Standards For Physiotherapy Practices

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Standardsfor PhysiotherapyPractices(8th Edition: 2011)Standards approved by APA Board of Directors May 2007Assessment Indicators approved by APA Board of Directors June 2011Editorial amendments February 2014

AcknowledgementsThe Australian Physiotherapy Association (APA) Standards for Physiotherapy Practices, 8th Edition2011,builds on the Association’s proud history of commitment to quality physiotherapy and the work of all thosewho have contributed to the development of each successive edition of the standards.APA appreciates the contribution that many people have made to this edition of the standards. In particular,the APA would like to thank: physiotherapists in accredited practices for their ongoing commitment to quality primary healthcare accreditation surveyors for their invaluable knowledge and expertise individual physiotherapists who have commented on successive drafts and participated in field testing stakeholder organisations for useful practical and strategic suggestions APA members and staff who contributed to the 2004 independent review of the Association’s formerQuality Endorsement Program Physiotherapy Business Australia who established the original accreditation program for physiotherapypractices and who have generously supported the ongoing development of both the program andthe standards Board members and staff of Quality in Practice Pty Ltd for their expert advice Royal Australian College of General Practitioners whose standards for General Practices (3rd edition)have provided useful inspiration Ms Clare Barr for her comprehensive review of accreditation standards, both national and international,during a student placement at the APA.The APA would like to acknowledge members of the working party entrusted by the Association’s Board of Directorsto this work:20071Ms Sandie Chapman-O’Meara, SurveyorMs Genevieve Dwyer, APA DirectorMs Sue Jones, former APA DirectorMs Rose-Anne Kelso, former APA DirectorMs Jennifer Lake, APA General Manager (Victoria and Quality Practice)Mrs Elizabeth Moorfield, Chair of the former APA Quality Endorsement Program.2011Mr Jonathon Kruger, APA General Manager—Advocacy and International Relations DivisionMr Neil Sherburn, Accreditation SurveyorMr Marcus Dripps, APA DirectorAPA Standards for Physiotherapy Practices 8th Edition 2011

NoteThe APA has approved two pathways towards accreditation against these standards: entry level accreditationor full accreditation.Practices that choose to commence their accreditation journey via the entry level accreditation pathway must comply withall non-asterixed indicators of the APA standards. Practices will be required to provide documentary evidence to enablea desktop assessment to be undertaken by a peer surveyor to achieve accreditation against the entry level standards.Practices that choose full accreditation must comply with all APA standards, including those with an asterix.Assessment against the full suite of standards will involve a desktop assessment as per the entry level process,supplemented by an on-site assessment undertaken by a peer surveyor. It is proposed that full accreditation willbe available from 2013.2

Contents3Foreword5Category 1Rights and needs of clients7Standard 1.1Criterion 1.1.1Criterion 1.1.2Criterion 1.1.3Criterion 1.1.4Criterion 1.1.5Human rightsRespectPrivacyInformed consentClient communicationCulturally appropriate care779101314Standard 1.2Criterion 1.2.1Criterion 1.2.2Client-centred careCollaborative goal settingHealth promotion151516Category 2Practice services17Standard 2.1Criterion 2.1.1Client health recordCompliance1717Standard 2.2Criterion 2.2.1Criterion 2.2.2Coordination of careReferralCommunication202021Standard 2.3Criterion 2.3.1Access to servicesResponsive healthcare2222Category 3Practice managementStandard 3.1Criterion 3.1.1Criterion 3.1.2Criterion 3.1.3Business systemsStrategic planOperationsPractice communication25252627Standard 3.2Criterion 3.2.1Criterion 3.2.2Human resource managementHuman resource management systemsCredentials282829Standard 3.3Criterion 3.3.1Criterion 3.3.2Criterion 3.3.3Criterion 3.3.4Criterion 3.3.5Health information systemsConfidentiality and privacyCollectionSecurityUse and disclosureAccess313132333436Standard 3.4Criterion 3.4.1Criterion 3.4.2Criterion 3.4.3Criterion 3.4.4Risk managementRisk managementOccupational health and safetyManual handlingEmergency systems3737394142APA Standards for Physiotherapy Practices 8th Edition 201125

