Improving the quality of mortality review equity reporting: Development of an indigenous Maori responsiveness rubric.

ABSTRACT

OBJECTIVE: To improve consistency in New Zealand's Mortality Review Committees' (MRCs) analysis, interpretation and recommendations, specifically related to equity and Maori (the Indigenous peoples of Aotearoa New Zealand) mortality. DESIGN: A qualitative Plan-Do-Check-Act design informed by Maori expertise to develop a rubric and guidelines. The rubric and guidelines aimed to improve MRCs' capability to analyse mortality data, its interpretation and the recommendations for preventing deaths. SETTING: New Zealand's MRCs make recommendations to address preventable deaths. Variation existed between the MRCs' understanding of equity, and its application to reduce avoidable mortality for Maori, which subsequently influenced their analysis, reporting and the recommendations generated. Improving the quality and robustness of MRCs' recommendations and reporting are crucial for improving equity. PARTICIPANTS: Maori Caucus (comprising MRC members with Maori health and wellbeing expertise) designed the rubric and guidelines with input from the secretariat and other MRC Chairs and members. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) None. RESULTS: The rubric comprises four key 'pou' (metaphorical posts or domains) 'Tika' (doing things right); 'Manaakitanga' (caring compassionately); 'Mana' (status, authority); and 'Mahi tahi' (working collaboratively); and criteria for three levels of practice. Evaluation of the efficacy of the use of the rubric and its implementation showed further education and support was required. CONCLUSIONS: A shared understanding of equity about mortality is required. Effective implementation of a quality-based rubric into practice requires careful planning and ongoing education and support for staff and committee members at multiple levels. Follow-up support is needed to support its implementation into practice.