take care of your emotional health during thisexperience. Involvement in health care delivery settings can be traumatic for someconsumers. It may awake memories of trauma, pain and illness you have experiencedyourself. Sometimes it can just be distressing to be in an environment where peopleare sick and in pain. It is important that you think about how you will cope in thisenvironment, and put some strategies in place in case you need them.

Having someone else who is aware that there may be a problem, and who is availableto talk to you during and after the event may be helpful. Tell your friends andfamily about what you are doing, and ask if you can de-brief with them if necessary.If there is no-one to talk to at that time, write down your feelings and then talkabout it when there is someone around.



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If you are in a large health service and you need some space or time-out, excuseyourself and find a quiet place to sit and collect your thoughts. This may be agarden seat or a chapel. For some people a noisy place is better, so go to the canteenor walk around the streets outside for a while. These are quite normal responses –and it is not ‘weak’ or ‘crazy’ to need this space. What you bring to the process thatis special is your empathy with other consumers. It requires you, to some extent, toretain a greater degree of vulnerability and openness to the experiences of thosearound you.

Sometimes it is helpful to carry something in your pocket or in a bag which representswhy you want to be involved in this process. When you feel distressed, this cansometimes ground you and help you remember why it is important that you arethere. Other options can be something which helps you smile when you feel down– or something that makes you laugh. All of these can help, when you are feelingvulnerable.

Maintaining your consumer perspectiveMaintaining your consumer perspectiveMaintaining your consumer perspectiveMaintaining your consumer perspectiveMaintaining your consumer perspective

Involvement in committees or teams with people who are involved primarily asproviders of services can make it difficult to maintain your consumer perspective– particularly if you are the only consumer there. It is often quite hard not to focuson the concerns of providers – although, of course, they can be very important.

Keep in touch with your consumer networks and consumer organisations as muchas you can. This will help to keep you grounded in consumers concerns. Anotherstrategy which some consumers employ is to keep a checklist of consumer issueswhich need to be raised, or just kept in mind. Look at this before you go into ameeting. One handy document to read is the United Nations Eight ConsumerRights – this is published in the Consumers’ Health Forum’s Guidelines for ConsumerRepresentatives (see Section 6) – it will give you a quick checklist of things you needto think about.

It is important to remember that while you may be working with the health serviceor accreditation agency, you have an important role representing consumers andthe public interest more generally. In most cases, where you have a concern aboutsomething which you think might infringe these broader interests, you should discussit with your committee chair or the team leader. Usually, people in these positionswill act responsibly to ensure your concerns are taken into account and acted upon.In the rare event that this does not occur, you have other options if you areconcerned. You could have a confidential discussion with one of the moreexperienced consumers in the organisation that nominated you, or someone else,whose integrity and confidence you trust either inside the organisation or elsewhere.



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Confidentiality issuesConfidentiality issuesConfidentiality issuesConfidentiality issuesConfidentiality issues

As a consumer representative or surveyor/reviewer, you will often have access toa lot of confidential information. You need to ensure that you understand what isconfidential and what is not. As a reminder to yourself and other readers of thepapers, you can ask that confidential papers be stamped confidential – that is goodpractice for the agency or service in any event.

As a rule of thumb, any information which is personal and identifying or involvescommercial interests should be treated confidentially. It is important that you donot ‘gossip’ about the information discussed at meetings, even if you hear healthservice providers doing it. This is particularly so with any individual’s personalhealth information which may come to the committee or that you become awareof as part of the review. At the very least it is poor practice and you may well bebreaking the law.

You also need to think carefully about what you report to your nominating consumerorganisations. While you need to be accountable to other consumers, and whileprocesses needs to be as tranparent as possible – the content of any reports needto recognise the sensitivities of other committee and team members and the needfor quality improvement activities to be discussed openly and in an atmosphere oftrust. It is usually wise to discuss any reporting requirements with the chair of thecommittee or the review team, and negotiate what can and cannot be reported.

You also need to understand whether some material needs to be stored securely,and if you don’t have secure storage, ask for assistance from the agency or healthservice. You might, for example, be able to borrow a lockable filing cabinet whileyou are a committee member.



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CCCCCHECKLISTHECKLISTHECKLISTHECKLISTHECKLIST FORFORFORFORFOR CONSUMERSCONSUMERSCONSUMERSCONSUMERSCONSUMERS

Get involvedGet involvedGet involvedGet involvedGet involved

� Contact health services in your area; or

� Talk to a consumer organisation; or

� Contact an accreditation agency.

