Glossary

Where appropriate, glossary definitions from external sources have been adapted to fit the context of the National Safety and Quality Primary and Community Healthcare Standards.

advance care directive: a type of written advance care plan recognised by common law or specific legislation that is completed and signed by a competent adult. It can record the person’s preferences for future care, and appoint a substitute decision-maker to make decisions about health care and personal life management. In some states, these are known as advance health directives.14 see also advance care plan

advance care plan: stated preferences about health and personal care, and preferred health outcomes. An advance care plan is usually the result of a process of planning for future health and personal care, whereby the person’s values and preferences are made known so that they can guide decision-making at a future time when the person cannot make or communicate their decisions.14 see also advance care directive

adverse drug reaction: a response to a medicine that is noxious and unintended, and occurs at doses normally used or tested in humans for the prophylaxis, diagnosis or therapy of disease, or for the modification of physiological function.15 An allergy is a type of adverse drug reaction.

adverse event: an incident that results, or could have resulted, in harm to a patient or consumer. A near miss is a type of adverse event. See also near miss

alert: warning of a potential risk to a patient.

allergy: occurs when a person’s immune system reacts to allergens in the environment that are harmless for most people.16 Typical allergens include some medicines, foods and latex.16, 17 An allergen may be encountered through inhalation, ingestion, injection or skin contact.16 A medicine allergy is one type of adverse drug reaction.

allied health (professionals): trained professionals who are not doctors, dentists or nurses.18 Allied health professionals use evidence-based practices to prevent, diagnose and treat various conditions and illnesses; they often work in multidisciplinary health teams to provide specialised support to suit an individual’s needs.19 An allied health professional is a healthcare provider.

antimicrobial: a chemical substance that inhibits or destroys bacteria, parasites, viruses or fungi, and can be safely administered to humans and animals.20

antimicrobial resistance: failure of an antimicrobial to inhibit a microorganism at the antimicrobial concentrations usually achieved over time with standard dosing regimens.20

antimicrobial stewardship: an ongoing effort by a healthcare service to reduce the risks associated with increasing antimicrobial resistance and to extend the effectiveness of antimicrobial treatments. It may incorporate several strategies, including monitoring and review of antimicrobial use.2043

appropriate care: patients are receiving the right care, and the right amount of care according to their needs and preferences, at the right time. The care offered should also be based on the best available evidence.21

aseptic technique: a set of practices aimed at minimising contamination and is particularly used to protect the patient from infection during procedures.22

assessment: a healthcare provider’s evaluation of a disease or condition based on the patient’s subjective report of the symptoms and course of the illness or condition, and their objective findings. These findings include data obtained through laboratory tests, physical examination and medical history; and information reported by carers, family members and other members of the healthcare team. The assessment is an essential element of a comprehensive care plan.23

audit (clinical): a systematic review of clinical care against a predetermined set of criteria.24

Australian Charter of Healthcare Rights: specifies the key rights of patients when seeking or receiving healthcare services. The second edition was launched in August 2019.9

Australian Open Disclosure Framework: endorsed by health ministers in 2013, it provides a framework for healthcare services and healthcare providers to communicate openly with patients when health care does not go to plan.3

best possible medication history: a list of all the medicines a patient is using at presentation. The list includes the name, dose, route and frequency of the medicine, and is documented on a specific form or in a specific place. All prescribed, over-the-counter and complementary medicines should be included. This history is obtained by a healthcare provider working within their scope of clinical practice who interviews the patient (and/or their carer) and is confirmed, where appropriate, by using other sources of medicines information.25

best practice: when the diagnosis, treatment or health care provided is based on the best available evidence, which is used to achieve the best possible outcomes for patients.

best-practice guidelines: a set of recommended actions that are developed using the best available evidence. They provide healthcare providers with evidence-informed recommendations that support clinical practice, and guide healthcare provider and patient decisions about appropriate health care in specific clinical practice settings and circumstances.26

business decision-making: decision-making regarding service planning and management for a healthcare service. It covers the purchase of equipment, fixtures and fittings; program maintenance; workforce training for safe handling of equipment; and all issues for which business decisions are taken that might affect the safety and wellbeing of patients, visitors and the workforce.

