Appendix 2 Safety and quality standards
Safety and quality standards
This section provides information about Australian formal standards for safety and quality, and how these standards set expectations about partnerships, continual quality improvement, and accountability. These standards are very important documents for consumers, carers, families and kinship groups because they ‘set the standard’ for what you should expect from your care, service experience and participation.
There are two key sets of national standards that relate to safety and quality in mental health care.
The first set is the National Safety and Quality Health Service (NSQHS) Standards. The eight NSQHS Standards were developed by the Australian Commission on Safety and Quality in Health Care, and are designed to provide a nationally consistent statement about the level of care that people can expect from health services. Each standard has key required actions for implementation. Table A1 lays out the six standards that are highly relevant to public mental health services and shows important areas for improvement.
All public and private hospitals, day-procedure services and public dental practices in Australia must be accredited to the NSQHS Standards. Because they cover a wide range of services, some of the NSQHS Standards are more relevant to physical health services than to mental health services (such as standards for infection control and blood management). However, the NSQHS Standards still provide important guidance on the delivery of safe and high-quality mental health care.
The NSQHS Standards include a specific Partnering with Consumers Standard. This standard requires health service organisations to include consumers as partners both in their own care and in the planning, design, delivery, measurement and evaluation of systems and services. The Partnering with Consumers Standard is considered particularly important because, along with the Clinical Governance Standard, it underpins all of the other NSQHS Standards. A summary table of actions that health services are required to achieve is found in Section 2 Getting engaged.
The second set of standards is the National Standards for Mental Health Services (NSMHS).31 The Australian Government Department of Health manages the NSMHS, which guide continual quality improvement in mental health services throughout Australia.
The NSMHS apply to a broad range of mental health services, from general practice to community mental health services and acute hospital-based services. They also apply to all sectors (public, private and non-government).
Table A1: Actions with high relevance to mental health in the NSQHS Standards
|Standard||Criteria||Area of focus and action|
|Clinical Governance||Governance, leadership and culture||Governance, leadership and culture
|Patient safety and quality systems||Policies and procedures
Measurement and quality improvement
Incident management systems and open disclosure
Feedback and complaints management
Diversity and high-risk groups
|Safe environments for delivery of care||Safe environment|
|Partnering with Consumers||Partnering with patients in their own care||Healthcare rights and informed consent
Sharing decisions and planning care
|Medication Safety||Documentation of patient information||Medication reconciliation
Adverse drug reactions
|Comprehensive Care||Developing the comprehensive care plan||Screening of risk
Developing the comprehensive care plan
|Delivering comprehensive care||Using the comprehensive care plan|
|Minimising patient harm||Predicting, preventing and managing self-harm and suicide
Predicting, preventing and managing aggression and violence
Minimising restrictive practices: restraint
Minimising restrictive practices: seclusion
|Communicating for Safety||Communication at clinical handover||Clinical handover|
|Communication of critical information||Communicating critical information|
|Recognising and Responding to Acute Deterioration||Detecting and recognising acute deterioration, and escalating care||Recognising acute deterioration
|Responding to acute deterioration||Responding to deterioration|
Reference: National Quality and Safety Health Service Standards: User Guide for Health Services Providing Care for People with Mental Health Issues, 2018.
The NSMHS have a strong focus on promoting the rights, responsibilities and safety of people who use mental health services. The NSMHS also include specific consumer standards and carer standards that provide guidance on what consumers and carers can expect from mental health services.
The NSQHS Standards and the NSMHS set national benchmarks for safety and quality in mental health services. They are useful tools for ensuring accountability, identifying shortcomings in service provision, and encouraging improvements in the safety and quality of services.
States and territories have a range of policies, guidelines and legislation that influence the way mental health services are provided. Some healthcare organisations also have their own service standards and guidelines.
These standards often cover issues related to safety and quality and, like the national standards, provide useful benchmarks for identifying shortcomings and encouraging improvements. Even if a particular state, territory or service has its own set of safety and quality standards, however, the NSQHS Standards and the NSMHS may still apply.
When engaging with mental health services, think about the different standards that may apply to a service and how these standards could be used to open a discussion about safety and quality. A good starting point is to ask services for information about the standards, policies and guidelines they use to ensure safety and quality.