Who benefits from the maze of accreditation standards affecting the work of Aboriginal Community Controlled Organisations (ACCOs)?
This critical question is raised in the article below, which invites ACCOs to participate in research investigating the impacts of accreditation standards on their work. It is by Jenifer Darr, a Yuwi Vanuatu woman and researcher.
Jenifer Darr writes:
Australia has a national network of more than 154 Aboriginal Community Controlled Health Organisations (ACCOs) providing holistic primary healthcare wrap around services to Aboriginal and Torres Strait Islander people.
Accreditation Standards are premised on supporting quality improvement in the work of ACCOs. However, the application of multiple, different standards represents a significant business expense for ACCOs.
In the last decade, the Australian business landscape has experienced an enormous influx of national and international Certification Accreditation Bodies.
The Joint Accreditation System of Australia and New Zealand (JAS ANZ) is the organisation responsible for the oversight of Certification Accreditation Bodies in Australia and New Zealand. The Australian Standards organisation is responsible for assessing and passing the design and quality of Standards operating within Australia.
In 2010, the national accreditation framework for the Australian healthcare system at the tertiary, secondary and primary healthcare level was introduced. This was a result of National Health and Hospitals Reform Commission recommendations in 2009.
Now in 2021 we are at the start of its second decade of roll out. In the past 11 years the introduction of multiple accreditation standards for different aspects of healthcare has grown, creating multiple silos of accreditation processes.
As outlined in the table below, this translates into a cost for the sector of $300,000 for each of the 154 services – in total $46.2 million per accreditation cycle.
The siloing of accreditation standards for separate service programs promotes limited synchronicity between each standard.
As an example of how this plays out, consider an ACCO offering the following services of (1) mental health, (2) primary health care, (3) youth and or disadvantage youth, (4) aged care, (5) disability and (6) out of home care and (7) dental and (8) whole of organisation certification.
The corresponding Standards are – (i) National Safety and Quality Health Standards (NSQHS); (ii) Royal Australian College of General Practice (RACGP); (iii) NSQHS; (iv) Human Services Quality Framework (HSQF); (iv) HSQF; (v) National Aged Care and (vi) National Disability Insurance Scheme; and (vii) Human Services Quality Framework (Qld); or the Victorian Human Services Framework; and (viii) NSQHS and (xi) ISO 9001:2015 Quality Management Systems of Whole of Organization certification. The Aged Care sector had until 1 July 2019 to make the change from four different standards to the one national Aged Care standard, then COVID 19 arrived, shifting the focus.
Where ACCOs provide aged care, those that have not made the transition to the national aged care standard apply four aged care standards on top of the already existing nine – now 13 Standards are applied by the one ACCO.
This example shows that for eight streams of service delivery, the ACCO applies 9 to 13 different standards with limited or no synchronicity between them. For any three-year accreditation cycle, the ACCO could have three or four different accreditation cycles of assessment or service accreditation.
The pricing structure is dependent on the size of the organisation and the number of sites determines the cost to participate and apply any one accreditation standard. Enter the third party of the Certification Body which is engaged by the ACCO to accredit their business to the Standard.
Table 1 below displays approximate accreditation standard costs based on my project management knowledge of various Standard applications in ACCOs and this aged care website.
Table 1. Approximate cost of various accreditation standardsMulti-million dollar costs
On average, ACCOs apply HSQF and ISO standards. Based on these approximate figures, a cost of $300,000 multiplied across the national network of 154 ACCOs results in collective costs of $46,200,000.
The imposition of these costs need to be understood in the context of services that operate in complex environments striving to meet the needs of communities with multiple, complex health and social needs.
It is therefore important to question who benefits from the application of these multiple standards, and whose interests are disadvantaged.
My PhD research project examines the impact on efficiency and sustainability through the application of quality management systems in ACCOs.
This research is done through James Cook University, College of Public Health, Medical and Veterinary Sciences, Bebegu Yumba campus, Townsville. Thanks to the team of advisors; at JCU: Dr Kristin McBain-Rigg, Professor Richard Franklin; at CQU, Dr.Vicki Saunders. Nkosinathi Sithole is our research associate.
I am a Yuwi Vanuatu woman with decades of managing Aboriginal Community Controlled Organisations in urban, rural and remote locations in Queensland and Victoria. My consulting business, Jadee Consulting, is designed to walk NGOs through their accreditation journey.
I study as an external PhD student with a planned research end date in December 2023 and move into the field work phase in 2022. We are thankful to the Lowitja Institute for a community-led scholarship allowing Radarborg to employ a Research Associate to assist in the research.
We welcome the participation of ACCOs as partners in this project.
See Croakey’s extensive archive of stories about Indigenous health.
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