Service Quality Framework

8/8/2019 Service Quality Framework

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Service Quality

Framework

February 2002


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Published by the Policy and Strategic Projects Division

Victorian Governm ent Departm ent of Hu man Services,

Melbourne, Victoria

Also published at:

ww w.KNet/ PolicyStrategicProjects/ QualityinServices

February 2002

(0560701)

Copyright State of Victoria 2002

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Contents Forword iv1. Introduction 1

2. Commitment to Service Quality 2

3. The Framework: Summary 3

4. Defining Service Quality 5

5. The Building Blocks of Quality Management 6

Key Category 1: Service User Responsiveness 7Key Category 2: Staffing and Physical Resources Quality 9

Key Category 3: Quality Assurance: Standards and

Monitoring 11

Key Category 4: Safety and Adverse Event Management 13

Key Category 5: Qu ality Im provem ent Processes 15

6. Implementing Department-Wide Service

Quality Infrastructure 17

Debating Quality, Developing Leadership 19Department and Program Qu ality Management Structures 19

Planning for Quality 20

Reporting on Quality 21

Service Quality Performance Measurement 21

Attachment: Outline of the Quality in Services

Flagship Project 22

Developing Quality Services > Service Quality Framework

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ForewordI am very pleased to introdu ce the first

Department-wide Service Quality Framework.

The Framew ork was d eveloped by the Quality

in Services Flagship Project with contr ibutions

from m anagers and staff across the

Department. The Frameworkis designed to

guide the d evelopm ent of quality systems and

initiatives across the Departments program

portfolio and encourage the tran sfer of qu ality

man agement expertise between programs.

The goal of such efforts is to continu ously

improve the quality of services to our clients

and patients.

The Executive of the Department formally

initiated th e Flagship Project in Jun e 2001. In

deciding to develop a Service Quality

Frameworkdu ring 2001, the Executive was

keen to build on an d imp rove the quality

man agement systems that already op erate in

the Departm ent. The Framework is intended

to encourage a more comprehensive and

consistent app roach, rather th an over-ride the

good w ork already und erway.

The Framew ork establishes dimensions of

quality that d efine what w e mean by service

quality. Drawn from the quality managemen t

literature and case pr actice, the ad option of

these dim ensions will ensure a consistent

language across the Departm ent and p rovide a

frame for the developm ent of stand ards and

measu res of service quality.

The Framework identifies building blocks of

quality managementthe categories of

practical action for quality assurance and

improvem entand p rovides suggestions for

measuring progress, and examp les of practice,

in each of these categories:

Service user responsiveness

Staffing and physical resources quality

Quality assurance: standards and

monitoring

Safety and adverse event management

Quality improvement processes

Finally, the Framework outlines the features of

continuous quality improvement that

contribute to a culture of quality at the

organ isational level. Over the next year,

Departm ent-wide initiatives to strengthen a

culture of quality will include:

Opportunities for information sharing and

discussion on qu ality managem ent

initiatives and systems, includ ing a seminar

series

Establishment of a Quality Executive to

drive implementation of the Service Quality

Framework at senior level across the

Department

Developm ent of the service quality element

of the Agency Performance Monitoring and

Review instrum ent for implementation from

2002/ 03

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Using the Framework

Executive Directors and Directors have been

asked to ensure that the Framework is

reflected in program policy and business

structures. Each Division will:

Develop appropriate organisational

structures at senior managem ent level to

drive and monitor quality improvement in

Divisions and/ or programs, where such

structures are not already in place;

Develop quality strategies or action plans,

that reflect the dim ensions of quality and

building blocks identified in the Service

Quality Framework, wh ere such

docum entation has not already been

developed;

Liaise with the Quality in Services Projectstaff and Business Development Branch on

the developm ent of a reporting format to be

incorporated into program quarterly

performance reporting to Executive from

Jun e 2002. It is expected that the rep orts w ill

illustrate progress against milestones

identified in the plans or strategies.

I am aware that m any programs already h ave

specific quality man agement structures and

have developed service quality strategies, or

are in the process of doing so. Where such

initiatives have not yet been taken, program

man agers may find it helpful to consult the

Qu ality in Services Flagship Project Group

mem bers and staff.

Further w ork on Regional quality management

issues will be a key element of the Quality in

Services Flagship Project du ring 2002. A

Regional Quality Management Group will be

established to guid e this work.

Finally, this Framework is an important

quality managem ent milestone for the

Departm ent, but it is not an end point. Its

future developm ent will be informed by the

work undertaken across the Department on

service quality p olicies, strategies and

imp rovem ent projects. Ou r d irect service

man agement challenges, engagement with

external agencies and the w ork of the new

Operations Division will all provide essential

feedback for improvement of the Framew ork.

I comm end the Service Quality Framework to

all Department staff.

PATRICIA FAULKNER

Developing Quality Services > Quality In Service

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page vi


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1. Introduction

The Department of

Human Services strives

to provide aged care,

health, housing, disability

and community services

of the highest quality.