Being involvedBeing involvedBeing involvedBeing involvedBeing involved

� Value your own experience and expertise.

� Join a consumer organisation and/or network with other consumers.

� Clarify your role and tasks with the agency or service you will be involvedwith.

� Obtain relevant information about the committee, its structure, scope ofactivity, authority and method of operation.

� Obtain information about other members of the committee.

� Identify your training needs and investigate options for meeting those needs.

� Read the Guidelines for Consumer Representative’ or the Little Purple Book ofCommunity Rep-ing.

� Discuss your information and orientation requirements with the committeesecretariat.

� Discuss payments and expenses with the head of the committee secretariat.

� Ensure that there is an evaluation process.

� Discuss how to report back to consumers with the committee secretariat andyour consumer group.

� Discuss issues about confidentiality of information with your committee.



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Looking after yourselfLooking after yourselfLooking after yourselfLooking after yourselfLooking after yourself

� Check out the timetable and workloads you will be expected to undertake –discuss them with the committee secretariat or chair of the committee if theyare likely to be onerous for you.

� Consider whether working in the environment will be physically or emotionallydifficult for you – and put appropriate supports in place.



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SECTION 6: RESOURCES TSECTION 6: RESOURCES TSECTION 6: RESOURCES TSECTION 6: RESOURCES TSECTION 6: RESOURCES TO HELP INVO HELP INVO HELP INVO HELP INVO HELP INVOLOLOLOLOLVE CONSUMERS INVE CONSUMERS INVE CONSUMERS INVE CONSUMERS INVE CONSUMERS INAAAAACCREDITCCREDITCCREDITCCREDITCCREDITAAAAATIONTIONTIONTIONTION

In this section we set out some resources and organisations that will help you toinvolve consumers in accreditation process. It includes:

� information about the major accreditation agencies;

� information about organisations that can help you involve consumers; and

� information about written resources.

A.A.A.A.A. Accreditation agencies: Who are they? What doAccreditation agencies: Who are they? What doAccreditation agencies: Who are they? What doAccreditation agencies: Who are they? What doAccreditation agencies: Who are they? What dothey do?they do?they do?they do?they do?

There are many agencies which run accreditation programs in different areas. Manyfocus on specialist services such as pathology, radiology and fertility treatments.This section provides information about a selection of the agencies which accreditmany of the general health care services including hospitals, community healthservices and general practices.

Australian Council on Healthcare StandardsAustralian Council on Healthcare StandardsAustralian Council on Healthcare StandardsAustralian Council on Healthcare StandardsAustralian Council on Healthcare Standards

The Australian Council on Healthcare Standards (ACHS) is an independent not-for-profit organisation which is dedicated to continually improving the quality ofhealth care in Australia. It was established as the Australian Council on HospitalStandards in 1974 by the Australian Medical Association (NSW Branch) and theAustralian Hospital Association (Victorian Branch) and renamed as the AustralianCouncil on Healthcare Standards in 1988.

In 1994 the ACHS undertook a major review of its standards and survey processwhich culminated in the launch of a new program and set of standards – theEvaluation and Quality Improvement Program (EQuIP).



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The starting point for EQUiP is the ACHS standards which cover:

1. Continuum of Care

2. Leadership and Management

3. Human Resources

4. Information Management

5. Safe Practice and the Environment

5. Improving Performance Function

Australian Council on Healthcare Standards5 Macarthur StreetULTIMO NSW 2007Phone: 02 9281 9955Fax: 02 9211 9633Email: [email protected] address: http://www.achs.org.au

Quality Improvement CouncilQuality Improvement CouncilQuality Improvement CouncilQuality Improvement CouncilQuality Improvement Council

The Quality Improvement Council (QIC) is responsible for the coordination of theQIC National Review/Accreditation Program and use of the QIC Standards,delivered through affiliated Licensed Providers. QIC is a national, non-profitorganisation that aims to promote and assist health and community services througha continuous quality improvement framework.

Reviews are undertaken to support organisational development and accreditationis available. The Quality Improvement Council is governed by a Board of Directorsand the QIC National Secretariat is based in Melbourne. The QIC Standards aredelivered through modules to ensure maximum flexibility and minimum duplication.Service specific standards are available to use in conjunction with the generic CoreModule.

QIC Standards modules include:

� Health and Community Services Core Module

� Community and Primary Care Services Module

� Home Based Care Module



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� Maternal and Infant Care Services Module

� Integrated Health Services Module

� Alcohol, Tobacco and Other Drug Services Module.

