The consumer engagement quality and safety marker (QSM) seeks to answer the question ‘What does successful consumer engagement look like, and (how) does it improve the quality and safety of services?’.

Please click here to view the consumer engagement quality and safety marker.


Download the consumer engagement QSM framework
(132KB, pdf) 


Visit the data
submission page

The Ministry of Health’s annual planning and statement of performance expectations guidance for 2021/22 advises:

Improving consumer engagement

Progress the implementation of the quality and safety marker (QSM) for consumer engagement by:

  • Continuing to support the governance group (or oversight group) of staff and consumers guiding implementation of the marker.
  • Report against this QSM twice-yearly (Q1 and Q3) via the online form on the Commission’s website using the SURE framework as a guide. 

For Q1 this will be by 30 September 2021, Q3 will be by 31 March 2022.

If you have any technical queries, contact:

  • What is the goal of this quality and safety marker?

    The goal of this QSM is to address ‘what does successful consumer engagement look like, and (how) does it improve the quality and safety of services?

  • What is the framework behind this QSM?

    A framework underpinning this QSM has been developed: Supporting, Understanding, Responding and Evaluating (SURE). The SURE framework focuses on four areas:

    • Supporting: What is in place to support consumer engagement?
    • Understanding: How do organisations make sense of what consumers are telling them?
    • Responding: What has been done to respond to what consumers have said?
    • Evaluating: What has been the impact of these interventions?

    By completing the form above, you are contributing to the ‘SURE’ framework.

    There are three domains to rate:

    1. Engagement: The environment created to support community engagement | Te Tūhononga: Ko te taiao kua hangaia hei tautoko i te tūhononga hapori
    2. Responsiveness: Responding to and acting on what consumers are saying about the service and having the right information at the right time for consumers accessing services | Te Noho Urupare: Ko te urupare, ko te mahi i ngā kōrero a ngā kiritaki mō te ratonga me te whai i te mōhiohio tika i te wā e tika ana mō ngā kiritaki e uru ana ki ngā ratonga
    3. Experience: The systems in place to capture consumer experience, and act upon the results | Wheako: Ko ngā pūnaha kua whakaritea hei mau i te wheako kiritaki me te whakatinana i ngā mahi i runga i ngā hua.
  • How do I assess where my organisation is at?

    There are four possible ratings for each domain:

    1 – minimal | te itinga iho
    2 – consultation | te akoako
    3 – involvement | te whai wāhi
    4 – partnership & shared leadership | te mahi tahi me te kaiārahitanga ngātahi

    Download a detailed description for each rating (132KB, pdf).

    To support your rating, there is an opportunity to comment on why a rating was chosen, and upload examples to support this rating. It is important to note that these will be available publicly.

    Existing data (including demographic data) from the adult inpatient experience survey and primary care experience survey will be included with the QSM.

    It is less important what the final rating is, it is more about understanding where the organisation is so that improvements can be made over time.

    The pilot sites have found various ways to collect district-wide information. Each pilot site developed a form or survey to send to different services. These are available directly from the pilot sites. (see ‘buddy system’ under ‘who developed this QSM and how can I access support?’).

    It is not essential to focus on every service, and this may not be practical to start with. The pilot sites did find ways to capture this information and can offer advice on how this was achieved. Counties Manukau Health developed a survey and a template for collecting organisation-wide information.

  • What are the principles behind this QSM?

    What are the principles behind this QSM?

    In the development, maintenance and monitoring of this framework the following principles were developed by the consumer engagement QSM reference group:

    • Authentic partnerships between consumers and providers underpin all interactions
    • Suitably prepared consumers are resourced and supported to engage in all processes
    • People understand that the driver for the marker is improvement of consumer engagement and equity
    • Ethically sound values guide engagement
    • Processes are open and transparent
    • The articles of Te Tiriti underpin all aspects of this framework

    The Health Quality & Safety Commission’s understanding of the articles of Te Tiriti o Waitangi and how these are applied to our work are described below:

    Kāwantanga – partnering and shared decision-making

    Our work is informed and shaped equally by tangata whenua and tangata Te Tiriti worldviews and perspectives.

