ENSURING the quality of health services is as much the responsibility of the individuals offering them as of the systems
and organisations in which they take place, Director-General of Health Dr Karen Poutasi says.
"Quality resides with both the individual as well as the hospitals and involves not only the development of appropriate
regulations, but also ensuring doctors having the right systems in place to ensure they can safely manage and deliver
new technology," Dr Poutasi said today
"Nuchal translucency is a case in point. It's been known for some time that some foetuses with some chromosomal
abnormalities have thickening around the back of the neck which is visible on ultrasound examination of the pregnant
mother at around 12 weeks.
"Development and refinement of the technique has subsequently given foetal medicine specialists tools to measure the
thickening, and they then use the measurement to estimate the risk of certain chromosmal abnormalities such as Down
"Hence some NZ specialists, following the lead of their British counterparts, have begun to use this advance to offer
pregnant women another way of screening for such conditions.
"Initially they trained under the supervision of the British specialists who developed the technology. They continue to
work with them, ensuring that informed consent and appropriate counselling are available and feeding back their results
for peer review and quality assurance.
"Screening always involves false positives and false negatives. Patients being offered screening must be informed of
"This is exactly the sort of approach the health sector should have - quality assurance programmes alongside the
introduction and development of new technologies."
"However nuchal translucency measurement has also been taken up by other health professionals who are not plugged into
the quality assurance programme. This is a real concern. Now that it has been brought to our attention, we are
discussing the best way of dealing with it to ensure that quality is built in wherever nuchal translucency is
"All parents-to-be want to know their baby is healthy and whole. There will always be a demand for options which offer
reassurance on this score. It is essential that as any such screening tests are developed quality assurance keeps pace
"We are already working on quality assurance and improvement with the introduction of the Health and Disability Services
Safety Bill. This Bill provides a regulatory framework for safety and quality assurance.
"However it is equally important that hospitals continually focus on quality improvement systems, including
credentialling which is another mechanism for ensuring professionals are competent to manage and safely deliver new
technology as it is introduced, and it is important that professionals are credentialled to use that technology. Some
hospitals already have credentialling processes in place, others are working on them.
"Quality is a multifaceted issue, and hence requires action at many levels. It behoves all of us working in the health
sector to ensure quality is built into everything we do in our professional lives and that we build systems to focus on
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