Appendix A The principles of quality and safety in the Standards for health services in Australian prisons
The principles of quality and safety in the Standards for health services in Australian prisons
Indicators of quality can be developed for a range of stakeholders with different, sometimes overlapping or conflicting perspectives,65–67 who emphasise different priorities, and who may wish to use indicators in different ways.68 The legitimacy and utility of indicators of quality and safety depends on their acceptability to the stakeholders they affect, including those who use them.69
Different levels of the healthcare system (patient, practitioner, whole organisation, region or country) can be the focus of standards, as the creation of latent conditions for error and harm can occur at all these levels.70
In primary care, process factors are pervasive, contributing causes of medical error.71 Therefore, there is sound reason to focus on the setting and process of healthcare to analyse issues of safety and quality.
Quality and safety in healthcare depends on more than the performance of each health professional working in isolation. Efforts to assess and enhance quality need to include attention to the structure and organisation of health services.72
In recent years, there has been a growing recognition of the role of healthcare systems (both small and large scale systems) as a precursor to safety and quality. Service structures and processes were therefore considered within the scope of the Standards together with informal aspects of an organisation such as the safety culture and safety related behaviours.73 Indicators of processes and structures that support a safety culture are needed. For example, it is important that infection control processes are documented in a way that is meaningful (eg. a written policy). However, it is arguably more important that the relevant staff members understand and utilise suitable infection control processes.
Viewing and analysing healthcare as a system has practical implications. First, improvements in the quality of healthcare delivery are unlikely without changes to the systems: working harder within the same system is unlikely to result in improvements. Second, change in a system is more likely to be successful if it is first undertaken on a small scale. It is then possible to determine whether the change achieves its intended outcome and whether any unintended consequences also result.74
Quality care can be described in terms of the structure, process and outcomes of the health service.75
- Structure relates to material resources, facilities, equipment and the range of clinical services provided at the health service
- Process relates to what is done in giving and receiving care (eg. the consultation, ordering tests or prescribing)
- Outcomes relate to the effects of care on patients and communities (eg. immunisation coverage rates, diabetes management, or cervical screening).
Structure, process and outcomes are important in defining quality in primary healthcare. Most of the content of these Standards refers to structure and process issues within a health service, as these are within the direct control of each health service. Some outcomes are also included.
These Standards cannot address everything that impacts on the health and wellbeing of people incarcerated in Australian prisons. Some issues (eg. blood borne virus, substance abuse, mental health concerns) are beyond the scope of these Standards and will need to be addressed by government departments and the companies contracted to manage the day-to-day operations of prisons.