Part 3: Corporate Performance

• Introduction
• Legislative compliance
• Corporate Goals
• Approach to Claims Processing and Case Management
• Responsiveness to Māori

Introduction

3.1
In this part we discuss ACC’s performance in regard to:

• legislative compliance;
• corporate goals;
• approach to claims processing and case management; and
• responsiveness to Māori.

Legislative Compliance

Statutory Purpose

3.2
The Act is clear that, where injuries occur, ACC’s “primary focus” should be on rehabilitation, with the goal of achieving an appropriate quality of life by providing entitlements that restore to the maximum practicable extent a claimant’s health, independence, and participation.

3.3
It is appropriate for ACC to place an emphasis on rehabilitating claimants in the shortest time possible, to the point where they no longer require ACC’s assistance.

3.4
In addition, the Act expressly requires ACC to deliver its services so as to minimise the overall incidence and cost of personal injury, while ensuring fair rehabilitation and compensation, in a cost-effective and efficient manner. As a responsible public entity, ACC needs to control the cost of its services.

Legislative Awareness

3.5
The Act is prescriptive and complex. We expected that this level of legislative detail would mean that ACC needed to take extra care to ensure that its activities and decisions are consistent with the many requirements of the Act.

3.6
ACC staff have a high level of legislative awareness. They understand that they must comply with the legislation. Internal policies are drafted with a close eye on the legislative wording, and are reviewed by legal staff. The policies frequently refer staff directly to the relevant statutory provisions.

3.7
Staff are comfortable working with the Act, and where there is doubt about a particular set of circumstances they know to prefer the text of the Act over internal policies. Nevertheless, and despite ACC’s focus on legislative compliance, staff do get it wrong on occasion.

The Constraints Imposed By Legislation

3.8
In our discussions with claimants, a common criticism was that ACC staff “hid behind” the legislation when explaining why particular decisions had been made. In our view, ACC’s reliance on the wording of the Act is appropriate, given the prescriptive nature of the Act.

3.9
The Act requires ACC to limit its activities to those for which claimants have cover under the Act. If ACC did not do so, it could properly be criticised for spending money outside the scope of its lawful authority.

3.10
ACC’s approach is to provide entitlements that are required and allowed by law, and nothing more. Staff have little or no discretion in relation to many decisions.

3.11
In relation to determining whether a claimant has cover, the Act is detailed, and provides little staff discretion (see paragraphs 2.7-2.10 on page 29). In particular, ACC is constrained by the legal definition of “cover” and related terms. For example, where cover is questionable, ACC must undertake assessments to accurately determine the precise cause of a medical condition, or whether or not a new medical problem is related to an existing injury for which the person has cover.

3.12
Decisions about some entitlements allow more scope for judgement by ACC, particularly in regard to provision of social and vocational rehabilitation services (see paragraphs 2.11-2.18 on pages 30 and 31). For example, ACC must weigh up a number of specified considerations when deciding whether to provide vocational rehabilitation. Where a claimant has an IRP, the services to be provided are usually determined by agreement between the case manager and the claimant. However, as discussed in paragraph 4.38 on page 63, agreement between the claimant and the case manager is not always reached.

3.13
In some cases, delay on the part of ACC – such as in determining whether a person has cover – will result in an automatic decision in the claimant’s favour.

3.14
Decisions about entitlements can be reviewed (see paragraphs 6.31-6.47 on pages 94-97). If a decision is challenged, the reviewer will consider the situation on its merits. Because these matters involve judgement, a reviewer’s finding against ACC will not necessarily mean that ACC breached the Act when it made the original decision.

Internal Monitoring of Compliance

3.15
ACC measures and closely monitors the performance of branches and individual staff against a range of KPIs. Most of the KPIs relate to internal procedures and are not directly linked to specific legislative requirements.

3.16
One KPI (that is also a statutory duty) is the requirement that IRPs must be prepared within 13 weeks of accepting a claim for cover if rehabilitation is likely to continue beyond that time. This requirement is currently not being complied with fully, as discussed in more detail in paragraphs 4.49-4.52 on page 65.

Corporate Goals

3.17
ACC’s Business Plan 2002-2003 notes “improved rehabilitation” as a performance goal.²⁶ If this is occurring there should be a reduction:

• over time, in the average length of time that claimants receive assistance from ACC; and
• in the number of long-term claimants (those who have received weekly compensation from ACC for more than 52 weeks).

3.18
ACC told us that it wants to be recognised as an organisation that provides a high standard of claimant service and aims for continuous improvement. In this regard, we understand that ACC has started several initiatives for informationsharing and receiving advice (including regular meetings with key stakeholders, claimants, and treatment providers). ACC is also funding special projects, along with research, to improve knowledge in areas such as treatment techniques, rehabilitation services, and more cost-effective management of claims.

