The 2007/08 review and the 2012 quality reviews of the Well Child/Tamariki Ora (WCTO) programme identified variable clinical practice, service quality and health outcomes, and recommended an evidence-based quality framework be developed to ensure the WCTO programme consistently achieves its aims.
The Ministry of Health, in partnership with sector expert advisors, developed the WCTO Quality Improvement Framework, drawing on New Zealand and international research.
The Framework has three high-level aims, focusing on family/whānau experience, population health and best value for the health system resource. The Framework sets quality indicators to audit health system performance.
The Framework and quality indicators provide a mechanism to drive improvement in the delivery of WCTO services. Ultimately, they aim to support the WCTO programme to ensure all children and their families/whānau to achieve their health and wellbeing potential.
Purpose
The purpose of the Framework is to support continuous quality improvement for the WCTO programme. Monitoring of the Framework will demonstrate the value of the programme in supporting families/whānau to maximise their children’s health and developmental potential.
The Framework focuses on the health and social service environment that the WCTO programme works within, including core contacts, additional contacts and the B4SC, as well as other primary care services, referred services and early childhood education. It places deliberate emphasis on the key intersections between the WCTO programme and other health and social services, to promote delivery of seamless and collaborative care.
The Framework does not replace WCTO providers’ existing individual quality assurance and improvement processes, and complements the Well Child Service Specifications and associated contractual arrangements between the Ministry of Health and WCTO providers (Ministry of Health 2010e). The Framework seeks to align existing frameworks and processes across the system and provide common understanding and shared accountability for quality improvement. Implementation of the Framework should be done in partnership with existing quality improvement activities including local Maternity Quality & Safety Programmes.
Methodology
Litmus Ltd developed the WCTO Quality Improvement Framework concurrently with a number of nationally commissioned quality reviews of individual components of the WCTO programme (Litmus 2012b, 2012c, 2012d). This helped the Framework address two key questions of any quality review process: what is working well, and what can be improved? It also meant that the perspectives of family/whānau, service providers and funders were a focus from the outset.
A critical component in the development of the Framework was the establishment of and input from an expert advisory group. The group included professional expertise from across the WCTO programme and the child health sector, including in the following areas:
- WCTO service funding and provision
- kaupapa Māori WCTO policy and service delivery
- Pacific WCTO policy and service delivery
- midwifery and primary maternity care
- primary health care and general practice
- public health
- paediatrics
- screening and surveillance
- quality improvement.