New Zealand

Background

In New Zealand most guideline activity is funded by two central government agencies – Accident Compensation Corporation (ACC) and the Ministry of Health. ACC and the Ministry develop and  implement guidelines themselves, and commission other agencies to do this.

In NZ it is not mandatory to follow guidelines, however, guidelines are seen as a statement of ‘best practice’ and are used to encourage changes in practice.

All NZ guidelines address health inequalities and the particular health needs of indigenous Maori and Pacific peoples living in New Zealand.

Accident Compensation Corporation (ACC)

The ACC administers New Zealand’s accident compensation scheme, which provides personal injury cover for all citizens, residents and temporary visitors to New Zealand. In return people do not have the right to sue for personal injury, other than for exemplary damages. ACC’s pledge is to prevent injury, to provide the best treatment and care if injury occurs, and to quickly rehabilitate people back to work or  independence. ACC is a member of the Guidelines International Network.

The team at ACC provides an evidence base for specific interventions used for treatment and rehabilitation after injury. Details of their work can be found at www.acc.co.nz/for-providers/operational-guidelines/WCM2_020215?ref=2.  If any G-I-N members would like further information about any of the projects below, or are interested in sharing relevant resources or would like to partner with ACC in any of the projects, please contact us at ebh@acc.co.nz.

ACC has a horizon scanning project that gathers intelligence on new, emerging or changing issues that might have an impact on ACC’s business. The project covers four broad domains – healthcare, injuries, scheme and work. We share knowledge with the rest of ACC via regular bulletins and a web site. The web site is currently open to ACC staff only but we plan to make it available externally later in 2009.

ACC is working to build links with overseas organisations and experts in the fields of horizon scanning, health technology assessment, rehabilitation and workers’ compensation. For more information about the project contact horizon.scanning@acc.co.nz.

NZ Ministry of Health

The Ministry of Health is currently commissioning a suite of cancer guidelines which includes:

• An evidence review of PSA testing
• Guidance for improving supportive and rehabilitative care for adults with cancer in New Zealand

Other guideline work commissioned by the Ministry of Health includes:

• Other guidelines such as: CVD and diabetes and obesity.
• Depression management in primary care. The Ministry is facilitating a comprehensive implementation programme with four main components: a primary care decision support tool; supporting information and resources; a primary mental health workforce development plan and the establishment of systems for monitoring and evaluating the impact of the guideline.

New Zealand Guidelines Group (NZGG)

One of the agencies that is commissioned to undertake guideline development and implementation projects is the New Zealand Guidelines Group. NZGG is a founder member of G-I-N.

NZGG has three evidence-based services: the development of evidence-based guidelines; support and implementation of those guidelines, and the promotion of an evidence-based clinical decision culture. NZGG is increasingly able to leverage these services off one another, which helps it lead the health and disability sector in the effective use of reliable evidence.

NZGG is updating a cardiovascular care handbook for primary care practitioners. A live link to the launch proceedings on 29 March will be available at: www.nzgg.org.nz/cvdhandbook. The link will be also archived for viewing at other times.

NZGG is currently updating its guideline development methodology. The handbook will have a broader focus and will address Maori health issues and inequalities within guidelines and the development process. NZGG is also determining how best to respond to the increasing desire to adapt international guidelines, and is looking at the best ways to maintain the currency of existing guidelines given shifting funder priorities.

NZGG is working to put in place a ‘living guideline’ process for the Autism guideline.

Implementation of guideline recommendations

NZGG has experience in a broad range of implementation activities, including:

• fostering a multidisciplinary Community of Practice around the management of self-harm presentations to emergency departments; this involves training in both quality improvement methodology, and performance measurement, as well as in the Maori concept of whakawhanaungatanga, in which the quality improvement work occurs in an atmosphere of new ‘kinship’ so that both practitioners from other disciplines and consumers are accorded ‘manaaki’ (hospitality), ‘awhi’ (helpfulness), ‘tiaki’ (guidance), and aroha (warmth or love). This is part of the implementation of the guidelines for the assessment and management of people at risk of suicide.
• supporting the implementation of the autism guideline, by preparing the implementation plan, facilitating a consumer-led implementation advisory group, administering processes for putting in place new funding and services, contributing to sector communications, and designing national referral and assessment protocols for professionals in both the health and education sectors in New Zealand.
• administering a website for cancer clinicians through which they can share practice in a supportive environment. This has already resulted in a national initiative to standardise some clinical practice.

NZGG is developing comprehensive implementation plans for the cancer guidelines based on formal gap, barrier, and solution feasibility analyses. One output of the planning process is likely to be definition of audit and/or performance measures around key recommendations, potentially including detailed data specifications which reference existing and planned clinical data collection coding systems such as SNOWMED CT.

Promotion of evidence-based culture

The guideline development and implementation work is important to the promotion of this culture, and is supported by conference presentations, an electronic news bulletin, a primary care focused evidence news column, and the development and promulgation of PEARLS (Practical Evidence About Real-Life Situations).

Strengthening Consumer Voice and Participation Initiative

In 2005, NZGG convened a meeting of consumer representatives to discuss the evidence-based report, ‘Effective consumer voice and participation for New Zealand’. At the end of the summit, a representative planning group was given a mandate to develop a draft constitution, including its roles, the principles by which it would work and rules for membership. In November 2007, NZGG facilitated a second summit to discuss the proposed constitution and establish a national entity that would work in collaboration with consumer organisations to strengthen and enhance the work they do and raise the profile of consumer perspectives.

Fifty government entities and NGOs are signed up to partner in the initiative, having publicly declared their support for a national consumer collaborative. This partnership is a clear message of support to consumer groups, a belief in the benefits of having a stronger consumer voice as well as an ongoing interest in wanting to engage in meaningful ways with consumer groups.