3.19
The introduction of case management during the mid-1990s progressively changed ACC from a relatively passive, payment-processing organisation to one more active and focused on rehabilitation. Long-serving staff told us that ACC’s aims, policies, and culture have changed greatly in recent years – for the better. Employers and health service providers that we visited also spoke of an improvement in ACC’s service delivery.

3.20
ACC’s focus today is consistent with its statutory obligations, and new and short-term claimants generally react positively. However, as a result of past ACC practices, we understand that some long-term claimants have become accustomed to receiving weekly compensation without active rehabilitation. Claimants in this position are sometimes unsettled by ACC’s stronger emphasis on rehabilitation.

3.21
ACC is now more rigorous in reviewing decisions about cover on an ongoing basis (as it is entitled to do) as situations change, and as newer and better medical information becomes available to determine whether a claimant’s current condition is linked to their original injury. Claimants who did not face such rigour in the early years of their injury often find this re-evaluation stressful.

3.22
In addressing past failings in its method of claims processing, ACC has become strongly process-oriented and aims for continual progress on case files, to actively keep claimants moving through the system. While this is efficient for ACC, and represents a more comprehensive approach to rehabilitation, it sometimes also results in criticism by claimants that ACC is impersonal and lacking in empathy. ACC’s response is that its role is simply to provide those entitlements required by law, and nothing more. Nevertheless, ACC must act in accordance with its obligations to claimants under the Code of ACC Claimants’ Rights²⁷.

Approach to Claims Processing and Case Management

3.23
ACC is quick to set up initial processes and entitlements once a branch receives a claim.

3.24
Overall, ACC has thorough case management practices to help staff to make sound decisions, to record information, and to monitor and audit staff and files. Many of the practices and procedures have been implemented only in recent years.

3.25
ACC told us that it sets high standards and aims for continual reassessment and improvement of its processes, with new initiatives being launched regularly. During our audit, we learned that ACC has further plans to review and overhaul many of its case management procedures.

3.26
In another year or so, the way ACC provides its services may change again. In particular, we understand that ACC is keen to increase the level of computerisation for claims processing, reporting, and decision-making, and in some of its dealings with health service providers. However, such changes have the potential to alienate some claimants by further de-personalising key relationships. ACC needs to be careful to deal with claimants in a manner consistent with the Code of ACC Claimants’ Rights.

3.27
Case managers are the primary link between the claimant and ACC. We discuss the role of case managers in the rehabilitation process in Part Five. We discuss the interaction between case managers and claimants in Part Six.

Communication Between Head Office and Branches

3.28
Communication between Head Office and the branches generally works well, with branch managers and area managers meeting at Head Office monthly to discuss management issues.

3.29
Another method of communication is through regular visits to branches by the Chief Executive and the General Manager responsible for the branches. Other senior managers visit branches too, and the launch of any new initiative or policy is commonly followed by branch visits by the General Manager with responsibility for the change. Such visits provide senior management and branch staff with the opportunity to discuss any issues or policy changes, and also allow Head Office to maintain links with the branches.

3.30
ACC’s intranet provides the Chief Executive with the ability to brief staff about current events on a daily or weekly basis. Important messages from the Chief Executive can be placed on the intranet for staff to see as soon as they log on to their computers.

3.31
The “Reality Check” facility on the intranet also allows staff to send anonymous e-mails to senior staff at Head Office, making suggestions for improvements. This facility provides an opportunity for staff to give feedback on Head Office initiatives, and there have been occasions where e-mailed suggestions have raised the awareness of Head Office management to realities faced by staff.

3.32
Policy development at Head Office does not occur in isolation. As part of its Outlook programme, ACC identifies highly performing case managers (through the Performance Review System) and brings them together to discuss possible improvements to ACC’s processes. Some of these staff members are also seconded to Head Office to work on special policy projects, which are then piloted at specific branches before being implemented nationally. This process helps ACC to identify best practice initiatives to apply to all branches.

3.33
A recent ACC staff survey indicated that less than half of ACC staff agree that there is good communication between teams within ACC. In our view, strong communication between teams is imperative for the sharing of best practice. We acknowledge that ACC recognises the benefits of better inter-team communication, and has initiated measures (such as a web page) to improve communications.

3.34
ACC’s case management is built around a solid core of formal training (three times a month) and informal coaching (when needed). The formal training regime has been in place since March 1999. We talk about this more in Part Five.