Standard 3.5Criterion 3.5.1Improving practice managementQuality improvement4343Category 4Physical environmentStandard 4.1Criterion 4.1.1Criterion 4.1.2Criterion 4.1.3FacilitiesPractice environmentCompliancePractice access45454648Standard 4.2Criterion 4.2.1EquipmentEquipment safety and maintenance4949Standard 4.3Criterion 4.3.1Infection controlInfection control standards5050Category 5Quality physiotherapyStandard 5.1Criterion 5.1.1Criterion 5.1.2Criterion 5.1.3Clinical best practiceRecognised best practiceOutcome measuresClinical risk management51515253Standard 5.2Criterion 5.2.1Professional standardsProfessional conduct5555Standard 5.2Criterion 5.2.2Criterion 5.2.3Professional standardsContinuing professional developmentClinical supervision575758Standard 5.3Criterion 5.3.1Criterion 5.3.2Quality improvementClient feedbackImproving clinical care5959604551Summary of contact details61References654

ForewordWhat are the APA Standards for PhysiotherapyPractices?The APA Standards for Physiotherapy Practicesare standards developed by physiotherapists forphysiotherapists. The standards are owned by the APAand are designed to help physiotherapy practices inthe private sector deliver safe, high quality healthcareand embrace continuous quality improvement as goodbusiness practice.There are five categories of standards, which cover: rights and needs of clients practice services practice management physical environment quality physiotherapy.Client feedback—a lynchpin in the quality cycleOngoing learning underpins the APA Standards forPhysiotherapy Practices. This learning is encapsulatedin a quality cycle that moves from planning to action,evaluation and feedback, then back to planning—and so the cycle continues.Client feedback is a pivotal component of the qualityenhancement process and is a fundamental buildingblock in the day-to-day work of improving clinical careand practice operations. The ultimate quality test forany physiotherapy practice is a client’s satisfactionwith their health outcomes. And this test lies at the heartof a successful accreditation system.How can a practice use the standards?Each category contains guidance material to helppractices interpret thestandards, as well as resourcematerial to assist practices in complying with each setof mandatory assessment indicators.5Why are the APA Standards for PhysiotherapyPractices important?The APA standards provide a basis for excellence inclinical care and practice operations—excellence whichjustifies community trust in the expertise and integrityof physiotherapists.The standards reflect hallmark qualities of thephysiotherapy profession in Australia – respect forthe individual, professional accountability,evidence-based practice, sound risk managementand ongoing learning.For the first time, APA Standards for PhysiotherapyPractices include a set of standards that relatespecifically to the quality of clinical care. This puts thephysiotherapy profession in Australia at the frontlineof safety and quality in primary health care.APA Standards for Physiotherapy Practices 8th Edition 2011The APA Standards for Physiotherapy Practices is availablein the public domain as an important indicator ofbenchmark expectations on safe, high quality healthcareand sound practice operations.Physiotherapy practices in the private sector can usethe APA standards to self-assess the safety and qualityof primary healthcare they provide to the Australiancommunity, and to self-assess the efficiency andeffectiveness of their practice operations.Practices can also go a step further and seekformal accreditation against the APA Standardsfor Physiotherapy Practices.Why accredit?Accreditation against the APA Standards for PhysiotherapyPractices is the ultimate formal acknowledgement ofa practice’s commitment to safe, high quality healthcare.Accreditation sends important messages to the community,clients, peers, medical colleagues, third party purchasersand key decision makers in the Australian health caresystem that physiotherapists are seriously committedto excellence in primary health care.

How does accreditation work?Managed by expertsAccreditation against the APA Standards for PhysiotherapyPractices is managed by Quality in Practice (QIP),a subsidiary of Australian General Practice AccreditationLimited. This means physiotherapy practice accreditationis managed by a market leader with specialist expertiseand is awarded independently of the custodian of thestandards, the Australian Physiotherapy Association.Comprehensive practical supportQuality in Practice provides comprehensive practicalsupport to physiotherapy practices preparingfor accreditation and offers customised software(Accreditation Pro) to minimise the level of administrationinvolved in the accreditation process.Feedback on the 8th editionThe Association is keen to ensure that APA Standardsfor Physiotherapy Practices is a useful day-to-day toolfor evaluating and improving the safety and quality ofprivate sector physiotherapy as well as the efficiencyand effectiveness of practice operations.To ensure the 8th edition standards set the quality barat the appropriate level, the APA is committing toreviewing the standards regularly to make certainthey continue to reflect the highest standard expectedof contemporary physiotherapy practices.Marcus DrippsNational PresidentAustralian Physiotherapy Association6