The modules are divided into sections and each section is organised around aconsumer principle and a service principle followed by key outcomes. They givethe underlying rationale for the standards in that section. Within each sectionthere is a set of standards that define and describe what is required of the servicefor quality and effectiveness. Each standard has a list of indicators which serve asa guide to service development and as evaluation criteria to assess a service’s levelof attainment of the standard.

Quality Improvement CouncilAustralian Institute for Primary CareFaculty of Health SciencesLa Trobe UniversityBUNDOORA VIC 3086Phone: 03 9479 5630Fax: 03 9479 5977Email: [email protected] address: qic.latrobe.edu.au

Australian General PAustralian General PAustralian General PAustralian General PAustralian General Practice Accreditation Ltdractice Accreditation Ltdractice Accreditation Ltdractice Accreditation Ltdractice Accreditation Ltd

Australian General Practice Accreditation Ltd (AGPAL) is an independent companyowned by its members who include the Australian Medical Association (AMA),Royal College of General Practitioners (RACGP), Rural Doctors’ Association ofAustralia (RDAA), Australian Association of General Practitioners (AAGP),Australian Divisions of General Practice (ADGP), Australian College of Ruraland Remote Medicine (ACRRM), Australian Association of Practice Managers(AAPM) and National Association of Medical Deputising Australian (NAMDS).The Consumers’ Health Forum and the Federal Health Minister have nominees toAGPAL’s Board of Directors.

The Standards to be used in the process of accreditation are the RACGP EntryStandards for General Practices. These are the only set of validated Standards thatexist for use by the profession at present and were found, in the RACGP Field Testand Commonwealth and Division of General Practice Demonstration Trials in1994, to be acceptable and achievable by most GPs.



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Australian General Practice Accreditation LtdLevel 1, 65 Park RoadMILTON QLD 4064Phone: 1300 362 111Fax: 1300 362 110Email: [email protected] address: www.agpal.com.au

International Organisation for StandardisationInternational Organisation for StandardisationInternational Organisation for StandardisationInternational Organisation for StandardisationInternational Organisation for Standardisation

Established in 1947, the International Organisation for Standardisation (ISO) is aworldwide non-Government federation of national standards bodies from some130 countries. The mission of ISO is to promote the development of standardizationand related activities in the world with a view to facilitating the internationalexchange of goods and services, and to developing cooperation in the spheres ofintellectual, scientific, technological and economic activity. The Australian bodyis Standards Australia. Standards Australia has a fully owned subsidiary, QualityAssurance Services, which certifies to ISO 9000. There are many other certifyingorganisations who perform a similar function. All of these organisations have tobe registered and approved by JAS-ANZ. JAS-ANZ is a not-for-profit, self-fundinginternational organisation established under a Treaty between the Governmentsof Australia and New Zealand on 30 October 1991 to act as the joint accreditationbody for Australia and New Zealand for certification of management systems,products and personnel.

The ISO 9000 series relates to quality management and quality assurance. It is ageneric model which conceptualises an organisation in process terms. For example,it includes management responsibility, contract review, design control, documentand data control, inspection and testing and control of quality records. In Australia,the model has been ‘applied’ to health care in a separate publication called theGuide to AS/NZS ISO 9001, 9002 and 9003 for health services, which was releasedin 1998. The ISO 9000 series does not address specific characteristics of the healthcare process. However it requires the organisation to address issues of customersatisfaction, be able to show how it has considered customer requirements, and beable to demonstrate measurement, analysis and improvement. The relevant clausesare Customer Focus 5.2, Customer related processes 7.2 and Customer satisfaction8.2.1.

Standards AustraliaGPO Box 5420SYDNEY NSW 2001Phone: 02 8206 6013

1300 654 646Fax: 1300 654 949Email: [email protected] address: http://www.standards.com.au



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Australian Quality Council’s Business Excellence AwardsAustralian Quality Council’s Business Excellence AwardsAustralian Quality Council’s Business Excellence AwardsAustralian Quality Council’s Business Excellence AwardsAustralian Quality Council’s Business Excellence Awards

The Australian Quality Council (AQC) is a non-government, not-for-profit,membership-based organisation which is recognised by the Commonwealth ofAustralia as the peak body assisting Australian enterprises to develop and spreadthe skills that achieve and sustain business excellence through the adoption of themanagement principles and practices reflected in the Australian Business ExcellenceFramework. The AQC has worked within the wider spectrum of healthcareorganisations for over a decade.

