In developing its first seven standards for implementation by all health service providers in Queensland, the Health Quality and Complaints Commission (HQCC)1 considered the questions raised by Brand and colleagues2 regarding health care standards. We believe that the HQCC standards fit the framework suggested by Brand et al in that they are regulated, the measures of processes and outcomes are quantitative, and the criteria used for their development are evidence-based. In seeking to minimise conceptual confusion, the HQCC has “regulated” existing clinical guidelines and health standards with the aim of improving the quality of health services by requiring providers to establish systems to monitor and report on key aspects of care. The standards address the following areas:

• Review of hospital-related deaths;

• Management of acute myocardial infarction on and following discharge;

• Surgical safety, including antibiotic prophylaxis, prevention of venous thromboembolism, and correct surgery;

• Hand hygiene;

• Credentialling and scope of clinical practice;

• Complaints management; and

• The duty of health providers to improve the quality of care.

The HQCC is now establishing a responsive regulatory framework to monitor compliance with the requirement for all health service providers to implement and maintain quality improvement processes.

Brand and colleagues are critical of initiatives that burden providers with data collection and potentially distract from efforts to improve quality.2 But we contend that, without collection, analysis and review of data, the capacity to improve quality is limited. Since July 2007, the HQCC has required all acute care facilities to regularly report against the standards. Our intention is not to make the HQCC into a data repository, but rather to ensure that providers have the ability and the motivation to measure and monitor their own performance. Nevertheless, as a consequence, a unique dataset has been created that reflects wide variation across the state. This approach aligns with the model of metaregulation (or enforced self-regulation) and triple-loop learning espoused by Healy and Braithwaite.3

Ultimately, the purpose of health care standards is to improve the quality of care and drive a culture of quality improvement. Although the HQCC designed its compliance framework to evaluate the impact of its standards on quality and culture of the health system over an extended period, there are already promising indications of a positive effect after only 12 months.