Category 1Standard 1.1Rights and needs of clientsHuman rightsThe practice respects the rights and dignity of clients.Criterion 1.1.1 RespectClients receive respectful care and are not discriminatedagainst on the basis of their age, gender, ethnicity, beliefs,sexual preference or health status.GuidanceRespect for clientsClients have the right to be treated in a manner thatrespects their individuality. Clients, their families andcarers should be treated courteously. There should befull recognition of client needs, culture and beliefs in allaspects of communication, assessment and intervention.7At a practical level, health professionals should givespecial consideration to the inherent sensitivity in theclient-practitioner relationship where hands-on treatmentis involved.Where a client is particularly vulnerable (such as a clientwith mental health problems or a client who is a minor)and/or there is potential for the client-practitionerrelationship to be particularly sensitive, the practicemay choose to demonstrate extra respect for the clientby scheduling appointments for a time when others arein the practice or, with the client’s consent, have a thirdparty present.Practice staff should have good interpersonal skillsto work with clients, their families and carers in arespectful way.Client responsibilitiesFor the best possible health outcomes, the clientand the clinical team need to share information openly.Clients need to provide the clinical team with all relevantinformation about their presenting condition as wellas any other information about their health that mayaffect options for intervention. Clients should treatpractice staff and other clients with respect, observepractice policies including the practice fee schedule,and communicate their needs, expectations and concernsin a timely manner.APA Standards for Physiotherapy Practices 8th Edition 2011Anti-discriminationPractices need to be aware of the requirements ofthe Federal Disability Discrimination Act (1992) and anyother state and territory Disability Services Acts andEqual Opportunity Acts which prohibit the discriminatorytreatment of people based on their age, gender, ethnicity,beliefs, sexual preference or health status.Practice staff should understand that information theycommunicate or record about clients should not bederogatory, prejudiced, or prejudicial. Such statementsmay have serious consequences for client intervention,compensation and other legal matters, and maycontravene anti-discrimination legislation.Client rightsClients have the right to know the qualification of theirtreating health professional. Clients have the right to seethe physiotherapist of their choice, refuse interventionor seek a further opinion. Practices need to recordsuch information in the client health record includingan explanation of the action taken. If a client elects togo to another health professional, appropriate healthcareinformation should be provided if requested.Health professional rightsPhysiotherapists and other health professionals havethe right to refuse to provide a service where there arereasonable and non-discriminatory reasons for doing so.Health professionals have the right to discontinueintervention when a client has behaved in a threateningor violent manner, or there has been some othercause for a significant breakdown of the therapeuticrelationship. The practice should have a policy fordiscontinuing a client’s episode of care and the policyshould include safety measures to protect staff,assistance with ongoing care including referral to otherhealth professionals, and clear documentation of thecircumstances leading to the discontinuation of care.Health professionals have the right to protect theirprofessional reputations and to take reasonable stepsto avoid any possible misunderstanding of professionalboundaries.Client informationThe practice needs to provide written information abouta client’s right to see the physiotherapist of their choice,obtain a second opinion, refuse an intervention, providefeedback or make a complaint. The practice may also

