Quality Framework for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program
2 Overview of the Quality Framework Design
2.1 Structure of the Quality Framework: Key ElementsThe Quality Framework includes:
- a set of standards
- a review process to assess and measure progress against the Standards
- tools and guides to support service providers and quality reviewers to implement the Quality Framework
2.2 The Quality StandardsThe Quality Standards are key elements of the Quality Framework.
In developing the standards for the Quality Framework, ensuring cultural safety for all service users and promoting continuous quality improvement were recognised as important. Standards themselves need to be simple in intent, achievable and measurable.
Therefore, the standards have been developed to include:
- overarching principles: ideals to be incorporated in all aspects of the standards
- outcome and process driven standards: standards that focus specifically on outcomes for service users and also on systems and processes to support outcomes for service users (that is, have an indirect influence on service user outcomes)
- expected outcomes: which are the results that are expected to be achieved under each standard
- guide to requirements: which provide further details and examples of how service providers can show that they are meeting the expected outcomes; i.e. what evidence
- is needed.
- The two overarching principles - Cultural Safety and Continuous Quality Im-provement (CQI)
- Cultural safety is about recognising, respecting and nurturing the unique cultural identity of Aboriginal and Torres Strait Islander people and meeting their needs, expectations and rights
- Continuous Quality Improvement (CQI) is about always working to improve services and outcomes for people. It means looking for better ways to do things
- Two Standards, each with Expected Outcomes
- Guide to requirements for each Expected Outcome.
Figure 2.1 Diagram of Quality Standards Structure
Figure 2.1 shows a diagram of the Quality Standards Structure. It shows that there are two overarching principles – Cultural Safety and Continuous Quality Improvement. Under these principles there are two standards each with Expected Outcomes and each Expected Outcome has a separate guide to requirements.
2.3 The Quality Improvement Cycle and the Review ProcessThe Quality Improvement Cycle is implemented over two years. Figure 2.3 provides a visual outline of the timing of the Review Process and the Quality Improvement Cycle. The first year includes a formal review against the Quality Standards including self-assessment by the service provider and a site visit by the Quality Review Team. The second year includes follow up and support visits to ascertain progress against results of the formal review and the agreed Quality Improvement Plan.
The Review Process aims to:
- support capacity building for the service provider, sector and community
- support continuous quality improvement while addressing accountability through quality assurance processes
- promote development of internal systems and processes.
Figure 2.2 shows the Review Process key steps, outputs and indicative timelines in the Quality Improvement cycle.
Cycle One – year one - self assessment, 8-12 weeks from notification
Desktop review - within 2 weeks of receiving self assessment
On site review – 1-2 days
Draft Report and Feedback within 6 weeks
Quality Improvement Plan for next year agreed six weeks after review.
Cycle Two – year two - Monitoring of progress, ongoing
Support visit if required, Progress Report/Updated Quality Improvement plan – one year from agreement to Quality Improvement Plan, Monitoring plus additional support as required, ongoing.
The key steps in the quality improvement cycle are:
- Self-assessment: completed by service provider. Service providers will be given eight to twelve weeks notice of the date for submission of the self-assessment. This is provided via a letter from the Quality Review Team.
- Desk Top Review: completed by Quality Review Team within two weeks of receiving the self- assessment, includes planning for on-site review. The desk top review assists in prioritising areas for focus at the on-site review and examines other information such as records of previous review findings and/or other relevant information provided in the Service Provider self-assessment.
- On-site Review: Following the desk top review, the on-site review will be scheduled and conducted by at least two reviewers; normally lasting between one and two days, depending on the service types delivered. The Quality Review Team would generally allow one day for on-site review of community care providers, and up to two days for residential and mixed service type providers. Large residential service providers may require two full days for on-site review.
- confirming the date, time and duration of the visit
- discussing the proposed schedule
- checking if any permits or departmental identification cards are required
- checking if an interpreter is required
- asking the Service Provider to notify staff and care recipients that the visit will be taking place and that a reviewer might talk to them about their experience at the service
- discussing travel and accommodation options (if necessary).
- Draft Report and Feedback: within two weeks of the visit a draft report of the on-site review is submitted to the service provider. The On-site Review Report will use the same format as the self-assessment report completed by service providers and will include:
- an Executive Summary
- an Assessment Matrix
- evidence examples sighted during the visit to demonstrate compliance with each expected outcome
- review findings detailing the reasons for the reviewers’ rating for each expected outcome and the applicable rating
- Quality Improvement Plan to address any identified gaps against each Expected Outcome of the Quality Standards and/or plans to support continuous quality improvement, where applicable.
The service provider will have four weeks to work through the draft Report and return their feedback to the Quality Review Team. Feedback may include any service provider comments and factual errors in the draft Report, as well as completing the Quality Improvement Plan, that will include who will be responsible for each action and the due date for completing actions. Feedback may be provided verbally, electronically via email or in a letter. Feedback may include any errors or omissions or requested changes to the draft Report.
Quality Improvement Plan for Next Year: the Quality Review Team has two weeks to finalise the draft On-site Review Report and the Quality Improvement Plan with the service provider. The return of the final agreed Review Report and Quality Improvement Plan for the next year to the service provider by the Quality Review Team is a key output of Cycle One.
- Monitoring Progress of Quality Improvement Plan: the service provider will use the Quality Improvement Plan to schedule, monitor and report on the planned actions required to meet the expected outcomes of the Quality Standards.
If serious matters relating to health, safety and well being of care recipients arise, the issue will be referred to the Quality Review Team to manage in consultation with the Program manager and further assessment by the Quality Review Team may be necessary.
- Support Visit to achieve Quality Improvement Plan: to monitor progress of the Quality Improvement Plan, Program staff and/or the Quality Review Team, must include at least one support visit to the service provider following the On-site Review. The timing of this will depend on the support required by the service provider and their progress in implementing their Quality Improvement Plan.
- Progress Report/Quality Improvement Plan for next year: in order to maintain the momentum of Continuous Quality Improvement, service providers will be required to submit a Progress Report against their Quality Improvement Plan a year after that plan has been agreed. The service provider will also update their Quality Improvement Plan for the next calendar year.