The Department iscommitted to constantly

seeking new ways to

improve its services,

consistent w ith i ts

mission:

To enhance and protect

the health and wellbeing

of all Victorians,emphasising vulnerable

groups and those most in

need.

The Departments service environment is complex, reflecting the

diverse needs and aspirations of the commu nity to wh ich it

seeks to respond. Continuou s quality improvement w ill require

a Dep artment-wid e effort an d a ran ge of strategies carefully

tailored to the specific needs of program s and regions.

Many factors together determine the qu ality of provided or

fund ed services: quality dep ends p artly on the skill of trained

hu man services professionals and supp ort staff. It is guided by

docum ented service standard s and th e efforts mad e to monitor,

measure an d continu ously improve service performan ce. Good

quality service conform s not on ly to excellent technical

standard s, but is also responsive to individu al needs and

cultural norms. Efforts to protect clients and patients from error

are vitally important to service quality.

This Department-wide Service Qu ality Framew ork has been

developed to strengthen efforts to make m easurable

improvements over time to the quality of services to clients and

patients.


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2. Commitment to Service QualityThe Departmen ts commitment to improvem ent in service

qu ality is reflected in its 200102 Depar tmen tal Plan: a key

Departm ental objective is that th e qu ality of h um an services

improves each year.

In Jun e 2001 the Departm ent ad opted organisational values and

behaviours to guid e its day- to-day activities:

Acceptable behaviours that express the individual v alue of

Quality includ e:

Looking for ways to imp rove how things are done.

Identifying and implementing actions to improve quality.

Establishing high standards and working to achieve them.

Encouraging others to find better ways to get things done.

Consistent service quality in a comp lex environmen t requires a

concerted strategic effort to sup port this und erlying value and

the behaviours required of all Departm ent staff.

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3. The Framew ork: SummaryThe Service Quality Framework gives

expression to the Departmental Objectives and

Values, and is focused on th e service quality

experienced by the client or patient. It is

intended to complement other Department-

wide policies and strategies, including

Program Effectiveness Reviews and the

Agency Performance Monitoring and Review

Framework.

This first Departmen t-level Framew ork bu ilds

on the w ork of program s and regions. It is a

milestone, but not an end point. Program-level

service quality po licies, strategies and Priority

Action Projects, and the Departments

engagement w ith external stand ards agencies,

will continue to inform the future

developm ent of the Framew ork. The work by

Operations Division an d Regions on direct

service man agement, service plann ing and

agency partnerships will provide essential

feedback for continuou s quality improvem ent.

Operations and regions:service quality planning

and monitoring

Program-based qualitypolicies and strategies

Service QualityFramework

Our Values

External framework: quality,safety & accreditation

A comprehensive approach to Service Quality


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The Service Quality Framework will:

1. Define the dimensions of quality, to

ensure a consistent language in quality

man agement and to provide a basis for the

ongoing d evelopment and maturation of

quality measures and indicators.

2. Provide a practical framew orkthe

building blocksfor program management

to achieve high stand ards in each of the

dimen sions of qu ality:

Service user responsiveness.

Quality staff and facilities.

Quality assurance: service standards and

monitoring.

Patient/ client safety and adverse event

management.

Quality improvement processes.

3. Propose Department and program

infrastructure , building on current

initiatives, to consolidate and report on

strategic quality managem ent.

These elements of the Service Qua lity

Framework are dep icted below:

Monitoring of the implementation and further

developmen t of the Framew ork will be the

respon sibility of the Quality Executiveout lined in section 4.4.

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Effectiveness &

Capability

Safety

Appropriateness

Fairness

Acceptability &

responsiveness

Accessibility &

timeliness

Continuity

Sustainability

Good management

& efficiency

DimensionsofQuality

Defining Service Quality

Dep artment-wide infrastructureBuilding a Culture of Quality

Debating

quality,

developing

leadership

Quality

management

structures

Planning for

Quality

Reporting on

Quality

Quality

Monitoring

and Review

Service Use-

Responsiveness

Qu ality Staff &

Facilities

Quality Assurance

includ ing accreditation

Effectiveness &

Capability

Effectiveness &

Capability

Quality Management

Building Blocks

Quality

Services,

Quality

Outcomes


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4. Defining Service QualityManagement for service qu ality m ust give attention to the following

dimen sions of qu ality:

Ideally, these dimensions provide a fram ework for the d evelopm ent of

standard s and measures relating to service quality outcomes.

It is acknow ledged, how ever, that the developm ent of service quality

outcome m easures and indicators in h um an service settings is in its

early stages, even in clinical sectors. While efforts to streng then a focus

on ou tcomes w ill continue, the prim ary emp hasis in the imm ediate

term is likely to be on milestones toward the d evelopm ent of service

quality systems and imp rovements in quality man agement.


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Effectiveness and capability: the ou tcome desired by the client is

achieved w ith the requisite standard of skill, knowledge and

tangible facilities.

Safety: risks are accurately assessed, avoided or m inimised.

