What Does a Good Ethics Review Look Like? Lessons from Australia

How do we know whether an ethics review is actually 'good'?

It sounds like a simple question. But research ethics systems tend to measure the things that are easiest to count: how many applications were reviewed, how long reviews took, whether the right processes were followed, and whether committees met particular requirements.

Those things matter. But they don't necessarily tell us whether the review itself was high quality.

Australia is now confronting this question as part of significant reforms to its research ethics system.

From a One Stop Shop to Quality Assurance

Australia is developing a National One-Stop-Shop intended to create a single national system for health and medical research approvals and reduce duplication across jurisdictions.

Alongside this, it is developing national Quality Standards and an Accreditation Scheme for Human Research Ethics Committees (HRECs) and their host institutions; which goes beyond the approval which the NHMRC provides.

A national system creates a fundamental question:

If one institution is going to rely upon an ethics review conducted by another committee, how does it know that review can be trusted?

Australia's answer is increasingly focused on quality assurance. Its proposed accreditation scheme is intended to demonstrate that recognised standards have been met and, importantly, to build “reciprocal confidence” in ethics reviews and approvals.

So what does quality look like?

Australia's Department of Health, Disability and Ageing has recently reported on its public consultation on the proposed Quality Standards.

The findings are interesting. There was broad support for the direction of travel. Around three-quarters of respondents said accreditation would increase their trust and confidence in ethics reviews, while 71% believed the Quality Standards would improve the ethics review process.

But respondents also identified something fundamental that still needs work (the age-old question in this field):

What exactly do we mean by “quality”?

The consultation provides some useful answers. High-quality ethics reviews were described as reviews that adequately considered the risks and potential benefits of research, as well as its regulatory and cultural context. Feedback to researchers should be accurate, appropriate and useful. Committees should be capable of dealing with difficult issues such as waivers of consent and the management of data and biospecimens.

Expertise matters. So does consumer and community input.

And quality isn't just about the decision made on a particular application. Respondents also pointed to the characteristics of the committee itself: transparency, appropriate expertise, good communication, efficient workflows, clear procedures, robust complaints processes and appropriate management of conflicts of interest.

In other words, quality is considerably more complicated than speed.

Fast isn't necessarily good. Slow isn't necessarily thorough.

There is understandable pressure on research ethics systems to become more efficient.

Unnecessary duplication and bureaucracy don't protect research participants. In fact, Australia explicitly identifies duplicated ethics review as something that can delay research, waste resources and undermine confidence in the system.

But efficiency and quality aren't interchangeable. A committee that approves an application quickly hasn't necessarily conducted a good review. Equally, a committee that takes months and sends researchers several pages of questions hasn't necessarily conducted a rigorous one.

A high-quality review might actually generate fewer questions because reviewers can distinguish between issues that materially affect participants and issues that are simply administrative or matters of personal preference.

Perhaps the better question is whether review is proportionate, rigorous and useful.

Quality also requires looking at ourselves

One aspect of the Australian proposals is particularly interesting. The draft standards envisage HRECs and their host institutions undertaking regular quality assessment of their own ethics review processes. The consultation also explored opportunities for committees to share their findings, discuss common problems and learn from one another.

Participants, researchers and communities may also have a role. Suggestions included seeking feedback from research participants, maintaining transparent complaints processes, gathering feedback from researchers and involving diverse community and consumer perspectives in accreditation.

This shifts quality assurance away from simply asking whether a committee complies with a set of rules. It asks whether the system is capable of learning about and improving its own performance.

There is, however, an important caveat. Ethics review does not happen without resources. Many ethics committees and the secretariats that support them already operate under considerable workload and resource pressures. Introducing accreditation, ongoing quality assessment, additional training, reporting and self-audit may improve the system; but each also creates work.

The Australian consultation recognised this tension. Respondents raised concerns about the potential cost and administrative burden of accreditation, and more than three-quarters acknowledged that implementing the proposed Quality Standards may be challenging.

This matters. If we want committees to do more than process applications, those activities need to be properly resourced. Otherwise, there is a risk that quality assurance becomes another administrative requirement placed on the very people we are asking to improve quality.

What could Aotearoa learn from this?

Australia and Aotearoa New Zealand have different research ethics systems. We shouldn't assume that an Australian accreditation model can simply be imported here. But Australia is asking a question that is equally relevant on this side of the Tasman.

As our own research ethics environment evolves, much of the conversation will understandably focus on standards, structures and which organisations are able to provide ethics review. Quality should be part of that conversation too.

How do committees train and support their members? How do they know whether reviewers are applying ethical principles consistently? Do they periodically examine their own decisions? Do they seek feedback? How do they demonstrate appropriate expertise and independence? And how do they know whether their review actually improved the ethical conduct of the research?

Because the goal should not simply be a system that can demonstrate that ethics review has occurred. It should be a system that can demonstrate why that review deserves to be trusted.

Additional reading

Australian Government Department of Health, Disability and Ageing (2026). Quality Standards for Human Research Ethics Committees (HRECs) and their Host Institutions: Report on Public Consultations 2025: https://www.australianclinicaltrials.gov.au/sites/default/files/2026-08/quality-standards-for-hrecs-and-their-host-institutions-report-on-public-consultations-2025.pdf

Australian Government – National One Stop Shop for Health and Medical Research: https://www.australianclinicaltrials.gov.au/national-reforms/accreditation-human-research-ethics-committees