PEER AUDIT TOOL (PAT)

Malcolm Scott, Team LeaderCommunity Integration Program and Extended Care ServicesDisability Services DirectorateRoyal Rehabilitation Centre Sydney

Implementation assisted & supported by Clara Barton, Deputy Director DSD & Christina Vulic, Manager Policy and Behaviour Support DSD

Peer Audit Tool

Background

Disabilites Service Directorate (DSD) currently has 21 community based service outlets spread throughout the Sydney Area with services ranging from ‘drop in’ semi independent living support to 24 hour support services

Client group primarily ‘Weemala’ devolution with complex and multiple disability and new referral eg/ dual diagnosis

DADHC funded service uniquely attached to a rehab hospital – Royal Rehabilitation Centre Sydney

Peer Audit Tool

Team Leader role – office based not site based although out in the field at least 2 days per week

Investigation Risk management DSD Policies and Procedures based

upon NSW DSS – how do we assess the deliverance of services?

Peer Audit Tool

The audit is based upon service delivery over four domains

Equip Function ‘Leadership and Management’ Criteria 2.2.1 An organisation-wide risk management policy ensures that safety is considered in all activities

Self Assessment and Peer Review – Quality Driven Processes

Peer Audit Tool

Four domains in quality process

1:Client support standards Eg/ Is there a documented daily routine

in place for all the clients? Do all clients have a current (annual)

documented Individual Plan/Service Agreement?

Peer Audit Tool

2: Unit administration and systems

Eg/ Is there a medication checklist completed for the unit each week?

Where required are individual incident response plans in place?

Peer Audit Tool

3: Carer support standards

Eg/ Are there regular Team Meetings (min every 6 weeks)?

Is there provision made for staff study leave?

Peer Audit Tool

4: Living environment and home safety

Eg/ Are medications stored in locked cupboards?

Do staff knock on the front door before entry into the house?

Peer Audit Tool

Quality Assurance All activities that contribute to defining,

designing, assessing, monitoring, and improving the quality of services and products (Equalis www.equalis.com).

Four core principles of quality assurance 1/ Focus on the client: services should be

designed so as to meet the needs and expectations of clients and communities.

Peer Audit Tool

2/ Focus on systems and processes: providers must understand the service delivery system and its key service processes in order to improve them.

3/ Focus on measurement: data is required to analyse processes, identify problems, and measure performance.

4/ Focus on teamwork: quality is best achieved through a team approach to problem solving and quality improvement.

Peer Audit Tool

Method The DSD - CIP rollout of PAT December 2003 – April 2004 10 questions were selected for each of

the four domains by the Deputy Director (Operational Manager) from a pool of questions: 27 – 45 questions for each domain

Peer Audit Tool

Team Leaders were trained in scoring methods using a ‘likert’ scale: important for inter-rater reliability!

5 = yes or always 4 = usually or recognised practice by most staff 3 = sometimes, rarely or by some staff 2 = unclear expectation or practice being developed 1 = no, never or need to start Scoring for each service outlet then based on four

scores out of 50 – doubled to convert to percentage score

Peer Audit Tool

Team Leaders firstly conducted self assessments on their own service outlets and scores were tallied

Team Leaders were then assigned to their ‘buddies’ to conduct peer assessment upon their service outlets – scores were then tallied and the data analysed for trends, action priorities, and task delegation (who and when)

Report then created and sent to DD DSD and D DSD for review and reporting

Peer Audit Tool

ResultsImplementation of Audit (Self assessment compared to Peer assessment)

79

72.170.6 70.1

89.891.7

93.1

86.3

10.8

19.622.5

16.2

0

10

20

30

40

50

60

70

80

90

100

Client Support Standards Unit Administration andSystems

Carer Support Standards Living Environment &Home Safety

Audit Domains

Pe

rce

nti

le

Self Assessment (19 outlets)

Peer Assessment (21 outlets)

Variance

Peer Audit Tool

Result – analysis of variance PAT scores were significantly higher

when assessed by peers than first self assessment

Indicates that Team Leaders and CSW’s used the PAT to improve existing/implemented new systems into their service outlets eg/ Agency staff orientation folders

Peer Audit Tool

Discussion The results of these interventions allow service

management and senior staff to identify any broad trends, or areas of risk/concern to be addressed by action plans

PAT allows services to target interventions appropriately in an environment where off site management means service delivery risks require close monitoring

Community Support Workers and Team Leaders can tailor interventions which are measurable, evidence based and allows staff to think quality systems approach – new questions can be selected and the process repeated

Peer Audit Tool

Purchased from Equalis (www.equalis.com.au) and tailored to DSD requirements

Tool was originally designed for disability accommodation services with discrete structure, however DSD developed the tool to be flexible and responsive with application to others services and service needs.

Peer Audit Tool

Questions Quality is an ongoing process –

feedback loop from Director DSD to support staff - then included in business planning

Peer Audit Tool

Thank you for your time! Contact us: Malcolm Scott, Team Leader DSD Scottm@doh.health.nsw.gov.au Clara Barton, Deputy Director DSD BartonC@doh.health.nsw.gov.au

Peer Audit Tool

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