Appropriateness:justifiable intervention, relevant to the needs of

client/ patient, are provided in the least restrictive way and based

on established standard s.

Fairness: services are provided according to th e rules and to those

for whom they are intended, withou t partiality or favouritism.

Acceptability/Responsiveness:a respectful and caring ap proach,

compliance with clients rights, the offer of useful information and

relevant choices, and the encouragement an d gen uine

consideration of feedback.

Accessibili ty and timeliness: services are provided according to

need at the right time and place for service users.

Continuity:continu ity of care is assured across

agencies/ programs, and over time.

Sustainability:stable reliable provision and consistent

improvem ent of services, responsive to emerging n eeds.

Good management/efficiency: services are planned and well-

organised, perceived to be cost effective and administratively lean.


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5. The Building Blocks of Quality

ManagementFor service management to achieve a high an d improving level

of quality, as defined above, a full range of quality management

actions need to be emp loyed.

The basics remain the d evelopm ent and maintenance of a

qualified, skilled w orkforce and developmen t of d etailed

standard s and reporting arran gements, but effective qualityman agement now embraces mechanisms to prom ote clients

interests and incorporate their views. Efforts to establish and

prom ote good p ractice in service delivery are now common

features of program man agement. The active prevention and

man agement of injury to clients and patients is integral to

service qu ality.

Quality assurance and improvem ent is the responsibility of all

sections of the Department: regions, corporate services and

program man agement. While policy, service stand ardsdevelopm ent and best practice fund ing are the responsibility of

program Divisions, these are not the only fun ctions impor tant to

quality management.

The feedback loop carrying d ata from program implementation

and service pr actice is vital for qu ality imp rovement, and is

substantially th e responsibility of regions an d those un its that

manage critical incident reporting, ministerial correspondence,

complaints systems and performance information.

Further, the service qu ality literature emp hatically sup ports

decentralised quality initiative at regional and service provision

level. In practice, there are nu merou s examples of local initiative

across all Departmen t regions. The imp lementation of the

Service Quality Framework will seek to strengthen local

initiative and the potential for cross-Departmental learning. The

establishment of th e Op erations Division will strengthen this

effort w ith its critical mission to im prove service delivery,

especially in directly managed services.

The key categories of quality management action are detailed in

the following pages.


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Key Category 1:

Service User

Responsiveness

M easures to secure client

or patient opinions or

involvement, measure their

experience and safeguard their

interests.

1.1 Patient/ client survey

1.2 Complaint and

compliment mechanisms

1.3 Codes/ Charters of

service quality and/ or

clients rights

1.4 Systematic adv ocacy,

independent scrutiny

1.5 Client/ patient

participation in p rogram

planning an d d ecision

making

Achievement Measures

The interests of the hum an services user are the p rimary focus of

service m anagement. Pr actical efforts by p rograms to encourage

responsiveness may be gu ided by the following:

The active and independent participation of service users in

decisions about their ow n care and treatment is encouraged

and enabled.

Service users are fully informed about service options and

entitled to provid e feedback and m ake comp laints about the

quality of services at any time, without prejudice or

obstruction.

Service users have access to independ ent complaints

mechan isms tha t meet th e Australian Stand ard AS4269-1995.

Service users, their families, carers and friends are encouraged

and assisted by the Departm ent to participate in the planning,

delivery and evaluation of human services. Specific efforts

will be mad e to secure the involvement of Koori persons andthose from non -English sp eaking backgrounds.

Programs and services systematically plan and implement

service u sers surveys, analyse and develop strategies to

address service user concerns.

Current Practice and Developments

Surv eys of patient and client experience are widespread through

Department programs:

The Commu nity Health Client Outcomes Survey, which has

been trialled th rough four centres to date and will be rolled

out further through 200102.

The Patient Satisfaction Monitor, in its second year of

operation, provides for regular, ongoing, mon itoring an d

repor ting of pa tient satisfaction in key areas of service

delivery in Victorian hospitals. It enables the Department to

report results to hospitals on both an aggregate and

individu al hospital basis.


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The Child Protection Client and Family

Survey focused on the client/ carer s

experience of the service. It has been

prov ided to 450 clients and 450 family

members in 200102.

The National Social Housing Survey is a

national rand om su rvey of social housing

tenan ts (app rox. 1000 per State) which seeks

respon ses on client satisfaction, experience

of tenancy practices, estate management

and security.

The annual Drug & Alcohol Client

Satisfaction Surv ey seeks respon ses on client

experience, perceived benefits of treatment,

and barriers to outcomes, from users, family

and significant oth ers. It is condu cted by

indepen dent sur veyors, using a database of

consenting clients; specific and generalreports are provided.

Other initiatives include:

The Peer Facilitation Project is part of

DisAbility Services Client/ Carer

Consultation and Information Strategy.

Thirty people w ith a d isability have been

trained as peer facilitators. They will work

with program staff to assist clients to

par ticipate in their services quality

improvem ent initiatives.

