Service Quality Framework
Transcript of 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
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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
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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)
Achievement Measures
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.
Current Practice and Developments
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
Achievement Measures
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.
Current Practice and Developments
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
Achievement Measures
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.
Current Practice and Developments
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
Achievement Measures
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.
Current Practice and Developments
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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Developing Quality Services > Service Quality Framework
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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.
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Developing Quality Services > Service Quality Framework
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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Developing Quality Services > Service Quality Framework
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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.
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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.
Developing Quality Services > Service Quality Framework
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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.
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Developing Quality Services > Service Quality Framework
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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.
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