carer: a person who provides personal care, support and assistance to another individual who needs it because they have a disability, medical condition (including a terminal or chronic illness) or mental illness, or they are frail or aged. An individual is not a carer merely because they are a spouse, de facto partner, parent, child, other relative or guardian of an individual, or live with an individual who requires care. A person is not considered a carer if they are paid, a volunteer for an organisation, or caring as part of a training or education program.27

clinical care standards: nationally relevant standards developed by the Australian Commission on Safety and Quality in Health Care, and agreed by health ministers, that identify and define the health care people should expect to be offered or receive for specific conditions.44 | National Safety and Quality Primary and Community Healthcare Standards

clinical governance: the set of relationships and responsibilities established by a healthcare service between regulators and funders, owners and managers and governing bodies (where relevant), healthcare providers, the workforce, patients, consumers and other stakeholders to ensure optimal clinical outcomes.4 It ensures that:

  • The community can be confident there are systems in place to deliver safe and high-quality health care
  • There is a commitment to continuously improve services
  • Everyone is accountable to patients and the community for ensuring the delivery of safe, effective and high-quality health care. This includes healthcare providers, other members of the workforce and managers, owners and governing bodies (where they exist).

Depending on the size of the healthcare service, multiple roles may be carried out by the same individual.

clinical governance framework: describes the processes and structures that are needed to deliver safe and high-quality health care.4 These include:

  • Governance, leadership and culture
  • Patient safety and quality improvement systems
  • Clinical performance and effectiveness
  • Safe environment for the delivery of health care
  • Partnering with consumers.

clinical practice: the assessment, diagnosis, treatment and health care delivered to a patient.

clinician: see healthcare provider

cold chain management: the system of transporting and storing temperature-sensitive medicines and vaccines, within their defined temperature range at all times, from point of origin (manufacture) to point of administration, to ensure that the integrity of the product is maintained.

comprehensive care: health care that is based on identified goals for the episode of care. These goals are aligned with the patient’s expressed preferences and healthcare needs, consider the impact of the patient’s health issues on their life and wellbeing, and are clinically appropriate.

comprehensive care plan: a document describing agreed goals of care, and outlining planned medical, nursing and allied health activities for a patient. Comprehensive care plans reflect shared decisions made with patients, carers and families about the tests, interventions, treatments and other activities needed to achieve the goals of care. The content of comprehensive care plans will depend on the setting and the service that is being provided, and may be called different things in different healthcare services. For example, a health care or clinical pathway for a specific intervention may be considered a comprehensive care plan.

consumer: a person who has used, or may potentially use, health services, or is a carer for a patient using health services.

consumer advocate: see consumer representative

consumer representative: a consumer who has taken up a specific role to provide advice on behalf of consumers, with the overall aim of improving health care.28

cough etiquette: see respiratory hygiene and cough etiquette

critical equipment: items that confer a high risk for infection if they are contaminated with any microorganism, and must be sterile at the time of use. They include any objects that enter sterile tissue or the vascular system, because any microbial contamination could transmit disease.22

critical information: information that has a considerable impact on a patient’s health, wellbeing or ongoing care (physical or psychological). The availability of critical information may require a healthcare provider to reassess or change a patient’s comprehensive care plan.45

cultural safety: The former Australian Health Ministers’ Advisory Council identifies that consumers are safest when healthcare providers have considered power relations, cultural differences and patients’ rights.29 Essential features of cultural safety are:

  • An understanding of one’s culture
  • An acknowledgement of difference, and requirement that healthcare providers are actively mindful and respectful of difference(s)
  • Informed by the theory of power relations; any attempt to depoliticise cultural safety is to miss the point
  • An appreciation of the historical context of colonisation, the practices of racism at individual and institutional levels, and their impact on Aboriginal and Torres Strait Islander people’s living and wellbeing, both in the present and past
  • That its presence or absence is determined by the experience of the recipient of care and not defined by the healthcare provider.