A Complaints Management Information

Program w as established in the Southern

Metropolitan Region in Ap ril 2001. The

Departm ent h as recently initiated

improvem ents to its managemen t of

complaint hand ling, including th e

recruitment of a strategic managem ent

position to facilitate efficient complaint

hand ling systems across the Departm ent.

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Key Category 2:

Staffing and Physical

Resources Quality

Actions to ensure the quality of

staff and facilities

2.1 Legislative requirements

of staff qualifications

2.2 Credentialling/

re-credentialling

2.3 Training/ re-training

program requirements

2.4 Other non-accredited

training

2.5 Physical standard s

(facility, clean ing,

equipment)


The staff and facilities of all directly managed and funded

services should be of a quality standard sufficient to achieve

service objectives and encourage a high level of public

confidence. Programs seek to ensure th at:

Staff and facilities meet publicly docum ented (including

man datory) qu ality stand ards, with p articular reference to:

Staff qualifications and credentials

Physical standard s of safety and functionality in premises

and equipment.

Information and training on quality assurance and

improvement is available to service staff as part of the

implementation of program level quality strategies.


Cleaning Practice Standards w ere introduced to hospitals in

2000, followed by a comprehensive state-wide audit of acutefacilities. Other program s and standard s assure quality of

infection control and physical standards of hospitals.

The Residential Aged Care Quality Initiatives (Action Plan) on

Workforce Development and Education is developing

edu cation, training an d professional developmen t activities

that complement th e role of the Commonw ealth. The

Initiative aims to enhance the capacity of the workforce to

provide q uality services and improve th e standing of Aged

Care as an attractive and valued career option.

The DisAbility Services Learning and Developm ent Strategy

is establishing a sustainable, competent workforce across the

governm ent and non-governmen t d isability sector, in

collaboration with Higher Education (University) and VET

sector providers. The complementary DisAbility Workforce

Plan w ill also add ress recruitmen t, retention, reward and

recognition of disability staff employed by th e Departm ent.


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Legislated staff qualifications app ly to child

protection workers, preschool teachers,

child care staff, health clinicians, juven ile

justice wor kers, second ary an d primar y

nurses.

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Key Category 3: Quality

Assurance: Standards

and Monitoring

Standards and compliance,

including mandated or high

level requirement for

acknowledged external quality

assurance

3.1 Service Standards:

National or non-

Department

3.2 Department program-

based service quality

standard s, indicators,

performance measures

3.3 Client/ patient Ou tcome

information

3.4 Quality monitoring and

audit: Department

3.5 Quality monitoring and

aud it: external

3.6 Peer review

3.7 Self-assessment

3.8 Evaluation: p rogram

3.9 Evaluation: service

3.10 External accreditation


Service users should be assured that the care and treatm ent they

receive will produ ce measurable benefit and be in line with

established good practice. Practical efforts by programs to assure

quality may be guided by the following:

1. The quality of services provided is monitored and evaluated

systematically, with a focus on minimising inappropriate

practice variation.

2. Documented service stand ards have the following

characteristics:

Evidence-based.

Balanced between clearly defined minimu m, objectively

verifiable standard s and contingency-based stand ards that

promote continuous improvement.

Developed in consultation with credible indu stry bodies

and service providers.

Linked to national or international standards to promote

benchmarking.

Articulated between programs with a comparable client or

service provider base.

Consistent with legislative standards, where appropriate.

Designed to generate useful comparative information to

support effective decision-making.

Outcomes focused, but represent a mix of robust measures

across elements of program logic (see diagram below).


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Input Process Output Outcome

Client Focus


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3. Where approp riate, external accreditation of

services is sup ported . The Departm ent w ill

seek to ensure that accreditation is robustly

administered, incorporates explicit

standards across all dimensions of service

quality and involves direct observation,

verification and consultation with

consumers.


A Priority Action Project has been initiated

to develop operational standard s

docum entation and a pr actical system for

monitoring service stand ards in the Problem

Gambling program . While add ressing the

business needs of this program, the project

is also intended to d evelop m odel standards

and processes for broader ap plication.

Acute health programs have an ongoing

strategy to develop and implement

performance indicators to better m easure

the accessibility, ap propr iateness, safety,

efficiency and effectiveness of hea lthcare

services.

Residential aged services observe

Comm onw ealth stand ards and are subject

to independ ent accreditation. A State

Ministerial Advisory Com mittee considers

state regulatory safeguards for residents of

high care facilities, particularly w ith respect

to nurse/ patient ratios and provision of

information to the community, clients and

carers.

National Standards for Juvenile Justice

Custod ial Facilities have been established

by th e Australasian Juv enile Justice

Adm inistrators. These incorporate

aspirational statements and sam ple

ind icators, and cover client rights, care

issues, access to health and educational

services, physical standards, built

environment and staffing/ management

quality.

National Community Housing Standards

and an associated model accreditation cycle

have been developed for:

Tenancy management.

Asset management.

Tenant rights and participation.

Working with the community.

Organisational management.

Evaluation, planing and service

development.

Human resource management.

