Primary and Community Healthcare Partnering with Consumers Standard

• How does your healthcare service partner with consumers?
• What policies and procedures exist and how are they used to support partnering with consumers?
• How are risks associated with partnering with consumers identified and managed?
• What training has been provided to the workforce to support partnering with consumers?

• Set up and implement structures to enable partnering with consumers.
• Identify key principles or documents that underpin how the healthcare service partners with consumers.
• Use risk management systems to identify, monitor, manage and review risks associated with partnering with consumers.
• Deliver or provide access to training on partnering with consumers based on the specific needs of the workforce.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Policies and procedures that are implemented and cover
  • healthcare rights
  • informed consent 
  • shared decision making and planning care
  • health literacy and effective communication with patients, carers, families and consumers 
  • partnering with consumers in service design
• Feedback sought through surveys, verbally or through the healthcare service’s website
• Resources available to support consumer participation
• Observation of the workforce using the processes for partnering with consumers
• Evidence of the assessment of workforce needs for education and training in relation to partnering with consumers
• Feedback from the workforce about their training needs to support partnering with consumers
• Schedule of workforce education and training that includes partnering with consumers
• Documentation or examples of how consumer feedback, including complaints, has been used to inform workforce training and changes in systems and processes
• Feedback from consumers, consumer representatives, consumer organisations and carers on their experience of engaging with the healthcare service
• Examples of any risks the service may have identified that prevents consumers from engaging with the service and the actions taken.

• Does your healthcare service use a charter of rights? Is it consistent with the Australian Charter of Healthcare Rights (second edition) in that it addresses access, safety, respect, partnership, information, privacy and feedback?
• How is this information about healthcare rights communicated to consumers?
• How do people who use your service know what their healthcare rights are?
• How does the workforce use the charter of rights in the delivery of health care?
• Does your informed consent policy comply with legislation and best practice?
• How does your healthcare service monitor compliance with informed consent processes?

Healthcare rights

• Adopt the Australian Charter of Healthcare Rights (second edition) (with or without amendments).
• Provide ready access to copies of the charter, in appropriate languages or formats, to all patients, and their carers and families.
• Inform patients, carers, and families about the charter, and make sure that they can find it easily.
• Support the workforce to apply the principles of the healthcare service’s charter in the planning and delivery of care. This includes
• allocating responsibility for implementing and reviewing the charter to a manager with decision-making authority
• including information about the charter during orientation for new members of the workforce
• holding, or providing access to, regular education and training sessions for the workforce on their responsibilities for implementing the charter; this includes all members of the workforce, and, if relevant, volunteers
• building the charter into organisational processes, and staff codes of conduct
• documents that outline how the rights will be achieved.

Informed consent

Develop or adopt a process for informed consent by patients. This should include how the healthcare service:

• Informs patients (and, if applicable, their carers and substitute decision-makers) about the risks, benefits and alternatives of a treatment, including any fees and charges associated with treatment and referrals
• Determines patient preferences for treatment
• Documents patient consent to treatment
• Supports the healthcare providers workforce to meet legal and ethical requirements.

• The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:
• The healthcare service has adopted the Australian Charter of Healthcare Rights (second edition) in different languages and formats consistent with the community profile
• Charter of rights is displayed in areas that are accessible to the public
• Material showing that patients and carers received information about their healthcare rights
• Feedback from patients and consumers about awareness of the charter of rights
• Feedback from patients about the health care they receive that demonstrates the workforce is applying the charter of healthcare rights in the planning and delivery of care
• Policy documents for informed consent that reference relevant legislation and best practice and consider issues, such as
  • circumstances where consent should be obtained and when it is not required
  • circumstances in which verbal consent is acceptable and when written consent is required
  • requirements for consent to be valid
  • processes for when consent is not provided, or treatment is refused
  • obtaining consent from patients from culturally and linguistically diverse backgrounds
  • the age at which patients can provide consent and consent for minors
• Consent forms that are currently in use or documentation of the patient’s verbal consent where appropriate
• Audit results of patient healthcare records documenting informed consent
• Training documents on informed consent processes.

• What processes are in place to support the workforce to identify a patient’s capacity to make decisions about their own care?
• How are the workforce supported to identify and document a substitute decision-maker?

