If a health service organisation is to be child safe, child friendly and child aware, it should consider the broader healthcare setting and its own suitability to provide care for children.4,5
Why does this standard need special consideration by health service organisations that provide care for children?
To do this, health service organisations need to monitor and review the care provided to children to ensure thorough and effective clinical governance. Further, the workforce requires specific knowledge, skills and expertise in areas of child health and wellbeing, growth and development, parenting support, and working in partnership with children and their families.6
Effective governance in health service organisations that provide care for children ensures that:
- The rights of children are promoted and protected using the Charter on the Rights of Children and Young People in Healthcare Services in Australia7
- Children and their families are given opportunities to provide feedback on their experience of care to improve the quality of healthcare services
- The workforce has the relevant skills, knowledge, experience and access to clinical guidelines to provide safe child- and family-focused health care
- The workforce has access to, and complies with, relevant paediatric clinical guidelines
- The setting is suited to and safe for children
- Environments in which children receive care are safe, and meet their physical, mental and psychosocial needs.
Criterion: Governance, leadership and culture
Leaders at all levels in the organisation set up and use clinical governance systems to improve the safety and quality of health care for patients.
The workforce is required to clearly understand, and be equipped for, their roles and responsibilities in caring for children. This could be achieved by outlining roles and responsibilities in position descriptions, duty statements or employment contracts for clinicians responsible for providing care for children.
Health service organisations delivering health services to children should embed strategies that support a child-safe culture and organisation through leadership on:
- Creating a child safety policy or statement of commitment to child safety
- Creating a code of conduct that establishes clear expectations for appropriate behaviour with children
- Using screening, supervision, training and other human resource practices that reduce the risk of child mismanagement or abuse from the workforce9
- Developing a culturally safe workplace
- Building a workforce that is supported to fulfil their roles and responsibilities.
There are large disparities in health outcomes between Aboriginal and Torres Strait Islander children and other Australian children, including life expectancy, birth weight, child hospitalisation, youth trauma and rates of chronic disease.10 Health service organisations need to ensure that they meet the needs of all Aboriginal and Torres Strait Islander children and their families. To do this, high-quality, evidence-based child and family health services delivered to Aboriginal and Torres Strait Islander people must be informed by a holistic approach that recognises the diversity and strengths of Aboriginal and Torres Strait Islander people and culture.11
Health service organisations should refer to the National Framework for Health Services for Aboriginal and Torres Strait Islander Children and Families when developing policy, designing programs and implementing services to meet the needs of Aboriginal and Torres Strait Islander children and families. The framework articulates a vision and principles for the delivery of child and family health services to Aboriginal and Torres Strait Islander children and families across Australia.11
Criterion: Patient safety and quality systems
Safety and quality systems are integrated with governance processes to enable organisations to actively manage and improve the safety and quality of health care for patients.
Policies and procedures
Policies, procedures and protocols should include processes for identifying children at risk of harm from health care. Specific consideration should be given to address the risks associated with children’s privacy and safety, including:
- Minimising non-essential exposure of children to people not authorised to provide their care – for example, ensuring the unit is secure and there are processes to approve all visitors
- Implementing physical screening to promote privacy when possible; for example, screening of bench spaces used for nappy changes
- Promoting safe sleeping practices to prevent adverse events; such as
- the use of cots and beds that are appropriate to child’s size
- ensuring there are no ligature or entrapment points on beds and cots
- educating parents about safe practices
- implementing strategies to prevent sudden unexpected death in infancy
- Developing organisational policies about co sleeping arrangements based on the best available evidence and guidelines
- Detailing requirements for mandatory reporting
- Promoting children’s rights to use electronic devices, but balancing this with the risks they pose to privacy and safety.
All members of the workforce, including any non-clinical members, who provide care or services to children should comply with relevant state or territory ‘working with children check’ schemes. A health service organisation may ensure this by:
- Reviewing workforce participation in required child protection training, and renewing checks against state and territory requirements
- Ensuring every relevant member of the workforce undertakes a working with children check, criminal record check or police background check on recruitment and on an ongoing basis, as per state or territory requirements
- Reviewing workforce members’ disciplinary, complaints and conditions history.