The intent and the content of issues covered is consistent the Australian Health Practitioners’ Regulation Agency’s definition of cultural safety.

decision support tools: tools that can help healthcare providers and consumers to draw on available evidence when making clinical decisions. The tools have a number of formats. Some are explicitly designed to enable shared decision-making (for example, decision aids). Others provide some of the information needed for some components of the shared decision-making process (for example, risk calculators, evidence summaries), or provide ways of initiating and structuring conversations about health decisions (for example, communication frameworks, question prompt lists).30 See also shared decision making

disability: The Disability Discrimination Act 1992 (Cth) defines disability, in relation to a person, to mean:

  • Total or partial loss of the person’s bodily or mental functions; or
  • Total or partial loss of a part of the body; or
  • The presence in the body of organisms causing disease or illness; or
  • The malfunction, malformation or disfigurement of a part of the person’s body; or
  • A disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or
  • A disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgement that results in disturbed behaviour.31

The World Health Organization International classification of functioning disability and health recognises that disability is multidimensional and is the product of an interaction between attributes of an individual and features of the person’s physical, social and attitudinal environment. It broadens the perspective of disability and allows for the examination of medical, individual, social and environmental influences on functioning and disability.32

diverse backgrounds: The varying social, economic and geographic circumstances of consumers who use, or may use, the services of a healthcare service, as well as their cultural backgrounds, disability status, religions, beliefs and practices, languages spoken, sexual orientation, gender identity and gender expression, and sex characteristics.

end of life: the period when a patient is living with, and impaired by, a fatal condition, even if the trajectory is ambiguous or unknown. This period may be years in the case of patients with chronic or malignant disease, or very brief in the case of patients who suffer acute and unexpected illnesses or events, such as sepsis, stroke or trauma.33

environment: the context or surroundings in which health care is delivered. Environment can also include other patients, consumers, visitors and the workforce.

episode of care: a health problem from its first encounter with a healthcare provider through to the completion of the last encounter.34

goals of care: clinical and other goals for a patient’s episode of care that are determined in the context of a shared decision-making process.

governance: the set of relationships and responsibilities established by a healthcare service between its management, workforce and stakeholders (including patients and consumers). Effective governance provides a clear statement of individual accountabilities within the organisation to help align the roles, interests and actions of different participants in the organisation to achieve the organisation’s objectives. Governance structures will be tailored to the size and complexity of an organisation.

guidelines: clinical practice guidelines are systematically developed statements to assist healthcare providers and consumer decisions about appropriate health care for specific circumstances.35

hand hygiene: a general term applying to processes aiming to reduce the number of microorganisms on hands. This includes: application of a waterless antimicrobial agent (e.g. alcohol-based hand rub) to the surface of the hands; and use of soap/solution (plain or antimicrobial) and water (if hands are visibly soiled) followed by patting dry with single-use towels.22

healthcare identifiers: are unique numbers assigned and used in health related information to clearly identify the patient, the treating professional and the organisation where healthcare is provided to reduce the potential for errors with healthcare related information and communication.36,37 In Australia, the Healthcare Identifiers (HI) Service is a national system for uniquely identifying, healthcare providers, healthcare organisations and individuals receiving healthcare.36 These include:

  • Individual Healthcare Identifier (IHI) – identifies a patient (individual) receiving healthcare. An IHI uniquely identifies individuals who receive healthcare, including Australian citizens, permanent residents and visitors to Australia
  • Healthcare Provider Identifier – Individual (HPI-I) – identifies an individual healthcare provider who provides healthcare, such as general practitioners, allied health professionals, specialists, nurses, dentists and pharmacists, among others
  • Healthcare Provider Identifier – Organisation (HPI-O) – identifies the healthcare provider organisation where healthcare is provided, such as hospitals, medical practices, pathology or radiology laboratories and pharmacies.36

Healthcare providers (see definition) must be registered with the HI Service and assigned healthcare identifiers to access a patient’s My Health Record (see definition).38

health care: the prevention, treatment and management of illness and injury, and the preservation of mental and physical wellbeing through the services offered by healthcare providers.3

healthcare service: a separately constituted organisation that is responsible for implementing clinical governance, administration and financial management of a service unit or service units providing health care to patients. It can be in any location or setting, including pharmacies, clinics, outpatient facilities, hospitals, patients’ homes, community and primary healthcare settings, practices and clinicians’ rooms.47

health service organisation: see healthcare service

health practitioner: see healthcare provider

healthcare provider: an individual who practises a profession relating to the provision of health care. Healthcare providers may be required maintain profession-specific registration with a national board under the National Registration and Accreditation Scheme or be self-regulated.39 A healthcare provider may also referred to as a health practitioner, clinician or profession-specific description.

healthcare record: a record of a patient’s medical history, treatment notes, observations, correspondence, investigations, test results, photographs, prescription records and medication charts for an episode of care.

