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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 5.1 Facilities and access

Our practice provides a safe and effective environment for our practice team and patients.

Criterion 5.1.2

Physical conditions conducive to confidentiality and privacy

The physical conditions in our practice support patient privacy and confidentiality.

Indicators

► A. The physical facilities of our practice support patient privacy and confidentiality.

► B. Visual and auditory privacy of consultations and treatments is supported.

Explanation

Key points

  • Visual privacy includes physical privacy for patients and the privacy of patient health information
  • Auditory privacy means a patient’s conversation with a member of the clinical team cannot be overhead by an inappropriate person, such as another patient or staff member
  • This criterion cross references to Criterion 5.1.1 Practice facilities.

Visual privacy

Visual privacy can be afforded to patients during the clinical examination by the use of a gown or sheet and an adequate curtain or screen.

Members of the clinical team need to be sensitive to patient dignity when patients are required to undress/dress in the presence of the GP or practice nurse.

Auditory privacy

Where possible, consultations should not be able to be overheard by others. Auditory privacy within the practice can be enhanced by the use of appropriate background music to mask conversations between staff members and between staff and patients. In areas of the practice such as nurses’ treatment bays where auditory privacy is not possible, patients should be offered a private room for conversation as required.

The auditory privacy of consultation rooms can be significantly enhanced by having solid doors (rather than doors with paper cores), using ‘draught proofing’ tape around door frames and a draught excluder at the base of the door.

Protection of health information

It is important that patients have confidence their health information is being treated respectfully and with consideration to privacy and confidentiality. Privacy and confidentiality of patient information needs to be considered in all situations including discussions between staff members and telephone conversations between staff and patients.

Patient records and computer screens should be positioned such that confidential information is not readily visible to anybody but the appropriate members of the practice team and screen savers should be used (see Criterion 4.2.2 Information security). Although the focus of this criterion is confidentiality and privacy, it is noted that many doctors now use the computer screen as a useful tool for sharing information with patients during a consultation.

Physical layout of the practice

The RACGP has produced a design guide entitled Rebirth of a clinic: A workbook for architecture in general practice and primary care (2008). The design guide can assist practices with practical ideas on how to ensure auditory and visual privacy. The design guide is available through RACGP publications at www.racgp.org.au/publications.

Services providing care outside normal opening hours

There is a range of circumstances in which patient confidentiality may be compromised when care outside normal opening hours is being provided. Patient privacy is as relevant in an environment outside a general practice (eg. patients’ homes and residential aged care settings) as within.

Standard 5.1 Facilities and access

Our practice provides a safe and effective environment for our practice team and patients.

Criterion 5.1.2

Physical conditions conducive to confidentiality and privacy

The physical conditions in our practice support patient privacy and confidentiality.

In a nutshell

Patient privacy and confidentiality is protected by the physical layout and facilities of your health service.

Key team members

  • Health service manager
  • All clinical and reception staff

Key organisational functions

  • Culturally safe and competent clinical practice
  • Documentation and storage of patient health records
  • Electronic records policy
  • Patient health information policy
  • Patient health records policy
  • Patient confidentiality and privacy policy

Indicators and what they mean

Table 5.2 explains each of the indicators for this criterion. Refer to Criterion 5.1.2 Physical conditions conducive to confidentiality and privacy of the Standards for general practices for more information and explanations of some of the concepts referred to in this criterion. 

Table 5.2 Criterion 5.1.2 Physical conditions conducive to confidentiality and privacy
IndicatorWhat this means and handy hints
▶ A. The physical facilities of our practice support patient privacy and confidentiality. Your patients’ privacy and confidentiality is protected at two levels. At each of these levels, the physical facilities of your health service need to support staff activities to ensure they can maintain patient privacy and confidentiality.

During patient and staff interaction: physical facilities must provide for patients’ audio and visual privacy. Visual privacy can be aided by the use of gowns, curtains and screens. Audio privacy can be ensured when discussions and conversations between staff and between staff and patients are masked by background music, or held in a private room.

When documenting and using patient health information: patient health information must only be visible to the GP (and, if they choose, their patient) but not to any unauthorised person. The positioning of computers and computer screens and the use of screen savers should be carefully considered to hide information from the view of the general public.
▶ B. Visual and auditory privacy of consultations and treatments is supported. Visual privacy during consultations shows respect for patients. For example, if a patient needs to undress, they should be offered a gown or sheet to wear and an adequate curtain or screen behind which to undress.

Members of the clinical team need to be sensitive to patient dignity when patients are required to undress/dress in the presence of the doctor, nurse or health worker. Different patients may respond differently to these situations, and sometimes gender differences matter, so health professionals need to be sensitive to varying patient needs.

Auditory privacy means that conversations with patients or conversations with other staff about patient health information cannot be overhead by others. Consultation rooms can be made private with solid doors, the use of draught-proof taping around doorframes or draught excluders at the base of doors. Background music may also assist in masking conversations.

A patient should never be put in the situation where discussions about their health situation can be overheard by others. If there is the risk that this will happen during consultations, the patient needs to be offered a private room or space.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can provide physical conditions that are conducive to confidentiality and privacy. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

All the health service’s physical facilities are managed to ensure that patients’ visual privacy is maintained, whether they are in a consultation room, in the waiting room or in another service location. If the doctors go out in the mobile van, it is checked before departure to make sure there are enough clean gowns for the number of patients they will see. The mobile van has a curtain to ensure privacy for times when patients have to undress. When visiting outstations, the doctors make sure there is a private area where they can conduct patient consultations.

Staff members position computer screens so they are not visible from the waiting room or from corridors to which patients have access. Any paper-based patient information is not left visible on the desks in the reception area. The service’s facsimile machine, to which patient pathology results are on occasions sent, is located in an area to which patients do not have access.

The waiting room has either a radio playing or a television on to mask conversations that are held at the reception counter. If more private conservation is required with a patient, the staff member will take the patient to a free consulting room or office to continue the conversation. If there is no free room or office, they will take the patient to a place that is outside the hearing range of other patients or staff.

Staff use a low voice tone when talking with patients in the consultation room. Doors to consultation rooms are always kept closed when they are being used. If someone visits with the patient, they will be asked to leave the consultation room during patient consultations, procedures or treatments – unless they have the patient’s permission to be there. At no time do any staff members talk about patients with each other in a way that can be heard by people in the waiting room or anywhere in the service. When having phone conversations with patients or other staff, staff members make sure that nothing they say can identify the patient or reveal anything about them.

The mobile van is sound insulated so that no passer-by can overhear what is being discussed. Doctors doing home or other visits are especially careful to maintain auditory privacy, so that other family members cannot overhear what is being discussed. They make sure that if a person wants to be present at the consultation, this is only allowed with the prior consent of the patient. If the patient does not agree, the doctor will politely but firmly make sure that the other person is not present, or will make an appointment for the patient to come to the health service.

Showing how you meet Criterion 5.1.2

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

  • Through the use of direct observation.
  • Through the use of staff interviews.

Related RACGP criteria

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