Positive Health Online

What makes the service you offer to your patients good quality? What is quality? By what standard do you want your work evaluated? Do you believe that what you offer is beyond compare? Complementary therapists see their work as highly individual and individualised.

You might think that comparison against some set standard is difficult if not impossible. Yet if offering individualised care is your benchmark then how do you recognise it? Is it a full case history documenting physical, psychological, social or even spiritual considerations in assessment and management? No doubt we would each come up with different ways to recognise individualised care.

The point is that it should be possible for us to set some standards by which we practise. Complementary therapies in this country are currently in the fortunate position of having the freedom to define their own standards and competencies. This means a standard that is completely private and individualistic, bearing no relation to what the public expect in terms of safety and efficacy, is no basis for a profession's development. Fortunately, the lead bodies are making great strides in setting standards of practice that their members must aim for. That's why, before the statutory registration process for osteopathy and chiropractic could be established, the professions had to show that they could recognise and respond to instances of sub-standard practice.

However, the issue of quality and standards has a relevance much wider than complementary therapies. The whole NHS is currently having to get to grips with the Government's new framework for quality assurance and improvement outlined in the NHS Executive's 1998 paper, Clinical Governance: Quality in the new NHS. The November '99 Department of Health paper, Supporting Doctors and Protecting Patients, suggests increasingly stringent standards for the medical profession. The intention of Clinical Governance goes further than the prevention of serious failure, because it is also about improving the overall quality of provision. Although it will be NHS organisations that are responsible for leading the development of Clinical Governance, we should expect that soon enough, all health professionals will be guided by their professional bodies to adhere to the concept.

The development of clear standards and effective procedures to remedy any shortfall means that the public, professional bodies and government can have confidence in the service we provide. At a time when it is getting harder than before to provide complementary therapies within the NHS, those who can show they work to a standard are most likely to become the public sector providers.

The Government's model for achieving these standards is set out in Clinical Governance: Quality in the new NHS and entails:

1 Identifying the scope for improvement within available resources (establishing a baseline);
2 Ensuring that planned improvements have in fact resulted in the desired change (monitoring progress);
3 Making comparisons with models of best practice found elsewhere (benchmarking);
4 Providing information to the public about the quality of services (openness and accountability);
5 Monitoring adverse outcomes of care (early warning of serious service failure).

This model has similarities to principles of clinical audit where practitioners identify the criteria against which they will evaluate their work, identifying the gaps and implementing changes which are then monitored.

Complementary therapists should be asking many other questions with the aim of improving their own work and increasing the confidence of the public. These include:

* What makes me a safe and effective practitioner?
* What sort of patients am I seeing?
* How can I evaluate the benefits of their consulting me?
* How can I track adverse events and critical incidents that happen as a result of my treatments?
* How am I using these difficult cases and unusual interactions with patients as a learning opportunity?
* How well am I communicating with colleagues?
* What should my professional aims and objectives be this year… and for the next five years?

It remains to be seen how far complementary therapists will be able to adopt the clinical governance model given the practical constraints facing solo practitioners with limited resources and expertise to put these systems in place. Nevertheless, complementary therapists will increasingly need to demonstrate that the way they practise is consistent with patients' expectations and the growing call for public accountability. This is already the case for osteopaths and chiropractors, nurses, physiotherapists and doctors.

The Consumers Association recently highlighted the relatively toothless approach taken by most complementary therapy registering bodies. The British Medical Association has just submitted evidence to the House of Lords Select Committee on complementary therapies suggesting that standards of training and registration for complementary therapists have to improve.

It looks as though the pressure is on: from our fellow complementary practitioners, the public and the medical profession, as well as from an ever more litigious culture from government and insurers. If the professions fail to take up the challenge to demonstrate that their standards are monitored, then we can expect increasing external control of our clinical activity. After all, that's what is happening to doctors right now. It is also what happens with complementary therapists in many other countries.