Australian Quality CouncilPO Box 28ST LEONARDS NSW 1590Phone: 02 9901 9976Freecall: 1800 060 830Fax: 02 9436 3251Email: [email protected] address: www.aqc.org.au



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BBBBB..... Organisations which can assist with consumerOrganisations which can assist with consumerOrganisations which can assist with consumerOrganisations which can assist with consumerOrganisations which can assist with consumerparticipationparticipationparticipationparticipationparticipation

National RNational RNational RNational RNational Resource Centre for Consumer Pesource Centre for Consumer Pesource Centre for Consumer Pesource Centre for Consumer Pesource Centre for Consumer Participation inarticipation inarticipation inarticipation inarticipation inHealthHealthHealthHealthHealth

The National Resource Centre for Consumer Participation in Health (NRCCPH)has two closely related functions:

� a clearinghouse for information about methods and models of community andconsumer feedback and participation and associated concepts; and

� a centre of excellence in consumer participation where clients can seek adviceand assistance to develop, implement and evaluate feedback and participationmethods and models.

The NRCCPH is an initiative of the Commonwealth Department of Health andAged Care, and is endorsed by the Australian Health Ministers’ Advisory Council.It aims to identify emerging issues, inform and influence policy and practice, andsupport and strengthen the commitment of health service managers and providers,consumers, community based organisations/groups, researchers and policy makersto implement processes for effective community and consumer feedback andparticipation in health through a synergy of its clearinghouse and centre of excellencefunctions.

National Resource Centre for Consumer Participation in HealthRoom 539, Health Services Building 2La Trobe UniversityBUNDOORA VIC 3083Phone: 03 9479 3529Fax: 03 9479 5977Email: [email protected] (Information Manager)Web address: http://nrccph.latrobe.edu.au

Consumers’ Health FConsumers’ Health FConsumers’ Health FConsumers’ Health FConsumers’ Health Forum of Australiaorum of Australiaorum of Australiaorum of Australiaorum of Australia

The Consumers’ Health Forum of Australia (CHF) is a national consumerorganisation which represents consumers on health care issues. It provides a balanceto the views of government, manufacturers, service providers and other healthprofessionals. CHF nominates and supports consumer representatives on a varietyof government, professional and industry bodies.



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Consumers’ Health Forum of AustraliaPO Box 170CURTIN ACT 2605Phone: 02 6281 0811Fax: 02 6281 0959Email: [email protected] address: http://www.chf.org.au

Health Issues CentreHealth Issues CentreHealth Issues CentreHealth Issues CentreHealth Issues Centre

The Health Issues Centre (HIC) is an independent health policy and research centre.They believe that the health care system could be fairer and more efficient forconsumers and health workers. HIC uses its findings to lobby governmentdepartments, professional associations in the health sector and the electedrepresentatives responsible for health policies from all major political parties.

Health Issues CentreLevel 5, Health Sciences Building 2LATROBE UNIVERSITY VIC 3000Phone: 03 9479 5827Fax: 03 9479 5977Email: [email protected] address: http://home.vicnet.net.au/~hissues

Health Consumers’ Council of WHealth Consumers’ Council of WHealth Consumers’ Council of WHealth Consumers’ Council of WHealth Consumers’ Council of Western Australiaestern Australiaestern Australiaestern Australiaestern Australia

The Health Consumers’ Council of Western Australia is an independent community-based organisation that gives consumers a voice in health policy, planning, researchand service delivery. The Council’s mission is to ensure that individual healthconsumers and groups of health consumers contribute to the development of healthpolicy, planning research and service delivery through the provision of education,advocacy, training, information services and community participation. It currentlytrains and supports representatives on over 40 committees.

Health Consumers’ Council of WAUnit 13/14 Wellington Fair4 Lord StPERTH WA 6000Phone: 08 9221 3422Freecall: 1800 620 780Fax: 08 92211 5435Email: [email protected] address: www.hcc-wa.asn.au



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Health Care Consumers’ Association of the ACTHealth Care Consumers’ Association of the ACTHealth Care Consumers’ Association of the ACTHealth Care Consumers’ Association of the ACTHealth Care Consumers’ Association of the ACT

The Health Care Consumers’ Association of the ACT (HCCA) was formed in1978 by concerned ACT health care consumers to provide a voice for consumerson local health issues. HCCA aims to be a means for health care consumers toparticipate in policy, planning and service decisions that affect their health. HCCAworks to improve the quality and availability of health services by involvingconsumers through: regular meetings; newsletters to members; encouraging andsupporting consumer representatives on government and non-government planningcommittees, councils, advisory groups and reviews.