• Develop or adopt a policy or procedure for assessing the capacity of patients to make decisions about their own health care and identifying a substitute decision-maker where needed. It should
  • outline the identification process and requirements of the workforce assessing patients
  • outline the appointment process, where applicable
  • comply with relevant state or territory legislation
  • include a list of appropriate decision-makers that is consistent with relevant state and territory legislation and best-practice guidelines.
• The policy or procedure should be developed in consultation with the workforce responsible for assessing patient’s capacity to provide consent.
• The workforce must be trained in the healthcare service’s policies, procedures and protocols for assessing a person’s capacity to make decisions about their care and engaging substitute decision-makers.
• A periodic review of the policy/procedure should be scheduled, to consider the effectiveness and outcomes of the policy.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include: 

• Observation or documented examples of
  • identifying a patient’s capacity for making decisions about their care
  • identifying a substitute decision-maker, if a patient does not have the capacity to make decisions about their care
  • documenting substitute decision-makers such as next of kin, advocates, people with power of attorney and legal guardians
• Screening and assessment tools, or processes used to identify the patient’s capacity for decision-making
• Audit results of patient healthcare records that identify the patient’s capacity to make decisions, and confirm the identity of the substitute decision-maker, if required
• Audit results of patient healthcare records for compliance with policies, procedures or protocols for determining a patient’s capacity and determining a substitute decision-maker, if required
• Information packages or links to resources about advocacy, power of attorney and legal guardianship that are available for consumers in different formats and languages, consistent with diversity of the patient population and local community.

• How is the workforce supported to partner with a patient or their substitute decision-maker to plan, communicate, set goals and makes decisions about current and future care?
• How does the healthcare service review the use and outcomes of systems and processes for partnering with a patient or their substitute decision-maker?
• How does the healthcare service demonstrate that patient are supported to be actively involved in their own care?

• Develop processes to involve a patient or their substitute decision-maker in planning, communication, goal setting and decision-making for their current and future care, and review workforce compliance with these processes.
• Identify any communication barriers and areas for improvement and implement solutions to overcome these. Consider engaging consumers in this review process by establishing a focus group or seeking feedback from patients.
• Encourage healthcare providers to create an environment in which patients feel confident asking questions and healthcare providers respond positively to patient needs; this may involve speaking with patients in a neutral environment, away from the clinical setting.
  • During the delivery of health care, provide consumers with access to information and resources in a format that meets their needs; this may include
  • general information about their health, condition and healthcare arrangements
  • information about how they can be involved in their own care
  • information that has been developed specifically for them regarding tests and treatment options
  • provide patients with timely and open access to their healthcare record, test results and other clinical information relevant to their care.
• Implement ways to support patients self-manage their health care.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• A documented process, templates or other tools to support shared decision making, care planning and the development of goals of care, including supporting communication and interpersonal skills, shared decision making, and planning current and future care as well as advance care planning, where required
• Documentation in patient healthcare records, or observation that demonstrates
  • information was provided to patients and carers about care options
  • patients and carers, or substitute decision-makers, were involved in screening and assessment processes, decision-making, developing goals of care and given information about the treatment to be provided
  • a plan for care was developed with patients and the workforce, and provided to patients to review and retain a copy
• Patient information packages or resources about care options are provided to patients in different languages and formats consistent with the diversity of the consumer population and local community
• De-identified examples of patient notes and electronic healthcare record entries that demonstrate the engagement and discussions regarding planning and involvement in care
• Results of patient and carer experience surveys about involvement in shared decision making, care planning and actions taken to deal with the issues identified
• Use of technology such as mobile and tablet apps to interact and share information with patients before, during and after their care.

• Engage senior members of the workforce to act as champions for partnerships between healthcare providers and patients
• Provide enough resources to support healthcare providers to partner with patients in their health care
• Provide access to education and training to equip the workforce to partner with patients in their care. Education and training which develops the workforce’s skills to partner with consumers may include
  • communication and interpersonal skills
  • techniques for shared decision making
  • awareness of individual health literacy and the health literacy environment.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes or resources to support the workforce to partner with consumers in their care, such as policies for education and training on communication, interpersonal skills, shared decision making, health literacy and ways to actively involve the patient in their own care
• Schedule of workforce education and training that includes communication and interpersonal skills, shared decision making and health literacy
• Training documents (for example, syllabus, attendance records and competency assessments) about partnering with consumers in their care
• Audit results of the proportion of the workforce who have completed education and training on partnering with consumers
• Feedback from the workforce about their training needs
• Reviews and evaluation reports of education and training programs.