Victorian Disability Service Stand ards have

been developed from national standard s to

wh ich Victoria is a signatory. The Standard s

provide the basis for self-assessment and

will be comp onents of a comp rehensive

monitoring and quality improvement

framework to be rolled out over the n ext

few years. Each of the 9 Standardscomprises statements of client-centred

principle and a ran ge of criteria which

describe m anagement and staff practices to

meet Standards.

Legislated and non-legislated National

Stand ards app ly to pu blic health program s

includ ing environmental health, pu blic

health, immunisation, pest control, tobacco,

food and infectious diseases.

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Key Category 4: Safety

and Adverse Event

Management

Prevention, management,

reporting and review of adverse

events, potential or actual harm

to service users

5.1 Mandatory reporting

5.2 Operating procedures:

prevention,

managem ent, analysis.

5.3 Program (or higher)

review of adverse events

5.4 Formal risk

management systems at

agency level


A major objective of hu man service managem ent is to assure

service users of safe progress through all comp onents of the

service system. Efforts by programs to minimise the risk of harm

from the care provided and the environment in w hich it is

provided will involve a systematic strategy to:

Encourage the full and frank reporting of adverse events.

Understand the detailed causes of adverse events.

Improve the processes of care and tr aining of staff on the basis

of this analysis.


In 200102 the DisAbility Services Division will comm ence a

Priority Action Project to:

Strengthen management and reporting of adverse events at

service level.

Establish a sustainable quality imp rovement cycle

providing robu st analysis and feedback on ad verse events

at p rogram, regional and service provid er levels.

Consider cross-program ad verse event issues.

Critical incident reporting (CIR) is the main Departmental

central adv erse event m anagement system. The Department

has recently revised the system, which is intended to facilitate

analysis and prevention. The DisAbility Services Priority

Action Project w ill address the effective operation of the

system in this program .

Management of adverse events in p ublic hospitals has been

strengthened th rough the new Clinical Risk Management

program . The Quality Council and Consu ltative Coun cils

sup plement long-standing, diverse hospital-based p rocedu res

and review arrangements.


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Supp orted Residential Services regulations

require that records of any accident, injury

or mishap to residents are m aintained for

inspection by Advisors and Comm unity

Visitors. Prosecutions have been pu rsued on

the basis of inadequ ate records.

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Key Category 5:

Quality Improvement

ProcessesPrograms to develop an

evidence base, establish good

practice and ensure quality

improvement

6.1 Quality bonus/ reward

schemes

6.2 Service adaptation to

improve access/ equity

6.3 Other QI initiative

funding programs

6.4 Collaborations (cross-

agency or Departm ent/

agency) to develop an d

prom ote evidence base/best pr actice

6.5 Benchmarking program

6.6 Other qu ality

improvement programs


Continuou sly improving services make use of the best available

evidence. Programs are in a position to encourage the research

and development of sound evidence, to underpin continuous

innov ation an d serv ice effectiveness. Program s also facilitate and

mon itor the development, app lication and evaluation of good

practice guid elines or oth er forms of ad vice based on that

research. Ideally, a quality improvement strategy will:

Develop a systematic approach to improvement incorporating

a d ocumented cycle of measurement, comparison, action an d

review.

Ensure that high quality, comparative practice information is

actively marketed to hu man service providers and the pu blic,

to inform service improvement efforts.

Share information about good practice with service providers

and oth er stakeholders.

Promote cross-program and m ultidisciplinary work todevelop business systems and resolve service quality issues.

Provide service staff with opportunities to gain new

experience and expertise.

Provide opportunities and develop partnerships to pilot

innovative practice.


A range of programs including Primary Health, Mental

Health, Dental Services and Aged Care provide aw ards,

grants an d incentives for practice developm ent. Good p ractice

projects fund ed in p lacement and sup port w ere recently

docum ented in the pu blication Achieving Service Qu ality

Improvement.


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The Breakthrough Collaborative in

Emergency Care trialled evidence-based,

measurable pr actice imp rovements in a

strongly focused project to improve services

and redu ce waiting times. Workshops,

forums an d electronic formats are

commonly u tilised in Breakthough type

initiatives to disseminate the findings of

quality improvemen t projects and plan

further work.

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page 17

6. Implementing Department-

Wide Service Quality

InfrastructureIt is imp ortant th at qu ality initiatives and

systems imp rovement be strengthened by

leadership action to drive and prom ote a

service quality culture.

The principles and practices of continuou s

quality improvement should u nderpin

Department-wide sup port for program and

regional initiatives.

Individual quality initiatives are more likely to

be effective when introduced in a service

organisation that functions according to

continu ous qu ality improvem ent (CQI)

principles and practices.

The characteristics of organisations that adopt

CQI may be briefly sum marised:

The use of problem-solving approaches

based on statistical analysis and relevant

soft data.

CQI involves the ongoing gathering of d ata

to provid e quick feedback, and an alyse and

monitor p rocesses, outputs an d ou tcomes.

Decisions are based on the d ata and

improvem ent is measured over time. By

using broadly based d ata sets that have

wid espread acceptance as ind icators of

quality, there less likelihood of dom inance

by any par ticular element and m ore chance

of w hole-of-organisation supp ort for

improvement.

Service Quality Framework: Summary

Actions

The Department will sponsor

opp ortun ities for information sharing and

discussion on qu ality managem ent

initiatives and systems.

A Quality Executive will be established

to d rive implementation of the Service

Quality Framework at a senior level

across the Departm ent

Department programs will develop

quality plans broadly consistent w ith the

Framework, and ap prop riate structures to

implement them.

By June 2002, Department programs will

develop a reporting format incorporated

into quarterly p erformance reporting, to

illustrate progress toward quality plan

milestones.

The service quality element of the Agency

Performan ce Monitoring and Review

instrument will be developed for

implementation in 2002/ 03.


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The focus of ana lytical processes is on

un derlying organisational processes and

systems rather th an blaming individu als.

The CQI organisation ad opts systems

analysis as its first response to solving

problems. Most quality p roblems if not

caused by faulty systems are amenable to

changes in systems. Hum an error is

inevitable and su pp ortive systems need to

be developed to minimise it. A culture of

personal blame detracts from the p rodu ctive

analysis of systems.

The use of cross-functional employee teams

in continuou s imp rovement activities.

Successful, systems-based innovation and

problem-solving requ ires the involvement

of all who contribute to the system. Cross-

functional teams also m itigate any one

particular professional or functional view.

They provide some assurance of balance

wh en problems are being identified and

solutions sought. The collective ownership

of new strategies is necessary for successful

implementation.

Employee emp owerm ent to identify

problems and op portu nities for improved

care and to take the necessary action.

Empow ering employees to both identify

opportunities for improvement and to

implement ap prop riate responses has a

track record of success in CQI. Leadership

at all levels is characteristic of a su ccessful

CQI culture: the capacity of teams to

indepen dently identify method s of inquiry

(such as d ata p arameters and collection

techniques) and implement appropriate

responses with an emp hasis on systems

development.

An explicit focus on both internal

stakeholders and external consumers.

Internal stakeholders are those w ithin the

organisation w ho p lay a role, direct and

ind irect, in the d elivery of the direct service.

External consumers includ e the direct

service user, friends, family and other

providers, and to a varying extent, broader

comm un ities of interest. An explicit focus

on the consum er ensures that analysis and

decision-making about system changes

includ e consumer research and preferences.

Sustained management support for this way

of working is a foundation for success in all

quality improvem ent strategies.

A clear commitment to qu ality, backed by a

high level of knowledge and thorough

understanding of quality management

principles, is required at senior man agement

level. This commonly involves a change of

emp hasis to value quality equally with

throughput and budget control, and to

recognise interconnections between quality

and financial elemen ts of service. There

must be a commitment by management to

act on the reasonable recomm endations of

professional staff for system chan ge to

improve services.

The development of a culture of quality in a

large and complex organisation is necessarily

staged w ith regard to priorities and available

resources. The following initiatives will

provide an imm ediate term boost to

Department-wide quality management.

page 18


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page 19

Debating Quality, Developing

LeadershipIt is necessary for those w orking in hu man

services to take responsibility for the standard

of their own practice and share responsibility

for creating and m aintaining a system th at

provides h igh qu ality, safe service. The

Departm ent will sponsor op portu nities for

improved information sharing and d iscussion

and raise the profile of service quality

management among Department staff.

Methods for d oing so will include:

A seminar series for staff, incorporating a

quality and innovation conference in early

200203.

Recognition for quality management effort

by program or regional units, includ ing

through internal Departmental awards.

While this Framework is focussed on service

quality assurance and imp rovement, it is

acknowledged that the Departments own

business processes are key drivers of quality.

Quality management literature indicates that

effective process control or variation arising from

poor p rocess management are considered lead

indicators of good or p oor quality down the line.

Existing qu ality framew orks in hu man services

and other ind ustries incorporate consideration

of, for example, leadership, strategy and

planning, business process managem ent, and

supplier/ partner relationships. Individual

program s, regions and services have current

involvements with, for example, service

accreditation agencies and the Australian

Quality Council, and will be supp orted in local

efforts to implement internal process quality

improvem ent projects.

Department and Program Quality

Management StructuresEssential to quality managem ent are stru ctures

at senior managem ent level to drive, monitor

and sustain qu ality strategies. All Departm ent

program s w ill develop qu ality strategies,

assign peop le to implement them, and rep ort

against the m ilestones approp riate to each

program w ithin a broad comm on framework.

App ropriate organisational structures to drive

quality improvem ent w ill vary across

program s and Divisions. Some h ave

developed strategies or frameworks and h ave

established specific quality structures, or are

currently doing so. Examples includ e:

Aged residential services: the Victorian

Pub lic Sector Residen tial Aged Care Qua lity

Action Plan 200102 has been d eveloped ,

and a specialist Quality Improvem ent Unit

was established in Septem ber 2000.

Management of a wide range of quality

assurance and improvement programs in

Acute Health is the responsibility of the

Quality and Care Continuity Branch. A

state-wide Quality Council and consultative

councils in areas of speciality provid e

leadership on clinical quality and safety

matters and respond to recommendations

from various expert bod ies and coun cils.

Dental Public Health Services: the Strategic

Plan for Quality Imp rovement in Dental

Pub lic Health Services add resses objectives

identified by the Government in its Election

Policy. The Qu ality Reference Group (QRG)

was established in 1999.


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page 20

A specific unit to manage quality

monitoring, review, improvemen t has been

established in Disability Services, and is

developing a strategic approach to qu ality

management across disability services.

A senior Departm ent-wide structure will be

established to d rive implementation of the

Service Quality Framework and strategy. The

structure will be led by an Executive Director

and comprise Program an d Regional Directors

nominated by Executive.

The Quality Executive will oversee program

quality strategies and their implementation,

especially as reported in the qu arterly

Executive milestone reports. It will coordinate

Department-level efforts to consolidate a

culture of quality and p romote p olicy

developm ent in cross-program qu alitymanagement issues.

Planning for QualityIncreasingly, service agencies are required by

the Departm ent to prepare Qu ality Plans (or

similar), including for example all Comm un ity

Care funded agencies, public hospitals, and

disability serv ices agen cies.

As noted above, some program s, Divisions

and regions have also developed qu ality plans,

strategies or framew orks, or are doing so.Although sufficient allowan ce must be m ade

for the great d iversity in service contexts, it is

importan t for p ractical reasons (including the

interdependence of activities required for

quality service to clients) that a consistent

app roach to terminology, concepts and key

elements of imp lementation be adopted.

A Priority Action Project is proposed to

develop an overall quality strategy to draw totogether the d iverse strand s of quality

assurance and imp rovement currently in place

in the Ch ild Protection program . While

meeting the requirements of the specific

service environment, it is intend ed th at the

strategy be broadly consistent with th e

Departm ent-wide Service Quality Framew ork.

It is envisaged that the project will encourage

and provide guidan ce for similar efforts in

other program s delivered by the Department.


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page 21

Reporting on QualityAn essential adjunct to the managem ent

structure referred to above is a robu st

reporting arrangement designed to provide

regular information on the imp lementation of

quality strategies as w ell as data from qu ality

measures and indicators.

Executive set reporting: from Jun e 2002 a

reporting format based on the ServiceQuality Framework will be incorporated

into program quarterly performance

reporting to Executive, to illustrate progress

against quality managem ent m ilestones.

Regional Accreditation, Quality and

Governance key indicators for reporting on

regional performance to the Executive will

be developed by Business Developm ent

Branch in collaboration with the Quality inService and Regional Benchm arking projects

through the Future KPI Developm ent

Program.

Service Quality Performance

MeasurementThe service quality element of the Agency

Performance Monitoring and Review

instrument (APM&R) will be d eveloped in

200102:

A milestone approach will be adopted,

based on the mechanisms of quality

man agement identified above

Funding and policy plans will articulate the

Framework and program level quality

strategies, and nom inate pr iorities for

quality management development in

200203.

Regions and agencies to negotiate flexible

priorities, projects and indicators for

incorporation into Service Agreements.

Some examples:

Conduct of Client surveys, patient

satisfaction monitoring.

Achievement of accreditation or external

quality standard.

Achievement of staff qualifications

improvements.

Development of risk management

strategies.

Adoption of nominated best practice

programs.

Annual review of performance and report of

achievement.

Future development of the APM&R will

incorporate service quality indicators

developed throu gh the KPI Developm ent

Program.


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page 22

ATTACHMENT:

Outline of the

Quality in

Services Flagship

ProjectThe Qu ality in Services

Flagship Project was

initiated by the Executive of

the Department to d evelop a

cross-Department Service

Quality Framework for all

services provided or fund ed

by the Department and take

timely action to ad dress high

priority quality management

issues.

Current Approaches to Service QualityA key early task for the Project was to un dertake an Overview of

the Departm ents quality man agement systems and initiatives.

This revealed a high level of effort and diversity of good practice

across all programs. It identified key quality man agement

challenges:

Challenges for Service Quality Management

Service standards consistency and monitoring effectiveness

Documentation of stand ards relating to qu ality varies in

format and operational value. Systematic monitoring of

standard s is key to p ublic confidence and service

improvement.

Need to clear program policies on accreditation There is

growing p ressure for extending accreditation to a w ide range

of sectors, as well as a rang e of issues w ith curren t

accreditation arrangem ents. The d iversity of views w ithin the

Departm ent suggests the need for considered p olicy views at

program and Departmental levels.

Consistent approaches to safety Good systems to prevent,

mon itor, report and man age adverse events to clients and

patients are wid ely recognised as a key p art of quality

man agement. Most programs acknowledge the need for

substantial improvement.

