Partnering with consumers: the Australian experience of the development of a national health service accreditation standard

Objectives: Quality and safety of healthcare are promoted by the formation of partnerships between consumers and health service providers. We know little about effective processes for the development of accreditation standards to achieve this goal. The aim of this study was to explore enablers, challenges and
areas for improvement for the development of an accreditation standard evaluating consumer engagement in healthcare.

Methods: We examined the development of the Australian National Safety and Quality Health Service (NSQHS) Standard 2: Partnering with Consumers. The standard, developed between 2009 and 2011, assesses consumer partnership in three aspects of acute care service delivery: service planning, healthcare
design, and measurement and evaluation of healthcare services. The consumer engagement standard was developed in tandem with eight mandatory clinical standards, and one governance standard. Our study was conducted in May and June 2014, eighteen months after the 10 NSQHS standards were first
implemented.
Participants were key informants from across Australia, purposively selected from a working group tasked with developing the consumer engagement standard. An invitation to participate was extend to 12 key informants, and eight chose to participate in the study. Participants represented healthcare consumer organisations and government agencies. Four respondents took part in a focus group, and four participated in semi-structured individual interviews. A purpose-designed semi-structured interview tool was used covering the topics: evidence for consumer engagement; enablers and challenges to the development process; and areas where the process could have been improved. The focus group and interviews were audio recorded, and then transcribed. A stepwise process of general inductive analysis was used to identify themes representing participant views.

Results: Participants identified eight factors that enabled or challenged the development of the consumer engagement standard. Five factors that enabled development were: practical support for development; use of an established standards framework; an iterative and consultative development process; an
evidence base supporting the standard; and characteristics and participation of a range of stakeholder groups. Participants agreed that a particular strength of the process was the breadth and depth of consultation with individual healthcare consumers and consumer organisations. Three overarching challenges to the development of the standard emerged: healthcare providers’ deficits in understanding consumer engagement; healthcare organisations finding it hard to respond to potential changes in the way they engage with consumers; and difficulties with the integration of the consumer standard and mandatory
clinical standards. Participants’ suggestions further development of the standard included: streamlining and reduction of duplication; addition of health literacy as a core component; and development of supporting documentation to assist interpretation of the standard.

Conclusion: The iterative and wide-ranging process of stakeholder consultation used to develop the consumer standard reflects its ultimate aim: to partner with consumers in healthcare design, implementation and evaluation of service delivery. This approach offers a successful model for other standard developers, irrespective of sector or country setting. The interrelatedness of the enablers and
challenges, and suggestions for improvement to the development process, highlight the complexity of task and implementation goal.