    Tino Rangatiratanga – self-determination

    We recognise the importance of tangata whenua authority and autonomy. We support tangata whenua led processes, actions and decision making, through sharing power and resources.

    Ōritetanga – equity for tangata whenua

    We undertake specific actions to ensure equitable outcomes for tangata whenua and we recognise that these actions can also support equitable outcomes for other groups.

    Wairuatanga – upholding values, belief systems and worldviews

    Tangata whenua worldviews, values and belief systems are prioritised in our work.

  • Who developed this QSM and how can I access support?

    This QSM was developed in partnership with a QSM reference group and the Commission. The four pilot sites were Counties Manukau Health, Waitematā, Waikato and Canterbury DHBs.

    In addition to contacting the Health Quality & Safety Commission directly, a ‘buddy system’ has been set up to pair pilot sites with other DHBs to assist you:

    Consumer support can be sourced via your local DHB or PHO consumer councils or community networks. You can also contact the Health Quality & Safety Commission to request assistance from its consumer networks.

    Health Navigator New Zealand can assist through its health consumer advisory service. This service is part of the Ministry of Health’s initiative to increase engagement of consumers in the design, planning and development of services throughout New Zealand. Contact Susie at Health Navigator:

  • How much supporting documentation do we provide for each domain?

    It is possible to provide up to five examples as supporting documentation for the chosen rating. There is also ‘free text’ available to describe the rating.

    If the file size is too large, there is provision to upload larger files to a file-sharing service. All uploads are stored locally. For more information contact:

  • When can I complete the rating and upload information?

    Please report by March 2021. Although data can be submitted at any point during this time period, please note that data not submitted by Q3 (ie, by March 2021) cannot be included in the baseline report. 

  • Definitions of a consumer, co-design and equity


    Co-design is an important part of a process to identify a challenge or opportunity engage people; consumers, whānau, family and staff, capture their experiences and ideas, organise the learning that it brings to create new understanding and insight from the perspective of the care journey and emotional journey, stay together in partnership to review learning and ideas, plan and implement improvements then finally; review what difference that has made.

    Adapted from Partners in Care co-design programme with Dr Lynne Maher, 2020.


    Consumer can refer to an individual citizen or member of a community, patient, family, whānau, carer or tangata whai ora. This is not an exhaustive list, and it is recognised that a range of terms are used by different groups and communities. For consistency, consumer has been adopted for this QSM.

    A more detailed description of the consumer definition can be found in our document Consumer definitions for the Partners in Care programme.


    In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.

    This definition of equity comes from the Ministry of Health and was signed-off by Director General of Health, Dr Ashley Bloomfield, in March 2019.

  • Can I adapt the consumer engagement QSM framework for my service?

    For consistency, please complete the consumer engagement QSM according to the framework outlined. This does not prevent your service tailoring the framework to suit local needs. Canterbury DHB developed a framework to introduce the QSM, and Waitematā DHB added health literacy to the QSM framework.

  • How do the articles of Te Tiriti o Waitangi underpin this QSM?

    The articles of Te Tiriti o Waitangi were actively engaged with at every step of the QSM’s development. The descriptors contained within each rating were developed with a Te Tiriti lens in mind (eg, understanding experiences of whānau and acting on these experiences, having a workforce reflective of your population, broad involvement of the community).

    The 2020 Te Tiriti framework is one interpretation of how to further apply a Te Tiriti lens to the consumer engagement QSM and will assist when providing examples of upholding the articles of Te Tiriti at a local level. For instance, examples of active engagement with tangata whenua and demonstrating a partnership approach are more likely to be rated as a ‘partnership and shared leadership’ activity for an area if the example uploaded can demonstrate an authentic partnership. An organisation which understands and upholds the principles of Te Tiriti is more likely to demonstrate strong consumer engagement. This particular interpretation was informed by Ministry of Health guidance and the recommended principles of WAI2575.

Webinar recordings

Webinar 1: About the consumer engagement quality and safety marker

Download a copy of the accessible transcript (65KB, docx)

Webinar 2: Experiences of the pilot sites

Download a copy of the accessible transcript (65KB, docx)

Last updated 30/06/2021