• How does your healthcare service provide information about the services it provides?
• What processes are used to ensure the information provided by the workforce to patients meets the patient’s needs?
• How are the workforce supported to meet the information needs of patients for ongoing care and self-management?

• Set up processes to support the workforce to communicate effectively with patients about their health and healthcare needs.
• Ensure that the healthcare environment supports open, clear and effective communication between the patients and the workforce. This could be achieved by:
  • regularly observing the healthcare service’s environment to ensure the information consumers require is readily available
  • implementing a plain-language policy that makes written information easier to understand
  • providing the workforce with access to training on health literacy and communications skills.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Observation that the workforce, patients and carers have access to information about the healthcare service, the services it provides and common health conditions
• Evidence of a process for identifying and selecting consumer information materials and resources, for example, a needs assessment of patient information needs
• Examples of information materials and resources provided to patients and carers that are in plain language, and available in different languages and formats
• Access to the Translating and Interpreting Service (TIS National)
• Feedback received from patients and carers, including results of patient and carer experience surveys regarding the information provided about their care
• Training documents (for example, syllabus, attendance records, competency assessments) and records of workforce attendance at training programs on health literacy and communication skills.

• How can people find information about your healthcare service?
• How can consumers provide feedback about your service’s accessibility?
• How is information regarding costs made readily available to consumers in an accessible manner?
• Where would consumers find information about who they can contact in an emergency when your healthcare service is not available?

• Consider a resource that provides details about
  • the services available
  • the opening hours and how to access health care, including accessibility
  • who can access the service and contact for special requirements
  • estimated service costs
  • alternative health care when the service is closed, after-hours and in an emergency
  • service location(s) and access details, including parking and public transport
  • how to provide feedback or make a complaint and contact details for the appropriate healthcare complaints authority.
• Take into account that a resource may be a web page, fact sheet, poster display or a frequently asked questions sheet for the workforce.
• Ensure your resource is freely available and displayed in a prominent place, on your website (if relevant), and available to the workforce to answer queries from consumers.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Healthcare service website that includes details of the services provided, how consumers can access those services, opening hours, costs, the service’s physical location, if applicable and contact details such as phone and email information
• Brochures, links to or information about options for emergency care providers when the healthcare service is not open or not able to provide urgent care or for additional support.

• How are consumers involved in the planning, design, monitoring and evaluation of care provided by the healthcare service?
• How does the healthcare service ensure that the diversity of consumers and local communities who use the service are reflected in these partnerships?

• Identify the diversity of consumers who use the services and who are part of the local community and ensure these groups are captured in any partnership activities.
• Identify opportunities to partner with consumers in the design, monitoring and evaluation of the healthcare service. Examples include when:
  • redesigning or refitting the service’s premises
  • reviewing the services available and their opening hours
  • considering introducing new services, or an additional healthcare provider
  • assessing consumer feedback on the service and designing actions to make improvements
  • assessing performance information on the service and designing actions to improve the consumer experience
  • inviting consumers to be part of ‘waiting room workshops’
  • talking with consumers in waiting rooms or at informal meetings at a time that is convenient to the consumer
  • using data about consumer experiences (such as patient experience surveys) to help identify key issues and opportunities for improvement
  • meeting with community and consumer organisations to identify key issues and opportunities for improvement
  • inviting consumers to take part in a lunchtime or evening workshop with members of the workforce.
• Ensure that, if feasible, the healthcare service acts on the information provided by consumers and feeds back information on changes that have occurred as a result of consumer suggestions.
• Ensure that information provided by consumers or carers about their experiences is treated sensitively, that privacy and confidentiality are maintained, and that consumers and carers are supported to share their experiences and stories to the extent that they are comfortable.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Observations or interviews with consumers that demonstrate how the healthcare service involves consumers in design, measurement and evaluation of the healthcare service’s performance and care
• Feedback from consumers engaged in partnerships with the healthcare service about their experience in being a part of the process
• Feedback from consumers that includes options for providing suggestions about ongoing improvement
• Records of actions that have been taken using consumer feedback and advice
• Workshop records (including activities such as ‘waiting room workshops’ or surveys) to seek feedback from consumers on how the healthcare service operates
• Evidence of informal interviews with consumers who attend the service to seek feedback on design, monitoring and evaluation of care provided by the healthcare service.