Part 2: Better integrating evidence-based guidance

Accident Compensation Corporation case management.

In our 2014 report, we stated that ACC needed to better integrate its research on successful treatment and rehabilitation pathways into the tools and systems its case managers use.10 We considered that this integration would support more effective and consistent decisions.

ACC had extensive information on proven effective treatment and rehabilitation pathways. However, it did not use this information to inform case management decisions as well as it could have. In our view, the information needed to be more accessible for case managers and better directed into decision-making at the case level.

In our 2014 report, we recommended that ACC:

set out the standard possible treatment and rehabilitation steps for a given injury, based on scientific evidence, in the information systems that its case managers use – to ensure that all claimants in similar circumstances receive consistent and effective treatment and rehabilitation, based on proven treatment and rehabilitation pathways.

In this Part, we discuss ACC's response to this recommendation.

Summary of findings

Overall, ACC has made good progress in integrating evidence into the guidance material, tools, and systems that case managers use when making pathway decisions. Case managers in each Recovery team are now better positioned to make consistent and informed treatment and rehabilitation decisions that factor in the needs of claimants.

ACC has done this in the following ways:

  • It provides case managers with improved access to clinical guidance within standard processes and systems.
  • It gives providers guidance that is informed by a variety of clinical expertise. This guidance helps providers to have detailed conversations with claimants about their injuries and informs effective decisions.
  • It has learnt from trials where claimants have more input into decisions about their treatment and rehabilitation, and where all providers are involved from beginning to end. This can result in decisions that better factor in the claimant's full range of needs. In our view, this can lead to the claimant having more ownership of their treatment and rehabilitation pathway, which is more likely to lead to greater commitment to the treatment.
  • It has improved how it gets feedback from staff and providers on the quality and usability of the guidance. This helps ACC understand how consistently staff and providers use and apply the guidance. It also informs how ACC assures the quality of case management and helps it identify improvements that it can make.

We acknowledge the efforts that ACC has made. However, because no direct measure of providers' feedback on the guidance material is available, we were unable to assess the impact of the changes that ACC has made.

We encourage ACC to monitor the feedback it receives on the guidance from staff and providers more systematically. This could help it understand the extent to which changes to guidance influence overall satisfaction.

Providing staff with improved access to clinical and technical guidance

Case managers work with claimants when deciding on the most appropriate treatment and rehabilitation steps for a claimant. To make well-informed decisions, case managers need ready access to specialist expertise, as well as ACC's guidance and other resources.

Case managers can now more easily access clinical guidance and decision-making tools within the systems and processes they use.

Case managers can speak to clinical experts in the Clinical Services team through a phone hotline when they need to. The Clinical Services team can discuss specific cases, answer clinical questions, and provide direct guidance on less complex cases. ACC supports these clinical experts to keep themselves up to date with the latest medical thinking and research.

Case managers can also talk directly to the Technical Advisory team for guidance on policy matters, including treatment and rehabilitation policy and legislative requirements. This team is now centralised, which enables it to provide more consistent advice on these matters.

ACC knows the importance of continually improving these processes and systems. ACC has set up new ways for staff to provide feedback and suggest improvements, such as through a survey of staff every two months.

Staff feedback can often be about technology systems. ACC regularly considers and makes changes to these systems. Smaller changes to the processes that case managers use can be implemented more quickly. Suggestions for more extensive changes, or those that might have greater impact or wider applicability to customers, enter ACC's "continuous delivery" process for consideration (see paragraphs 3.55-3.56).

Providing support and guidance to providers of treatment and rehabilitation services

ACC gives providers guidance material to help them discuss the best approaches to treatment and rehabilitation with claimants. The guidance includes standardised pathway information for specific types of injuries. Because we are not clinical experts, we have not assessed the guidance material's clinical content.

However, the guidance material we saw was clear and easy to understand. It explained the injury, the path ahead, and who will be involved. In our view, it is likely to support a meaningful conversation between the claimant and the provider.

ACC works with a range of providers and professional clinical bodies to help it provide consistent high-quality standards of care. For example, ACC works with professional bodies to develop decision-making guidance for treating specific types of injury. These working relationships help ACC understand how accessible its tools and written guidance are.

We have not specifically sought providers' views on the effectiveness of their relationships with ACC or the suitability of the guidance they get. However, ACC reports its measure of provider trust and confidence in ACC publicly. This provides some insight into what providers think of ACC's support.

Performance for this measure over the last three years is still below target and has not shown any substantive improvement. Although this was not a specific focus of our follow-up work, we encourage ACC to reflect on whether it could do more to improve its relationships with the providers it works with.

ACC's 2018/19 annual report identified opportunities to improve the interactions between providers and ACC. ACC is working on initiatives to make it easier to lodge claims, improve communications, and simplify processes for claimant care.

Trialling team-based decision-making

ACC has been trialling an approach that gives providers more decision-making control when assisting claimants with straightforward needs and less complex injuries. These claimants are likely to be at the lower end of the spectrum of ACC case-management support.

The Escalated Care Pathway is a separate trial of team-based pathway decision-making. Providers work with claimants to make decisions together from injury to recovery.

The different providers supporting the treatment and rehabilitation of the claimant work together to make decisions throughout the overall pathway to recovery. The focus is on achieving a successful outcome for the claimant, rather than focusing treatment decisions solely on specific injury types.

ACC told us it is committed to learning from the Escalated Care Pathway trial and is incorporating what it learns into its approaches to decision-making.

In our view, this type of team-based decision-making is more likely to help identify the right pathways to suit a claimant's specific circumstances. We consider that claimants are more likely to feel more in control of their recovery pathway if providers work on decisions together with the claimant. This, in turn, should lead to claimants having greater commitment to their treatment and rehabilitation, potentially contributing to a quicker recovery.

10: A pathway describes what treatment and rehabilitation services a claimant needs and what order those services should be provided in.