In 2008, an article appeared in InPsych titled, Will psychologists’ private practices have to be accredited? Eight years on and the requirement of psychologists to demonstrate accountability about how their practice operates, is emerging as a reality. Primary Health Networks, for example, are increasingly requiring health providers to demonstrate sound clinical governance processes, and in some states practice accreditation is required in order to provide services under the National Disability Insurance Scheme (NDIS).
Clinical governance systems in private practice
The Australian Commission on Safety and Quality in Health Care (the Commission) has identified high standards of care, transparency, accountability, and ongoing improvement as core elements of good clinical governance (ACSQHC, 2012). In practical terms this means that a practice must be accountable for the effectiveness of the services provided, have systems in place for managing patient safety and addressing risk, have a mechanism for dealing with complaints, and provide opportunities for continual learning and improvement of service provision.
Demonstrating clinical governance is a well-established requirement of public hospitals and health services but is a relatively new expectation to the primary-care setting. For example, the Royal Australian College of General Practitioners (RACGP) has established a set of clinical governance principles that demonstrate the quality of the service being provided through a formal accreditation process (see Standards of General Practice 4th edition http://bit.do/NSQHS-Standards) with accreditation linked to access to Government incentive payments for GPs. There is likely to be an increased focus on other professions being required to undertake assessment by an accreditation provider in the future.
What is accreditation and why do we need it?
The primary objective of accreditation within the health care sector is to ensure the safe delivery of high-quality services as well as the demonstration of positive client experiences and outcomes. An additional benefit of accreditation is that it can provide direct feedback about what is and is not working well in a practice which in turn can support improvements in the way services are provided to clients.
More than a decade ago the APS developed the Private Practice Management Standards (PPMS) for Psychology1. The PPMS provides a way to evaluate the context in which a psychologist provides a service using an educative framework to guide psychologists in making improvements to the way they operate their practice (see www.psychology.org.au/practitioner/essential/PPMS). The PPMS were developed following an extensive consultation process which included a pilot of the standards in 21 psychology practices over a six-month period (Mathews, Stokes, Littlefield, & Collins, 2011)2.
A voluntary PPMS self-assessment instrument has been developed which has been completed by more than 1,000 APS members and is used as a teaching tool in some psychology education programs.
While the government has not adopted the PPMS for assessing the functions of a psychology practice, there are no other standards used by the approved accreditation agencies that are specific to a psychology service. In addition, different government departments vary in their compliance requirements—e.g., compliance with state-based versus national Standards. The National Safety and Quality Health Service (ACSQHC, 2012) Standards, for example, developed by the Commission and endorsed by the Australian Government in 2011, have formed the basis for a national accreditation scheme for health service organisations with a plan for expansion to the primary care sector. The APS has argued that these Standards in their current form are not appropriate for the assessment of psychology practices and is involved in the Commission’s review of the Standards to ensure applicability to psychology.
Preparing psychology practices to demonstrate excellence
While many psychology practices will not be subject to audits or accreditation by an external body, it is increasingly crucial that psychologists and psychology private practices are able to defend their services and the context in which they provide them. Implementing a clinical governance framework can formalise and operationalise organisational activities that demonstrate excellence, and provide a mechanism for evaluation. For a practice this might include the annual completion of the PPMS as an internal audit, staff performance development activities, documented procedures and protocols for the running of the various aspects of the practice (e.g. administrative as well as direct service), client satisfaction surveys, the provision of ongoing professional development opportunities, transparency in reporting outcomes of investigations, and the involvement of all relevant staff in solutions to any issues identified (see Phillips et al., 2010 for a review). Establishing a practice-wide philosophy of making safety and quality in service delivery paramount can contribute not only to the quality of the service provided but is likely to be experienced as an added benefit by clients and those working in the organisation.
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- The APS developed the PPMS with funding support from the Federal Government.
- In 2010, the APS undertook a review and update or the PPMS and renamed it the Professional Practice Management Standards, acknowledging that psychologists in both private and public sector settings should demonstrate high standards in the delivery of psychology services.