like to provide general information about common clinicalconditions, health promotion and injury/illness material,and diagrams for activities such as home exerciseprograms.The information can be provided to clients in a variety offormats, including a client information sheet, brochuresor flyers.Communication with clientsAssessment indicatorsA. The practice has a policy that provides writteninformation about a client’s rights. This may includethe right to see the physiotherapist of their choice,obtain a second opinion, refuse an intervention,provide feedback or make a complaint.B. There is a policy for discontinuing a client’s episodeof care.The practice should promote a culture of opencommunication at all stages of client care.Good communication is a vital factor in the delivery ofquality healthcare. It is also essential in the day-to-daymanagement of risk and compliance.Further informationTailored communicationThe Australian Human Rights Commission hasinformation about human rights and people withspecial needs.humanrights.gov.auCommunication which is tailored to the individual needsof a client is fundamental to an effective client-practitionerrelationship built on mutual trust and respect. Tailoredcommunication includes spoken and written messages,body language, courtesy, active listening and a generalattitude that is sensitive to a client’s needs.Practice staff should adapt their communication toaccommodate particular client attributes such as firstlanguage, culture, age, gender, cognitive ability orhealth status.Communication supportA client may elect to have a third party supporterto facilitate communication during or related toa consultation.Client feedbackThe practice must actively seek client feedback.Such feedback forms an integral component of theAPA Standards for Physiotherapy Practices includingrespect for the rights and dignity of clients. Feedbackmay be solicited in a variety of ways including a clientquestionnaire. Client feedback is covered in more detailin criterion 5.3.1.The Australian Charter of Healthcare Rightsis available on the website of the Australian Commissionon Safety and Quality in Healthcare.safetyandquality.gov.auThe APA Code of Conduct provides a practicalinterpretation of client rights.physiotherapy.asn.auState and Territory Health Services Commissioners/Health Complaints Commissioners provide informationfor health consumers about making a complaint(see Summary of contact details).The APA consumer brochure What to Expect fromYour Physiotherapist is available on the APA website.physiotherapy.asn.auThe Physiotherapy Board of Australia has developedcodes and guidelines to provide guidance to elines.aspx8

Category 1Standard 1.1Rights and needs of clientsHuman rightsThe practice respects the rights and dignity of clients.Criterion 1.1.2 PrivacyThe practice is committed to protecting client privacy.GuidanceClients have a right to expect privacy in the provisionof their healthcare. The practice needs to have policiesabout client privacy and these policies must be upheldby practice staff.Identify individual privacy needs9Each client has a unique need for privacy during aconsultation. This need may vary according to personalpreference, natural modesty, the type of care beingprovided and the client’s familiarity with the intervention.For example, the privacy needs of a client may besignificantly different if the consultation involvesthe treatment of a sports injury versus continencemanagement.In determining the individual privacy needs of a client,practice staff should avoid stereotyping and generalising.Visual privacyIf a client needs to disrobe for a particular intervention,the health professional must provide a clear explanationof ‘adequate undress’ and the reason it is important.The health professional should offer suitable cover(such as a gown, shorts or drape) if it is necessaryto protect the client’s dignity.In some circumstances, the client should be invitedto disrobe behind a privacy screen. Alternatively,the health professional may turn their back or chooseto leave the room while a client disrobes.Where a client is particularly vulnerable and/or thereis potential for the client-practitioner relationship to beparticularly sensitive, the health professional may seekthe client’s consent to have a third party present ina chaperone role if the client needs to disrobe for anintervention.APA Standards for Physiotherapy Practices 8th Edition 2011Auditory privacyThe practice should have at least one area that offerssatisfactory auditory privacy so that discussions witha client can be conducted in private. In practiceswith curtained treatment areas, this may mean thatdiscussions at the commencement of a consultationneed to be conducted in private in a separate area.It is particularly important that discussion and telephonecommunication at the reception area be conducteddiscreetly, in the interests of respecting clientsand protecting the privacy of health information.Similarly, discussions between health professionalsabout a client should be conducted discreetly andshould not take place in the presence of other clientsor administrative staff.Assessment indicatorsA. Physiotherapists and other staff can describe howthey identify the individual privacy needs of a client.B. The practice has a policy which describes howthe privacy needs of individual clients are met.

Standard 1.1Human rightsThe practice respects the rights and dignity of clients.Criterion 1.1.3 Informed consentClients are given sufficient information to enable themto make informed decisions about their health care.GuidanceIntelligible informationClients need sufficient information to make appropriatedecisions about their own health care. Health professionalsneed to provide adequate information about theimportance, benefits and risks of proposed healthcarein language that is tailored to the individual needs ofa client.apply and the costs incurred for late cancellations o

Standard 3.5 Improving practice management 43 Criterion 3.5.1 Quality improvement 43 Category 4 Physical environment 45 Standard 4.1 Facilities 45 Criterion 4.1.1 Practice environment 45 Criterion 4.1.2 Compliance 46 Criterion 4.1.3 Practice access 48 Standard 4.2 Equipment 4

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