healthcare record system: a healthcare record and management system (that may be paper-based or electronic) that is used by healthcare providers in healthcare settings. Healthcare record information must be properly managed and safeguarded from start (record generation) to finish (record destruction) and the entire time in between.40

health literacy: the Australian Commission on Safety and Quality in Health Care separates health literacy into two components – individual health literacy and the health literacy environment. Individual health literacy is the skills, knowledge, motivation and capacity of a consumer to access, understand, appraise and apply information to make effective decisions about health and health care, and take appropriate action. The health literacy environment is the infrastructure, policies, processes, materials, people and relationships that make up the healthcare system, which affect the ways in which consumers access, understand, appraise and apply health-related information and services.41

high-risk medicines: medicines that have an increased risk of causing significant patient harm or death if they are misused or used in error. High-risk medicines may vary between healthcare settings, depending on the types of medicines used and patients treated. Errors with these medicines are not necessarily more common than with other medicines. Because they have a low margin of safety, the consequences of errors with high-risk medicines can be more devastating.42,43 At a minimum, the following classes of high-risk medicines should be considered:

  • Medicines with a narrow therapeutic index
  • Medicines that present a high risk when other system errors occur, such as administration via the wrong route
  • Schedule 8 medicines.

hygienic environment: an environment in which practical prevention and control measures are used to reduce the risk of infection from contamination by microbes.

incident: an event or circumstance that resulted, or could have resulted, in unintended or unnecessary harm to a patient or consumer; or a complaint, loss or damage. An incident may also be a near miss. See also near miss

infection: an infection occurs when a microorganism enters the body, increases in number and causes a reaction in the body.44 This may cause tissue injury and disease.45

information communications technology: Diverse set of technological tools and resources used to transmit, store, create, share or exchange information. These technological tools and resources include computers, the Internet, live broadcasting technologies, recorded broadcasting technologies and telephony.46

informed consent: a process of communication between a patient and healthcare provider about options for treatment, health care processes or potential outcomes.47 This communication results in the patient’s authorisation or agreement to undergo a specific intervention or participate in planned care.47 The communication should ensure that the patient has an understanding of the health care they will receive, all the available options and the expected outcomes, including success rates and side effects for each option.48

injury: damage to tissues caused by an agent or circumstance.49

invasive medical devices: devices inserted through skin, mucosal barrier or internal cavity, including central lines, peripheral lines, urinary catheters, chest drains, peripherally inserted central catheters and endotracheal tubes.

jurisdictional requirements: systematically developed statements from state and territory governments about appropriate healthcare or service delivery for specific circumstances.35 Jurisdictional requirements encompass a number of types of documents from state and territory governments, including legislation, regulations, guidelines, policies, directives and circulars. Terms used for each document may vary by state and territory.

leadership: having a vision of what can be achieved, and then communicating this to others and evolving strategies for realising the vision. Leaders motivate people, and can negotiate for resources and other support to achieve goals.50

local community: the people living in a defined geographic region or from a specific group who receive services from a healthcare service.

mandatory: required by law or mandate in regulation, policy or other directive; compulsory.51

medicine: a chemical substance given with the intention of preventing, diagnosing, curing, controlling or alleviating disease, or otherwise improving the physical or mental wellbeing of people. These include prescription, non-prescription, investigational, clinical trial and complementary medicines, irrespective of how they are administered.52

medicine-related event: any event involving treatment with a medicine that has a negative effect on a patient’s health or prevents a positive outcome. Consideration should be given to disease-specific, laboratory test-specific and patient-specific information. Medicine-related problems include issues with medicines such as:

  • Underuse
  • Overuse
  • Use of inappropriate medicines (including therapeutic duplication)
  • Adverse drug reactions, including interactions (medicine–medicine, medicine–disease, medicine–nutrient, medicine–laboratory test)
  • Noncompliance.53,54

medicines list: a way to keep all the information about medicines a person takes together.55 A medicines list contains, at a minimum:

  • All medicines a patient is taking, including over-the-counter, complementary, prescription and non-prescription medicines; for each medicine, the medicine name, form, strength and directions for use must be included56
  • Any medicines that should not be taken by the patient, including those causing allergies and adverse drug reactions.