Organisations should consider introducing activities that develop the resilience and capacities of children outside the care setting. This may include education, play, mental stimulation and physical activity.
Measurement and quality improvement
The recording and analysis of data to adequately recognise issues affecting children, and then responding appropriately, is important for health service organisations that provide care for children. Information about adverse events and safety investigations should be analysed for each age-specific grouping, developmental stage and service context.
To optimise the collection and analysis of data relating to children, health service organisations may consider:
- Ensuring data are collected on the age and physical and emotional developmental stage of each child
- Ensuring personnel assessing adverse event information are knowledgeable and skilled in the care of specific age and developmental groupings
- Ensuring analysis of adverse events data about whether the physical setting was appropriate given the child’s size and developmental stage.
Incident management systems and open disclosure
When an adverse event involves a child, the clinical team will, together with the family, need to make an informed assessment of what the child should be told about the event. In the case of young people who may have legal competency, the team will need to weigh up the young person’s maturity in the decision-making process.
The clinical team should assess the involvement of young people in the open disclosure process on a case-by-case basis, taking account of whether the child is mature enough to receive the information and considering the wishes of the young person and the family, if appropriate.12
Feedback and complaints management
Feedback on the experiences of the child and family is an essential part of the quality improvement system. However, for children, opinions and views about experiences of health care are often sought from families rather than the child.13,14 While there are some circumstances in which proxy feedback is necessary, such as for very young children, health service organisations should consider how children can express their views in ways that are appropriate to their developmental stage and age.14 This may include:
- Reviewing consumer feedback systems and removing barriers that prevent children from providing feedback
- Using child-specific tools and technology such as animations, pictures and visual scales for the collection of feedback from children
- Engaging children and their families in focus groups to design surveys suitable for children
- Seeking out children’s opinions and preferences about providing feedback.
Criterion: Clinical performance and effectiveness
The workforce has the right qualifications, skills and supervision to provide safe, high-quality health care to patients.
Credentialing and scope of clinical practice
Credentialing and defining the scope of clinical practice are essential processes to ensure that the workforce has the relevant knowledge, skills, experience and expertise to deliver safe, high-quality care. Processes for credentialing and defining the scope of clinical practice should specifically look at and document clinicians authorised to care for children.15 To do this, review panels should include clinicians with relevant paediatric skills and experience.
The health service organisation should ensure clinicians have ready access, either electronically or in hard copy, to clinical guidelines that meet the needs of children. Health service organisations should assess the effectiveness of clinical guidelines and support clinicians to use the best available evidence to provide safe, high-quality care.16
Criterion: Safe environment for the delivery of care
The environment promotes safe and high-quality health care for patients.
Projects to design or redevelop care environments should take into account relevant feedback and the physical, mental and psychosocial needs of children and their families. Health service organisations should consider:
- Accommodating children separately from adults to meet their unique needs and minimise the risks of harm
- Providing access to facilities for approved family members to accompany a child, including rooming-in
- Ensuring spaces for children and their families are culturally safe and appropriate
- Providing age-appropriate environments that incorporate bright colours and soft edges
- Providing dedicated communal play areas with play equipment that is age and developmentally appropriate, and in good working order
- Using equipment that meets relevant national or international safety standards and is designed to meet children’s needs, including size and developmental age (for example, the height and placement of cots, toilets, sinks and hand sanitiser)4
- Implementing service-specific policies on the requirements for visiting children for employees, visitors and volunteers to minimise children’s exposure to risks
- Eliminating ligature, strangulation or entrapment risks for smaller bodies and limbs
- Minimising restrictions on movement of children, especially for children with developmental delay or mental illness
- Designing spaces to prevent adverse events relating to self-harming actions – for example, by installing safety glass
- Minimising exposure to potentially distressing sights or sounds
- Considering lighting requirements, including ensuring good lighting in areas where medications are dispensed and adjustable lighting to take into account children’s sleeping and resting needs.
Children can experience fear when exposed to new surroundings. To mitigate this risk, health service organisations may provide children with separate spaces that make use of the approaches outlined above. These spaces may be included in areas like emergency departments, medical imaging departments and operating theatres.