There has been a lot happening in the disability and aged care sectors, but of course one of the biggest things impacting organisations has been the development and release of the new NDIS Practice Standards (replacing all state-based quality standards like the Human Services Standards and Human Services Quality Standards) and the Aged Care Quality Standards (which brought together the Aged Care Accreditation Standards and the Home Care Standards).
These two new standards are not vastly different from what we had before. But they do require some effort to implement in your organisation, so that you can be truly ready for the next time an external auditor comes to visit. Here are three things that you can do:
A consultant like myself can help you with steps 1 and 2 above, but step 3 will always be up to you, and it is a crucial step. Remember to keep records of your transition – include what you’re doing in your Improvement Plan, ensure you have a system for keeping records of any new process (e.g. signing new Codes of Conduct, adding new training to your Training Register).
If you do need help with steps 1 and 2, give me a call! I can work across all states and territories and can currently offer a quick turnaround for your project.
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I just downloaded the latest resource from EVPA and Social Value International, released 12 September 2017. It's called Impact Management Principles, and it's a short, highline look at how non-government organisations (or what they call social purpose organisations) can incorporate impact management / measurement into their information collection processes.
Link to website
Link to resource
We're still getting used to the idea of measuring outcomes in human services organisations here in Australia, but the time when it becomes mandatory for many service types is fast-approaching. It can seem overwhelming - you need to plan, maintain, analyse, report. What I like about this resource is that it breaks down impact management into manageable parts, and they've presented the information in a very easy-to-read format - great for beginners!
Don't forget I have organisational review packages running until the end of November - book me now to start 2018 fresh and clear about where your organisation is at with regards to meeting quality standards. Email email@example.com
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Please let me know if there's any other quality or business topics you'd like me to cover in a vlog!
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I might be a bit late to the party, but today I received my usual update from Stephanie Evergreen - data visualisation expert - which mentioned her Evergreen Data Academy. It took me about 15 seconds after clicking on the link to the Academy site to decide to sign up. Now, why would a quality manager want to pay to learn about data visualisation? Let me explain..
1. It should be very clear by now that how we "do" human services in Australia is changing very, very rapidly. We are no longer just 'delivering' services, nor do we just have to 'comply' to continue our funding. We are very much moving towards outcomes and competitive models. We need to be able to demonstrate what we are achieving. Organisations that can do that well will have a market edge.
2. How Quality Managers operate within human services organisations must change along with how are organisations will be run. We can't sit on the sidelines issuing reports detailing what people are doing wrong.
We must be able to proactively gather data about how services are running, and be able to display that data in a way that engages the management team to take action. We must also be able to engage clients and potential clients with that data - therefore, it needs to be accessible and appropriate to our audience.
3. A Quality Management professional should never sit still. We need to be the leaders in our organisations; the people others look to for advice; the people that others consult and collaborate with. This requires us to maintain, update, and expand our skills. I have no doubt that data and how it is used and presented is a very important part of the future of Quality Management. I am, therefore, so excited to be part of the Evergreen Data Academy, and I can't wait to start learning!
Best of all, increasing my skills means I can help your organisation more. Contact me if you'd like to talk about your data at firstname.lastname@example.org.
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I have been a huge fan of Christopher Paris’s work essentially since I first started in Quality Management way back when. His Eyesore 9001: A Smartass’s Guide to ISO 9001:2000 (now in 2008 version) basically saved my bacon when I was a Quality newbie. It was useful and applicable, and it told me that I wasn’t going crazy and that no matter how ISO tried to dress up 9001 as a standard for both ‘products and services’, it really, really wasn’t written for services at all (or by anyone who understood service organisations?), especially human services.
For ISO’s 2015 version of 9001, Paris hasn’t released an Eyesore – instead he went down the rabbit-hole and has written and published an entire book. This book is the most comprehensive drill-down of the ISO 9001 that you will ever read. How Paris made it out of his analysis alive and sane could be considered a miracle (or did he? Someone let me know), as he has really left out no detail – it’s pretty much a word-by-word breakdown of what is, in my opinion, the worst written anything of everything.
I have, since the beginning of my Quality career, been a huge critic of the use of ISO 9001 in human service organisations. I absolutely believe that organisations should have management systems in place, and should be concerned about the quality of their services and how they achieve quality for their clients. But it scares me that governments have written into service agreements that human service organisations must be certified to ISO 9001, and that some organisations are voluntarily opting-in (because they think it helps prove that they’re doing the right thing) when the standard just isn’t written in our language and is still very much “we make products” focused.
