title: Culturally specific process measures to improve mental health clinical practice: indigenous focus.
abstract: OBJECTIVE
  In New Zealand and Australia, a renewed emphasis on equity and efficiency in the provision of mental health care has seen outcomes-focused, culturally appropriate clinical practice become essential within mental health services. Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes, however, is hindered by the difficulty of measuring the process of quality care delivery.
  
  
  METHODS
  This paper argues that it is the process of care delivery (i.e. what clinicians do to, and for, patients) that is critical to the effectiveness of treatment and the degree to which treatment either inhibits or promotes an improvement in mental health recovery. Identification of the underlying causes of poor achievement of process factors is likely to positively impact on things such as readmission rates, shared care initiatives, and ultimately patient recovery. Such attention could be the difference between low-quality service provision and a high-quality service provision with positive recovery outcomes for patients.
  
  
  RESULTS
  Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes for indigenous people, however, is hindered by the difficulty of measuring such concepts. Australia has indeed embraced 'culturally appropriate' practice in recent years, but this appears to be piecemeal when compared with New Zealand. Certainly, there are inconsistent and variable approaches to cultural practices with indigenous people when comparing the two countries.
  
  
  CONCLUSIONS
  Using evidence from a bicultural mental health nursing study that developed and validated generic and Mâori-specific (indigenous) clinical indicators for mental health nursing standards of practice in New Zealand, it is argued that the process of care delivery is equally as important as outcome measures when ascertaining the effectiveness of nursing care. Second, this paper contends that accurate process measures must be culturally responsive to indigenous and other ethnic groups.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. murapo@nus.edu.sg
authors.forename: Anthony P
authors.initials: AP
authors.lastname: O'Brien
authors.forename: Julie M
authors.initials: JM
authors.lastname: Boddy
authors.forename: Derrylea J
authors.initials: DJ
authors.lastname: Hardy
mesh_terms: D001315:Australia; D018864:Cultural Diversity; D006303:Health Services, Indigenous / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards*; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards*