The National Maternity Monitoring Group (NMMG) and the Ministry of Health have developed a formal process to appraise and ratify externally developed guidelines.
Appraisal and ratification process
Entry to the ratification process begins in one of two ways. Either guideline developers approach the Ministry directly to ask that their guideline be ratified, or the NMMG nominates guidelines that have come to their attention to go through the ratification process. In this case, the NMMG will direct the guideline developers to approach the Ministry to ask that their guideline be ratified.
The ratification process is as follows.
The internationally recognised AGREE II instrument will be used to review guidelines for potential ratification. This tool can be found on the Agree Enterprise website.
The guideline developer will apply the Agree II instrument to their guideline, noting the following addendum:
Domain 2: Stakeholder Involvement – Q4: The individuals from relevant professional groups should be nominated by the professional organisations rather than selected by the guideline developer.
Once the developer has met all the requirements of the tool, he or she will submit the guideline to the Ministry along with the results of the Agree II appraisal and supporting documents. An appraisal team within the Ministry reviews this material, and then writes a recommendation either endorsing or not endorsing the guideline. The appraisal team will submit this recommendation to the wider Ministry and the NMMG for consideration.
In making its recommendation, the appraisal team will consider:
- whether the guideline is appropriate for the New Zealand context
- the cost implications of the guideline, including the cost of supporting and disseminating it
- prioritisation of guidelines to ensure that once endorsed there is appropriate resource funding provided. This would ensure that there is a limit to the number of guidelines that are endorsed annually whilst allowing appropriate support and dissemination of each guideline.
If the NMMG approves the guideline, the Ministry will consider ratification, and if accepted, publish it on the Ministry website as national guidance. The service specifications for district health boards providing maternity services require the service to adopt any applicable national clinical guidelines that are endorsed by the professional colleges.
The Ministry reviews national guidelines five-yearly. It is the guidance developer’s responsibility to review sector-developed guidance, also five yearly.
Dissemination of ratified guidance will take place according to established Ministry processes. The Ministry will review the uptake of guidance through the Maternity Quality and Safety Programme.
The appraisal team
The Ministry of Health will appoint the appraisal team in each individual case in consultation with the NMMG. It will consist of a Ministry representative, and members from the New Zealand College of Midwives, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and any other college relevant to the guideline under consideration.
As part of the appraisal process, the relevant Colleges may choose to circulate the guideline to their membership for feedback.