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Well Child / Tamariki Ora Quality Improvement Framework

Updated 18 October 2019.


The Ministry of Health, in partnership with sector experts, developed the Well Child / Tamariki Ora (WCTO) Quality Improvement Framework in 2013, drawing on New Zealand and international research.

The Framework has three aims: focusing on family/whānau experience; population health and best value for the health system; and setting quality indicators to audit health system performance.

The Framework and quality indicators provide a mechanism to drive improvement in the delivery of WCTO services. Ultimately, they aim to support the WCTO programme to ensure all children and their families/whānau are supported to achieve their health and wellbeing potential.

Babies Living in Smokefree Homes at 6 weeks

Babies Living in Smokefree Homes at 6 weeks is part of the Well Child Tamariki Ora (WCTO) framework and this measure was confirmed as part of the System Level Measures (SLMs) suite from 1 July 2018.

Sector Consultation

The Ministry has been working with representatives from Plunket, Karo Data Management, Central TAS, Auckland and Waitemata DHBs, Tui Ora, Hapai Te Hauora and the South Island alliance to address data quality issues identified with this measure; including:

  • Development of a data standard which includes nationally consistent methodology for WCTO providers to gather information from caregivers on household smoking status, and the household smoking field being mandatory to complete.
  • Changes to IT infrastructure for accurate and consistent method of data collection and reporting
  • Contractual changes to enable successful implementation of the data standard.

The following documents were provided to all WCTO providers and all DHBs enabling them to implement the changes:

For users of the indicator Babies living at smoke free homes at 6 weeks post natal, please refer to the corresponding System Level Measures page.

2016 Review

Under the Framework, the quality indicators are reviewed every three years. The 2016 review included consultation with the sector. The Raising Healthy Kids Health Target, the sector System Level Measures and the New Zealand Health Strategy were considered as part of the review.

The key changes to the indicators are the reduction in the number of indicators from 27 to 18 - indicators were either retired because they had been consistently achieved or removed to streamline the data set - and the inclusion of indicators on screening for family violence and Sudden Unexpected Death in Infancy (SUDI) awareness.

Publication of quality indicators data

The 27 WCTO quality indicator set reports were published every six months between September 2013 and March 2016, for the reporting periods ending respectively 30 June and 31 December and remain available on the Ministry of Health website and the HQSC Atlas of Healthcare Variation.

Available below is the latest quality indicator report and historical reports back to March 2015 for the new 18 indicator set. These reports support WCTO health system partners to maintain their focus on quality improvement and system integration, both within and outside of the WCTO Quality Improvement Framework.

Users of the reports will note improvements in the way the information is presented incorporating a definition table; a data table with numerators and denominators; and, interactive graphs with results by both DHB and indicator, by Māori and non-Māori and Pacific and non-Pacific populations, and by regions. 

WCTO Quality Indicator Report - May 2019

WCTO Quality Indicator Report - November 2018 

WCTO Quality Indicator Report - March 2018 

WCTO Quality Indicator Report - September 2017

WTCO Quality Indicator Report - March 2017

WTCO Quality Indicator Report  - September 2016

WTCO Quality Indicator Report - March 2016

WTCO Quality Indicator Report - September 2015

WCTO Quality Indicator Report - March 2015