Best practice and quality improvement

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Continuous quality improvement keeps universal aftercare accessible and responsive. Use co-production, meaningful data collection and best practice to support this.

Service accreditation

Universal aftercare services should be accredited, or working towards accreditation, through the Suicide Prevention Australia Standards for Quality Improvement. This ensures aftercare services provide safe, high quality and effective care.

Co-production

A universal aftercare system involves:

  • expanding existing aftercare services
  • establishing new services
  • trialling new and expanded aftercare referral pathways.

Consider the role of co-production in the design and expansion of aftercare services and processes. This involves consumers, their personal support networks, service providers, key partners and policy makers working together to design and implement a service that meets the needs of the community.1

Co-production occurs at every level of a program, including planning, design, delivery and evaluation.

Community participation is essential to ensure aftercare services are appropriately designed and implemented.2 This approach values input from service users, emphasising they are the best contributors to service design. Refer to further resources below.

Co-production occurs at every level of a program.

Principles of co-production

  • Accessibility: ensuring equal participation
  • Safety: creating and maintaining a safe environment
  • Partnering: fostering a balanced and fair power dynamic
  • Diversity: embracing all perspectives and skills
  • Reciprocity: ensuring mutual benefits and responsibilities

Measuring performance

Minimum data set

Data used to track aftercare program performance is captured in the Primary Mental Health Care Minimum Data Set (MDS), defined by the Australian Government Department of Health.

All aftercare providers must report the MDS to the relevant primary health network (PHN) as part of their funding agreement. PHNs may choose to tailor the MDS, as needed.

How to use the data

  • Incorporate this data collection into routine business, so information can be easily extracted from client management systems.
  • Use the MDS to understand service uptake, consumer and service engagement patterns, consumer needs and to inform service planning.
  • Provide snapshots of relevant MDS indicators back to the workforce to support quality improvement, e.g. via internal data dashboards, where possible.

Performance indicators

Performance indicators are negotiated at the PHN level to reflect local priorities and needs. Ideally, they will reflect meaningful outcomes to the consumer and the community.

Performance indicators typically draw from the MDS; however, they may require data that are not captured through the MDS.

The RE-AIM Framework is a useful guide when planning and evaluating programs according to five key outcomes: reach, effectiveness, adoption, implementation and maintenance.3

Here are some performance indicators relevant to aftercare using this framework.

Reach indicators measure the degree to which the program reaches the intended target group.

Examples:

  • Number of referrals
  • Number of referrals that translate into service engagement
  • Characteristics of people who are referred or engage with the program, e.g. gender, sexual orientation, age, priority populations, social determinants of health

Effectiveness indicators measure the meaningful outcomes people experience through participation in the program.

Examples:

  • Progress towards personal goals, e.g. Quality of Life Scale (QOLS)
  • Change in outcomes measures, e.g. K10 (Kessler Psychological Distress Scale), Suicidal Ideation Attributes Scale (SIDAS)
  • Consumer satisfaction, e.g. patient-reported experience measures or Your Experience of Service (YES) Questionnaire
  • Adverse outcomes: number and type
  • Re-presentations to hospital for suicidal-related reasons
  • Involvement from family members, carers, friends and kin (if applicable)

More about patient-reported measures.

Adoption indicators measure adoption by target staff, settings, systems and communities.

Examples:

  • Proportion of consumers who present to emergency departments in suicidal crisis who are referred to aftercare
  • Referrals by service and/or organisation type
  • Aftercare-employed workforce

Implementation indicators measure the nature of service delivery and core components of a program.

Examples:

  • Proportion of consumers who are contacted within two business days from receipt of referral
  • Proportion of consumers who engage with the service who complete a safety plan
  • Proportion of direct consumer contacts that are in person or virtual

Maintenance indicators measure the degree to which a program has become routine practice.

Examples:

  • Service phase, e.g. design, implementation, business as usual
  • Maturity of policies and procedures

Principles for meaningful data collection

Consider the following principles to ensure safe and meaningful data collection.

  • Provide clear information about what data are being collected; data and privacy protection policies; how the data will be used; and why it is important.
  • Only collect the data needed to reduce the burden on the consumer.
  • Make the data collection process easy for the consumer.
  • Enable the consumer to opt in and opt out.
  • Collect feedback from consumers at consistent intervals after contact with a service, e.g. 1 month after last contact, instead of once a year.
  • Share results with participants in a clear and accessible format.
  • Comply with privacy and confidentiality requirements.

Informing best practice

Performance indicators provide meaningful data to inform local practice and improve care.

  • Track performance indicators, share this with teams and discuss results in relevant governance forums. This will ensure the service is being delivered effectively, and helps to troubleshoot areas for improvement.
  • Track outcomes in real-time to review and discuss with the consumer. Changes in outcome measures can help to inform consumer engagement and identify what has contributed to positive outcomes or what needs to be addressed to progress change.
  • Where possible, supplement performance indicators with personal stories and experiences that speak to the impact the service has had (with consent). Experiential evidence helps to centralise lived and living experience, and demonstrate the benefits of aftercare services from a human perspective.

The Most Significant Change approach is a useful evaluation method for collecting and reporting personal stories of change.4 New Horizons successfully used a condensed MSC methodology to capture qualitative stories of the impact of the i.am Youth Aftercare pilot in 2023.

Further reading

Australian Safety and Quality Framework for Health Care
Framework outlines a vision for safe, high-quality care for all consumers and is based on core principles of consumer-centred care, data-driven decisions and safety standards.
Source: Australian Commission on Safety and Quality in Health Care

National Safety and Quality Health Service (NSQHS) standards
Provide a nationally consistent standard for the level of care consumers should expect from health service organisations.
Source: Australian Commission on Safety and Quality in Health Care

Resources to inform co-production and engaging consumers

References

  1. Co-Production: What it is and How to do it. London (UK): Social Care Institute for Excellence; 2023 [cited 25 Sept 2024].
  2. Vargas C, Whelan J, Brimblecombe J, et al. Co-Creation, Co-Design, Co-Production for Public Health - A Perspective On Definition And Distinctions. Public Health Res Pract. 2022 Jun 15;32(2):3222211. DOI: 10.17061/phrp3222211. PMID: 35702744
  3. RE-AIM: Reach Effectiveness Adoption Implementation Maintenance Framework. Fort Collins (CO): RE-AIM; 2023 [cited 25 Sept 2024].
  4. Most Significant Change. Melbourne (AU): BetterEvaluation; 2023 [cited 25 Sept 2024].
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