Communication Between ACC and the Community

3.35
ACC has moved to strengthen links with the community as part of its general focus on injury prevention and through visits by case managers to rural areas with no ACC branch nearby. Case managers in rural branches participate in the Heartland Services programme, which provides people living in remote areas with access to government services through the programme’s service centres. Case managers also travel to meet claimants in areas that do not have ACC branches, such as Haast or Kaitaia, as part of the programme’s Outreach service.

3.36
As noted in paragraph 2.49 on page 39, ACC has appointed nine Pae Arahi to liaise between the Māori community and ACC. We discuss the Pae Arahi further in paragraph 4.24 on page 60.

3.37
Health service providers, such as physiotherapists and occupational therapists, provide educational seminars for case managers. The interaction between these professionals and case managers helps to maintain networks and an understanding of the policies that each has to follow.

3.38
Branches have started to assign individual case managers to health service providers, a practice that has worked well in some smaller centres. One branch we visited has also assigned case managers to larger-scale employers in the city to foster a relationship between ACC and the employer. This relationship facilitates the early return to work of any injured employees.

3.39
Employers we spoke to that had an ACC case manager assigned to them told us that they found the arrangement beneficial as they had one contact point at ACC who could respond quickly to requests for information.

3.40
Such an approach would not be practical in all places because of different employment types and employer sizes. For example, some branches service areas where there are no large-scale employers. While we recognise that such an approach to employer relations is not possible at all branches, in our view ACC should look at implementing closer ties between case managers and largerscale employers where possible.

3.41
In some cases, claimants use the services of a support group to facilitate communication with ACC. Use of such a group is either to assist communication with ACC where conflict has arisen, or simply to help them through ACC’s claims process.

Responsiveness to Māori

3.42
A review by Te Puni Kōkiri (TPK) published in 1998 found deficiencies in ACC’s case management service delivery to Māori. Among the deficiencies, the review found that ACC’s strategic direction for Māori was not sufficiently focused, and that … Meaningful and specific objectives for Māori are not widely included in business plans … The report also noted that Māori were under-represented among ACC staff, and that … service delivery initiatives focused on Māori have been small scale and ad hoc.²⁸

3.43
A follow-up report in 2001 found that, overall, ACC had made significant progress in addressing the findings of the 1998 review. However, the 2001 report said ACC still needed to work on areas such as:

• the recruitment of more Māori staff and staff with an understanding of Māori perspectives;
• the continuation of efforts to establish working relationships with whānau, hapū, and iwi;
• the further development of Māori providers; and
• data collection and evaluation.²⁹

3.44
We did not audit specifically whether ACC had improved in those areas identified by TPK. However, we saw what ACC was undertaking to improve its responsiveness to Māori, especially through initiatives to recruit Māori staff, and the establishment and maintenance of working relationships with Māori. Of the Māori development initiatives that ACC has introduced since TPK’s 2001 report, the most significant are:

• ACC‘s appointment in May 2003 of a Pou Arahi (General Manager Māori Development); and
• the adoption of an internal Māori Development Policy Framework (the Framework) at ACC’s August 2003 Board meeting.

3.45
The appointment of a Pou Arahi allows all of ACC’s Māori initiatives to be co-ordinated and consistent, which avoids duplication. The Pou Arahi will also identify initiatives that are effective for Māori and assist with their implementation throughout ACC. We consider that the appointment of the Pou Arahi was overdue in terms of providing ACC with a strategic Māori direction that was envisaged by the TPK reviews.

3.46
The Framework includes the following strategic goals:

• improving Māori awareness of, and access to, ACC services and entitlements;
• improving outcomes for Māori communities and claimants;
• improving organisational responsiveness to Māori;
• maintaining strong relationships with Māori stakeholders to contribute to effective delivery of ACC’s service obligations; and
• earning the respect of Māori; and other agencies as an organisation that delivers for Māori within the fields of core business.

3.47
ACC has said that it has incorporated an Operational Plan for the Framework in its Business Plan.

3.48
The Framework and Operational Plan have been introduced since the appointment of the Pou Arahi, and ACC is in the process of implementing them both. Accordingly, while we cannot evaluate the Framework’s effectiveness, ACC should continue implementing the Framework as a priority.

26: Accident Compensation Corporation Business Plan 2002-2003, pages 36-37.

27: Injury Prevention, Rehabilitation, and Compensation (Code of ACC Claimants’ Rights) Notice 2002 (S.R. 2002/390).

28: Te Puni Kokiri, Review of the Adequacy of ACC’s Service Delivery to Māori, January 1998, page 8.

29: Te Puni Kokiri, Follow up Review of the Accident Compensation Corporation’s Service Delivery to Māori, 2001, page 4.