Ideally, a medicines list also includes the intended use (indication) for each medicine.5749

multidisciplinary collaboration: a process where healthcare providers from different disciplines and/or healthcare services share clinical information to optimise the delivery of comprehensive care for a patient.58

My Health Record: the secure online summary of a consumer’s health information, managed by the System Operator of the national My Health Record system (the Australian Digital Health Agency). Healthcare providers are able to share health clinical documents to a consumer’s My Health Record, according to the consumer’s access controls. These may include information on medical history and treatments, diagnoses, medicines and allergies.59

near miss: an incident or potential incident that was averted and did not cause harm, but had the potential to do so.60

open disclosure: an open discussion with a patient and carer about an incident that resulted in harm to the patient while receiving health care. The criteria of open disclosure are an expression of regret, and a factual explanation of what happened, the potential consequences, and the steps taken to manage the event and prevent recurrence.61

orientation: a formal process of informing and training a worker starting in a new position or beginning work for an organisation, which covers the policies, processes and procedures applicable to the organisation.

outcome: the status of an individual, group of people or population that is wholly or partially attributable to an action, agent or circumstance.61

partnership: a situation that develops when patients and consumers are treated with dignity and respect, when information is shared with them, and when participation and collaboration in healthcare processes are encouraged and supported to the extent that patients and consumers choose. Partnerships can exist in different ways in a healthcare service, including at the level of individual interactions; at the level of a service, department or program; and at the level of the organisation. They can also exist with consumers and groups in the community. Generally, partnerships at all levels are necessary to ensure that the healthcare service is responsive to patient and consumer input and needs, although the nature of the activities for these different types of partnership will depend on the context of the healthcare service.

patient: a person who is receiving health care from a healthcare service.

patient identifiers: items of information for use in identification of a patient, including family and given names, date of birth, sex, address, healthcare record number and Individual Healthcare Identifier.

person-centred care: an approach to the planning, delivery and evaluation of health care that is founded on mutually beneficial partnerships among healthcare providers and patients.62 Person-centred care is respectful of, and responsive to, the preferences, needs and values of patients and consumers. Key dimensions of person-centred care include respect, emotional support, physical comfort, information and communication, continuity and transition, care coordination, involvement of carers and family, and access to care.6 Also known as patient-centred care or consumer-centred care.

point of care: the time and location of an interaction between a patient and a healthcare provider for the purpose of delivering health care.

policy: a set of principles that reflect the organisation’s mission and direction.

primary health care: Primary health care is generally the first point of contact for individuals, families and communities with health services and brings health care as close as possible to where people live and work.1 It constitutes a large and essential part of the health care system.1 Primary health care includes health promotion, prevention, early intervention, treatment of acute conditions, management of chronic conditions and end of life care.2

procedure: the set of instructions to make policies and protocols operational, which are specific to an organisation.

process: a series of actions or steps taken to achieve a particular goal.63

program: an initiative, or series of initiatives, designed to deal with a particular issue, with resources, a time frame, objectives and deliverables allocated to it.

protocol: an established set of rules used to complete tasks or a set of tasks.

quality improvement: the combined efforts of the workforce and others – including consumers, patients and their families, researchers, planners and educators – to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.64 Quality improvement activities may be undertaken in sequence, intermittently or continually.

regularly: occurring at recurring intervals. The specific interval for regular review, evaluation, audit or monitoring needs to be determined for each case. In the Primary and Community Healthcare Standards, the interval should be consistent with best practice, risk based, and determined by the subject and nature of the activity.

reports (on patients): Documentation and information relating to a patient’s health care e.g. patient records, referrals and scans.

respiratory hygiene and cough etiquette: A combination of measures designed to minimise the transmission of respiratory pathogens via droplet or airborne routes in healthcare settings.65

reusable device: a medical device that is designated by its manufacturer as suitable for reprocessing and reuse.66

risk: the chance of something happening that will have a negative impact. Risk is measured by the consequences of an event and its likelihood.

risk assessment: assessment, analysis and management of risks. It involves recognising which events may lead to harm in the future, and minimising their likelihood and consequences.67

risk management: the design and implementation of a program to identify and avoid or minimise risks to patients, employees, volunteers, visitors and the organisation.

safety culture: a product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of an organisation’s health and safety management. Positive patient safety cultures have strong leadership that drives and prioritises safety as well as:

  • Shared perceptions of the importance of safety
  • Constructive communication
  • Mutual trust
  • A workforce that is engaged and always aware that things can go wrong
  • Acknowledgement at all levels that mistakes occur
  • Ability to recognise, respond to, give feedback about, and learn from, adverse advents.51

scope of clinical practice: the extent of an individual healthcare provider’s approved clinical practice, based on the individual’s skills, knowledge, professional registration (where applicable), performance and professional suitability, and the needs and service capability of the organisation.68

screening: a process of identifying patients who are at risk, or already have a disease or injury. Screening requires enough knowledge to make a clinical judgement.69

self-harm: includes self-poisoning, overdoses and minor injury, as well as potentially dangerous and life-threatening forms of injury. Self-harm is a behaviour and not an illness. People self-harm to cope with distress or to communicate that they are distressed.70

serious deterioration: physiological, psychological or cognitive changes that may indicate a worsening of the patient’s health status.

service context: the particular context in which health care is delivered. Health service delivery occurs in many different ways, and the service context will depend on the organisation’s function, size and organisation of care regarding service delivery mode, location and workforce.71

shared decision making: a consultation process in which a healthcare provider and a patient jointly participate in making a health decision, having discussed the options, and their benefits and harms, and having considered the patient’s values, preferences and circumstances.30

standard: agreed attributes and processes designed to ensure that a product, service or method will perform consistently at a designated level.49

standard national terminologies: a structured vocabulary used in clinical practice to accurately describe the care and treatment of patients. Healthcare providers around the world use specialised vocabulary to describe diseases, operations, clinical procedures, findings, treatments and medicines. In Australia, terminologies include SNOMED CT-AU and Australian Medicines Terminology.72 Standard national terminologies are also referred to as clinical terminologies.

standard precautions: work practices that provide a first-line approach to infection prevention and control, and are used for the care and treatment of all patients.22 Standard precautions include: hand hygiene, use of personal protective equipment (masks, gloves, gowns, protective eyewear) to prevent blood or bodily fluid exposure, routine environmental cleaning aligned to risk, safe use and disposal of sharps, reprocessing of reusable equipment and devices, respiratory hygiene and cough etiquette (including physical distancing), aseptic technique, linen and waste management.22

substitute decision-maker: a person appointed or identified by law to make health, medical, residential and other personal (but not financial or legal) decisions on behalf of a patient whose decision-making capacity is impaired. A substitute decision-maker may be appointed by the patient, appointed for (on behalf of) the person, or identified as the default decision-maker by legislation, which varies by state and territory.23

supported decision making: enables a person with cognitive impairment to remain involved in decisions about their health care rather than having their decision-making capacity removed.7352 | National Safety and Quality Primary and Community Healthcare Standards

system: the resources, policies, processes and procedures that are organised, integrated, regulated and administered to accomplish a stated goal. A system:

  • Brings together risk management, governance, and operational processes and procedures, including education, training and orientation
  • Deploys an active implementation plan; feedback mechanisms include agreed protocols and guidelines, decision support tools and other resource materials
  • Uses several incentives and sanctions to influence behaviour and encourage compliance with policy, protocol, regulation and procedures.

The workforce is both a resource in the system and involved in all elements of systems development, implementation, monitoring, improvement and evaluation.

telehealth: the use information and communications technologies (ICTs) to deliver health services and transmit health information over both long and short distances.74

timely (communication): communication of information within a reasonable time frame. This will depend on how important or time critical the information is to a patient’s ongoing health care or wellbeing, the context in which the service is provided and the clinical acuity of the patient.

training: the development of knowledge and skills.

transitions of care: situations when all or part of a patient’s care is transferred between healthcare locations, providers, or levels of care within the same location, as the patient’s conditions and care needs change.75

transmission-based precautions: extra work practices used in situations when standard precautions alone may not be enough to prevent transmission of infection. Transmission-based precautions are used in conjunction with standard precautions and include droplet, contact and airborne precautions or a combination of these precautions based on the route of transmission of infection.22

unwarranted variation: where variation is not due to difference in patients’ clinical needs or preferences. Unwarranted variation represents an opportunity for improvement.

variation: a difference in healthcare processes or outcomes, compared to peers or to a standard such as an evidence based guideline recommendation.21

workforce: all people working in a healthcare service, including healthcare providers and any other employed or contracted, locum, agency, student, volunteer or peer workers. The workforce can be members of the healthcare service or medical company representatives providing technical support who have assigned roles and responsibilities for care of, administration of, support of, or involvement with patients in the healthcare service. See also healthcare provider