Health Care Consumers’ Association of the ACTGPO Box 1659CANBERRA ACT 2601Phone: 02 6290 1660 (Office )Fax: (02) 6290 1662 (Office )Email: [email protected] address: www.actcommunity.org/hcca.htm

Health Consumers’ Network (NSW)Health Consumers’ Network (NSW)Health Consumers’ Network (NSW)Health Consumers’ Network (NSW)Health Consumers’ Network (NSW)

Health Consumers’ Network allows health consumer groups in NSW to shareinformation and experience, and provide a voice for health consumers on a statewidelevel. It aims to enable health consumers in NSW to contribute to the developmentof health policy, planning, priorities, service delivery and evaluation. In doing so,it seeks to achieve a more effective, equitable and high quality health system thatprovides health for all.

Health Consumers’ Network (NSW)C/- Public Interest Advocacy CentreLevel 1, 46 York StSYDNEY NSW 2000Phone: 02 9299 7833Fax: 02 9299 7855Email: [email protected]



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South Australian Consumer Representatives’ NetworkSouth Australian Consumer Representatives’ NetworkSouth Australian Consumer Representatives’ NetworkSouth Australian Consumer Representatives’ NetworkSouth Australian Consumer Representatives’ Network

The South Australian Consumer Representatives’ Network is a network of peoplewho represent consumers on a variety of committees across South Australia. Atthe moment there is a membership of about 60 people. It is run by a small steeringcommittee of experienced consumer representatives, who organize 3 or 4 meetingsfor consumer representatives a year. Some meetings are run as both formal trainingsessions with a facilitator and/or guest speaker/trainer. Topics vary and includelobbying skills and information about the political environment and governmentactivities.

Kathy MottConsumer Perspectives329 Brighton RoadNORTH BRIGHTON SA 5048Phone: 08 8358 1055Fax: 08 8377 2138Email: [email protected]

Chronic Illness Alliance of VictoriaChronic Illness Alliance of VictoriaChronic Illness Alliance of VictoriaChronic Illness Alliance of VictoriaChronic Illness Alliance of Victoria

The Chronic Illness Alliance of Victoria is an organisation representing over 40consumer and advocacy groups on policy matters of common concern. The Allianceis based at La Trobe University, and represents groups throughout Victoria.

Chronic Illness Alliance of VictoriaRoom 507, Health Sciences Building 2,La Trobe UniversityBUNDOORA VIC 3083Phone: 03 9479 3218Fax: 03 9479 5977Web address: www.chronicillness.org.au



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C.C.C.C.C. ResourcesResourcesResourcesResourcesResources

Guidelines for consumer representatives: Suggestions forGuidelines for consumer representatives: Suggestions forGuidelines for consumer representatives: Suggestions forGuidelines for consumer representatives: Suggestions forGuidelines for consumer representatives: Suggestions forconsumer or community representatives working onconsumer or community representatives working onconsumer or community representatives working onconsumer or community representatives working onconsumer or community representatives working oncommitteescommitteescommitteescommitteescommittees

This publication is designed to provide consumer representatives with informationto help and empower them in their representative role. The Guidelines are aimedat consumer representatives who are nominated onto committees by a consumerorganisation. It contains lots of basic advice and tips about representing consumers,dealing with difficulties and being effective. It also contains a number of loose-leaf check lists.

Cost: 4th edition (1999) - $22Available from:Consumers’ Health ForumPO Box 170CURTIN ACT 2605Phone: 02 62810811Fax: 02 62810959Web address: https://www.chf.org.au/publications/publications.html

Little purple book of Consumer Rep-ingLittle purple book of Consumer Rep-ingLittle purple book of Consumer Rep-ingLittle purple book of Consumer Rep-ingLittle purple book of Consumer Rep-ing

A humorous and accessible guide for people wanting to be community or consumerrepresentatives. The booklet was developed directly from the experiences of peoplewho had been consumer or community reps and contains lots of good advice andchecklists, as well as cartoons and humorous comment on the hazards of communityrep-ing. Published by the North West Suburbs Health and Social Welfare Council.

Cost: $10Available from:Adelaide Centre Community Health Service21 Market StADELAIDE SA 5000Phone: 08 8200 3927 (speak to Cathy Leong)Fax: 02 8200 3911



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Community and consumer participation Audit TCommunity and consumer participation Audit TCommunity and consumer participation Audit TCommunity and consumer participation Audit TCommunity and consumer participation Audit Tool forool forool forool forool forhospitalshospitalshospitalshospitalshospitals

An easy to use tool for hospital staff to use to gain an indication of the level ofcommitment to community and consumer participation in their hospitals. The AuditTool is based on the Australian Council on Healthcare Standard’s EQuIP standardsand criteria.

