Divisions CQI and Accreditation: a Victorian perspective 28 October 2004 Susan Webster

1. Divisions CQI and Accreditation: a Victorian perspective 28October2004Susan Webster Divisions Consultant and Team Leader for Continuous Quality Improvement

2. Overview • GPDV accreditation • GPDV support for Victorian divisions in quality improvement • Victorian Divisions involvement in accreditation • Policy issues arising to date • Emerging implementation issues for divisions

3. GPDV accreditation • GPDV participant in ADGP Quality Framework Taskforce • Frustrated with prolonged national processes around divisions accreditation • Decided to pursue accreditation within existing programs • Chose Quality Improvement Council standards as most appropriate for our operations • Opportunity to gain first hand experience of process, investment levels, challenges and rewards

4. GPDV achieved accreditation in October 2003

5. GPDV Star Divisions Program • Star Boards • workshops and resources • CEO Network • quarterly meetings, email intranet, fortnightly e-bulletin • Divisions CQI and Accreditation Network • quarterly meetings, web based resources, on-site support for individual divisions • Orientation for new CEOs and staff

6. Divisions CQI and Accreditation Formation meeting March 2004 18 Vic and 1 Tas division Needs assessment survey May 2004 16 divisions including 3 accredited Network meeting June 2004 16 Vic and 2 Tas divisions Network meeting September 2004 21 Vic divisions

7. Divisions CQI and Accreditation • Formation meeting March 2004 • Introductory presentations from • SAI Global, (ISO 9000) • ACHS • QIC • Discussion with CEOs of divisions which had already undertaken accreditation • Divisions CQI and Accreditation network formed with agreement to meet quarterly, facilitated by GPDV.

8. CQI and Accreditation Network GPDV Survey of divisions re CQI and Accreditation - May 2004 • Collected data about • Organisational approaches to CQI • Knowledge of systems options for accreditation • Current use of national standards across key areas of operations • Ongoing interest in support for CQI and accreditation

9. One or more key staff have training and or experience in using CQI principles and practices

10. Staff are familiar with & generally use systems thinking in their work

11. Board and management have explicitly embraced a policy of aiming for CQI across the whole organisation

12. Organisation systematically uses data analysis to inform planning and decision making

13. Most work involves multi functional teams where people who use / or are affected by systems of working or by outcomes have a say in how those systems work

14. Knowledge about systems for Accreditation

15. Meeting National Standards 1 = Not aware of standards10 = Confident division complies 1 = Not interested10 = Highly interested

16. CQI and Accreditation Network • Network meeting agendas to date: • Introduction to CQI principles and practices • Standards and systems for financial governance and management • Standards and systems for legal compliance • Standards and systems for Occupational Health & Safety • Getting started on accreditation: panel discussion with CEOS of accredited divisions

17. Divisions engaging in accreditation

18. Policy Issues arising to date • Accreditation as one criterion for DoHA assessment in relation to high performance • Voluntary vs compulsory accreditation • Costs of accreditation • Investing in specific standards development for divisions

19. Accreditation as one criterion for assessing divisions • Accreditation signifies that key systems and structures in an organisation meet agreed industry standards. • Structures provide the platform for sound performance but do not in themselves indicate attainment of quality service or program outcomes • Accreditation is an appropriate indicator to include among others for high performance.

20. 2. Voluntary vs compulsory accreditation • Standards Setting and Accreditation Literature Review and Report, Safety and Quality Council, April 2003 • Prepared for DoHA to inform the development of a national framework for standards setting and accreditation in health • “mandating one model …may have a negative impact on continuous improvement…more …in favour of external quality review without promulgating a single approach..” p. 9

21. 2. Voluntary vs compulsory accreditation • Discussions at June 2004 CEO network meeting indicated Victorian division CEOs do not favour compulsory accreditation

22. 3. Cost of accreditation • Costs vary between ~ $1500 and $7000 per annum depending on the provider and the size of the division • Divisions favour subsidy for these costs from DoHA • Potential for cost offset as Peer Review Panels would not be needed for these divisions.

23. 4. Standards development for divisions • To cover additional core areas of divisions’ operations • Provision of Continuing Professional Development to general practice • Practice support • IM development activities

24. Division implementation issues • In house experience and skills in application of CQI principles and practices is variable • Challenge of some new language and cultural elements e.g. • “customer focus” • “systems thinking” • “PDCA cycles” • Interpretation of national standards in divisions context • Variable stages of “readiness”

25. Accreditation: • the independent engineering report on the soundness of the division’s structure