Cancer services pilot accreditation program
When a diagnosis of cancer is made, the patient and their loved ones face a journey that will change their lives and priorities. In these circumstances, the health professional team works with the patient and their carers to provide the best treatment and the best chance of long-term survival. Thus, high-quality care and optimal treatment should be the usual standard of care.
The development and piloting of the Cancer Services Pilot
Accreditation Program (CSPAP) in 2007 was an important step in
identifying the very best approaches that will support optimal
outcomes for cancer patients in NSW. This report on the pilot of a
CSPAP provides an opportunity to increase our understanding of the
challenges and contribute to the discussion on the best methods for
further improving the quality of NSW cancer services.
The Cancer Institute NSW is continuing to investigate
appropriate indicators. Monitoring systems and standards systems
that will contribute to further improving the care provided
To determine the impact a cancer service accreditation program
might have on cancer services.
In March 2007, the Cancer Institute NSW commissioned Communio to
undertake the development of a cancer services specific
accreditation program. The CSPAP was pilot tested by Communio
across eight cancer services from October to December 2007. The
program was based upon a quality improvement cycle, and
- the development of 12 draft accreditation standards
- a pilot of the standards across eight cancer services in
- an external evaluation of the CSPAP as piloted.
The development of the evaluation framework allowed the pilot to
be assessed on nine criteria. Based on the evaluation report, two
of the drafted standards were not supported: credentialing and
scope of practice; and population health.
The evaluation found that further work on the meaning and
wording of the proposed standards is required to ensure consistency
in ratings between external and internal evaluators.
There were mixed views about the degree of overlap in the CSPAP
and existing accreditation systems. This aspect will require
further examination if a cancer service accreditation program is
introduced in NSW.
The evaluation found that additional infrastructure will be
required to support data systems before the effectiveness criteria
could be fully utilised, as existing data reporting systems do not
provide the required level of detail to monitor clinical
The evaluation identified that clinicians have concerns about
the utilisation of resources for an accreditation program when the
evidence that such a program will impact on clinical outcomes is
slight. This view is confirmed in the international literature.
This aspect alone requires a step back from directly moving towards
implementing a CSPAP in NSW, until systems are in place that can
demonstrate that an accreditation process will have an impact upon
cancer control and patient outcomes.
In November 2008 the NSW Report of the Special Commission of
Inquiry Acute Care Services in NSW Public Hospitals (Garling
Report) was released. The NSW Government official response to the
Garling Report supported recommendations that will allow clinicians
across the state to have access to information upon which to base
decisions and improved control over their local work. A greater
response on monitoring of clinical performance including outcome
and appropriateness of treatment is highlighted in the Garling
report and the NSW Government response. A Bureau of Health
Information will be created to support transparency in health data
and allow greater local control of information analysis. The Bureau
will undertake public reporting, performance monitoring, ad-hoc
data supply and analysis, evaluation and research. In addition,
chief executives will publish budget, performance and care status
down to ward level staff, so that improvements can be made locally.
The NSW Government response also emphasised that the NSW Clinical
Excellence Commission will become the primary body responsible for
safety and quality within NSW Health.
The Cancer Institute NSW is currently reviewing the findings of
the CSPAP evaluation and will conduct further investigations to
identify additional research and models that monitor the
effectiveness of cancer services in NSW. This will allow the
Institute to work closely with the new Bureau of Health Information
and the NSW Clinical Excellence Commission, to develop additional
mechanisms to ensure the further improvement of the quality and
effectiveness of NSW cancer services.
In summary, while there is support for a cancer service
accreditation model, further work is required on the most
appropriate model that would impact upon patient outcomes and hence
cancer control in NSW.