Reducing the impact of systems complexity on quality

Unnecessary comp lexity inhibits quality man agement, w ith

particular reference to fund ing and accountability systems,program arrangements and information management.

The need for effective program-level quality strategies As is

increasingly requ ired of fund ed agencies. all Departm ent

program s should h ave a current service quality policy and

strategy, and an effective structure to implement it.

ATTACHMENT


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Better use of practice information and systematic evaluation

for quality improvement purposes Quality management

practices in m ost program s (surveys, comp laints systems,

incident reports) generate valuable information that is

currently under-utilised. There is room for more extensive and

better use of imp act evaluation and continu ous qu ality

improvement methodologies.

Consistent approaches to understanding and responding to

client experience While Department programs haveresponded to the growing emp hasis on service user

perspectives of quality, app roached to captu ring and

analysing th eir views and experience vary greatly in

Priority Action ProjectsIn October 2001 the Executive considered the Overview and

analysis, approved the d evelopm ent of three Priority Action

Projects and endorsed in principle a package of Department-

wid e measures to d rive and prom ote a culture of service quality.

The Pr iority Actions Projects are:

Child Protection Developm ent of a comp rehensive quality

management strategy to draw together and strengthen the

range of quality assuran ce and imp rovement activity in the

program.

DisAbility Services Strengthen the management and reporting

of adverse events at service level and develop a sustainable

quality imp rovement cycle of analysis and feedback on

adverse event.

Problem Gambling Develop mod el operational service

standard s and a p ractical means to mon itor the achievement

of service qu ality.

By June 2002, three Priority Action Projects will be com pleted or

have made substantial progress against project briefs.


page 23

ATTACHMENT


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Endorsement of the Service Quality

FrameworkIn November 2001, the Executive adopted a

Departm ent-wide Service Quality Framew ork

designed to assist programs to strengthen their

quality assurance and improvem ent efforts.

The Framework will be pu blished in electronic

and docum ent form in January 2002.

Future M ilestonesIn February 2002 furth er recommend ations

will be made to the Executive about the

development of Department-wide

infrastructure to d rive implementation of the

Framework an d p romote a culture of quality.

The centrepiece will be a senior Quality

Execut ive, chaired by a nominated Executive

Director.

By June 2002 all Program s w ill comp lete a

quality action plan (against the Building

Blocks identified in the Framework) and a

reporting format to be incorporated into

program quarterly performance reporting

from July 2002.

Key Outstanding Issues

Regional Quality Management

Further w ork on Regional quality management

issues will be a key element of the Qua lity in

Services Flagship Project d ur ing 2002. The

following factors require consideration:

Quality assurance in most human service

program s is the op erational responsibility of

the Dep artm ents regions. The effective

condu ct of these responsibilities is a vital

consideration in the d esign of qu ality

systems and initiatives. Regional quality

man agement systems w ill be integral to the

developmen t of quality plans and Priority

Action Projects.

A wide range of quality improvement

activities is currently initiated at regional

and service provision level. The basic

principles of continuou s qu ality

improvement strongly support such

decentralised initiative and the

developmen t of a systematic app roach to

dissemination and cross-Departm ental

learning.

The feedback loop carrying data from

program implementation and service

practice is vital for quality imp rovement.

These functions are substantially the

responsibility of regions, together with

those units that manage critical incident

reporting, m inisterial correspond ence,

complaints systems and performance

information. The contextual analysis of

practice information and action to respond

to it rests mainly with regions.

page 24

ATTACHMENT


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page 25

It is important therefore that the Service

Quality Framework seeks to strengthen local

initiative and the potential for cross-

Departm ental learning. The establishment of

the Op erations Division, will strengthen this

effort w ith its critical mission to imp rove

service delivery, especially in d irectly managed

services.

Work betw een the Operations Division,

Regions and Flagship Project staff will be

initiated to strengthen these elements of the

Framework over the remainder of 200102.

Accreditation

External service accred itation is a potentially

importan t quality assurance device provided it

is robustly administered, incorporates explicit

standards across all dimensions of service

quality and involves direct observation,

verification and consultation w ith consum ers.

The most robust approaches employ a

combination of self-assessment and external

review and balance minimu m qu ality

assurance with encouragem ent to continuou s

quality improvem ent. Accreditation agencies

vary in these characteristics.

While in isolation accreditat ion activity does

not guarantee quality, it has a role in

reinforcing pu blic confidence in services. All

health programs mandate external

accreditation and there is supp ort for this

approach in some other service sectors. The

comprehensive use of external accreditation is

un der consideration in other jurisdictions.

It is recognised that to ensu re effectiveness in

service mon itoring, the sector mu st have

confidence in the p rocess and that

accreditation strategies will vary with the

service environment. Any d evelopm ent or

enhancement of current mechanisms should

occur in close cooperation with service

provider m anagement and service user

representatives.

The Flagship Project and Program

man agement w ill further consider this issue in

the course of developing quality plans and

Departm ent-wide strategies du ring 2002.

ATTACHMENT


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Documents

Service Quality Framework