Available from: National Resource Centre for Consumer Participation in Health(for contact details see below).

Consumer FConsumer FConsumer FConsumer FConsumer Focus Collaboration publicationsocus Collaboration publicationsocus Collaboration publicationsocus Collaboration publicationsocus Collaboration publications

The following five documents (overleaf) are all available from the National ResourceCentre for Consumer Participation in Health. They are available in hard copy or onCD-ROM as well as the National Resource Centre website. The Centre can becontacted as follows:

National Resource Centre for Consumer Participation in HealthRoom 539, Health Services Building 2La Trobe UniversityBUNDOORA VIC 3083Phone: 03 9479 3529Fax: 03 9479 5977Email: [email protected] (Information Manager)Web address: http://nrccph.latrobe.edu.au



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1 .1 .1 .1 .1 . Improving health services through consumer participation: AImproving health services through consumer participation: AImproving health services through consumer participation: AImproving health services through consumer participation: AImproving health services through consumer participation: Aresource guide for organisationsresource guide for organisationsresource guide for organisationsresource guide for organisationsresource guide for organisations

A resource for people working in health care organisations who want to increaseconsumer participation in the planning, management and evaluation of theirorganisations. It includes an introduction explaining the potential benefits of consumerparticipation, an assessment and planning section, a tools catalogue and additionalsections dealing with common challenges, answering frequently asked questions andlisting additional resources and where to find them. The resource guide was producedfor the Consumer Focus Collaboration in the Commonwealth Department of Healthand Aged Care.

2 .2 .2 .2 .2 . Education and training for consumer participation in health care: AEducation and training for consumer participation in health care: AEducation and training for consumer participation in health care: AEducation and training for consumer participation in health care: AEducation and training for consumer participation in health care: Aresource guideresource guideresource guideresource guideresource guide

A Guide for consumers and health care providers who are interested in undertakingsome education and training processes that will facilitate consumer participation inthe health care system. It is a guide to what other people have done, with somecommentary on the processes used and principles that might have underpinned thoseprocesses. The Guide was produced for the Consumer Focus Collaboration in theCommonwealth Department of Health and Aged Care.

3 .3 .3 .3 .3 . Review of existing models of reporting to consumers on healthReview of existing models of reporting to consumers on healthReview of existing models of reporting to consumers on healthReview of existing models of reporting to consumers on healthReview of existing models of reporting to consumers on healthservices quality: summary report and guidelinesservices quality: summary report and guidelinesservices quality: summary report and guidelinesservices quality: summary report and guidelinesservices quality: summary report and guidelines

A report on a review of existing models of reporting on quality to consumers, and theprinciples and strategies that contribute to their effectiveness. The Report sets outthe principles underpinning purposeful reporting to consumers, and includes detailedimplementation guidelines to assist health agencies intending to develop reports toconsumers on the quality of services and on performance over time. The documentwas produced for the Consumer Focus Collaboration in the CommonwealthDepartment of Health and Aged Care.

4 .4 .4 .4 .4 . FFFFFeedback, participation and consumer diversity: A literature revieweedback, participation and consumer diversity: A literature revieweedback, participation and consumer diversity: A literature revieweedback, participation and consumer diversity: A literature revieweedback, participation and consumer diversity: A literature review

This literature review looks at existing information about participation of previouslyexcluded groups of consumers and highlights current barriers to participation of thesemarginalised groups. These groups included people from a range of cultural andlinguistic backgrounds, Indigenous Australians, people living with chronic conditions,mental illnesses or a disability, rural and remote consumers, people living in povertyor social isolation, people who are young or old and people with low literacy levels.The document was produced for the Consumer Focus Collaboration in theCommonwealth Department of Health and Aged Care by the National ResourceCentre for Consumer Participation in Health.



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5 .5 .5 .5 .5 . Evidence in support of consumer participationEvidence in support of consumer participationEvidence in support of consumer participationEvidence in support of consumer participationEvidence in support of consumer participation

This is a brief statement, which documents the evidence supporting consumerparticipation in health care - at the individual care level, at the service level and atthe system level.



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A CONSUMER FOCUS COLLABORATION PUBLICATION · 10 A Consumer Focus Collaboration publication10...

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