(Also, governments, there are so many human services quality standards you can now pick from that you could ask organisations and services to demonstrate compliance to (without needing them to be certified if the standard is from another state). Why waste time with ISO 9001?)
Paris’s book is amazing, right from his documentation of the history of how the standard comes about (which should be appalling to all of us quality professionals), to his breakdown of the clauses, to how we can apply it in our organisations – but (and this is not Paris’s deficiency, but rather my conclusion), his book only further convinces me of the unsuitability of ISO 9001 for our industry. That being said, if you do work in human services and you do need help figuring out ISO 9001, this is the best book you could buy to help you.
PS – this blog post is not sponsored, and I don’t know Christopher Paris and I’ve never done any work with Oxebridge. I just really respect what he is trying to do and I have genuinely found his work to be very helpful to me as I’ve tried to navigate the ISO 9001.
* In the context of this blog post, when I say project I don’t just mean large-scope projects, but the smaller ones you may do as part of your day-to-day job.
In all of my readings and training in project management, one theme is clear: in order to complete a successful project, you have to do the planning part really well. You may develop your own or use established templates to help with your planning and execution. You’ve built a Gantt chart. You have your list of people to consult and collaborate with. You have what you think will be a reasonable timeframe.
But then…unexpected things keep coming up. Another little project takes your attention away, consulting seems to be taking a really long time, and nobody’s reading that Gantt chart much less sticking to the timeframes. Before you know it, the deadline has come, you don’t have what you expected and you think:
“maybe this wasn’t a good idea after all…”
In the reality of working life, the above scenario does happen (hopefully not too often though), even to the best and brightest of us. I would say particularly when you are working with a large group of people, in a complex organisation, or needing to create anything that requires IT (should note here that I've worked with great IT people; it's the systems that are complex). Should you just brush it aside and hope no one notices that you don’t deliver what you said you would? What can you do when a project fails? Here are my top three tips:
1. Conduct a critical review / audit of the project—if you have done your planning right you should have criteria (in the form of your project timeline, deliverables and quality controls) with which to conduct your review. If you can, get someone independent to help you. Determine what the turning point was for your project; when did it really start to fail, and why? Document what you've learned.
2. What good things can you take from your project? For example, did the consultation part go well? Were you really happy with the software you meant to implement?
3. Now see what you can salvage from your project. Build on what you were happy with and use what you learned from what went wrong to re-plan and try again. For example, if you were happy with the software, but the issue was consensus from your working party on a few things, determine what the top two options are, and give those to the working party. Narrow down your scope a bit if you need to. Tighten the deadlines. Most importantly, ensure that you learn from the mistakes and have a plan for how not to re-create them.
The most important lesson is not to give up. It can be hard when a project is dragging on or agreements can’t be reached, but that’s where you need to have a solid project plan and vision of the result.
Oh, and always document everything. You should (at the least) document all changes, scope-creep, and things that have gone wrong.
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The debate over whether to use continuous improvement or continual improvement is not a new one, but I thought I would weigh in, seeing as I do write about this subject, and have debated it vigorously many times!
So, a straight-up definition of 'continuous' from The Free Dictionary is that it is "uninterrupted in time, sequence, substance, or extent", or "unceasing". The Free Dictionary states that for 'continual', it is " usually used to describe something that happens often over a period of time".
Personally, I think you can see straight away from the definition why 'continual' should be used rather than 'continuous' when it comes to quality improvement - as much as we may like to improve, it is not really "unceasing" (at least I hope that's not your goal - otherwise, you might incite a staff revolt).
But if we get a little bit more cerebral about it, there are some very good reasons for using continual instead of continuous. For me it comes down to this:
Your improvements shouldn't be uninterrupted, because you cannot know if you've actually improved anything unless you stand back and check that your action has had its intended result. Improvement actions take time to embed and show results. If you are too quickly moving on to the next thing, or, worst case scenario, getting stuck in an endless loop of reviewing just one process, you are probably not improving much at all - or you'll never be able to properly evidence it, in any case.
By stating that your organisation has a culture or process of continual, rather than continuous, improvement, you can make a policy statement such as:
Our organisation has embedded a continual improvement framework across all of our operations and processes. Our improvements:
1. are considered as part of our quality management system, and as such are planned as much as possible, using consultative and collaborative techniques
2. can be reactive, or the result of feedback or a complaint from internal or external stakeholders 3. will always have the intended result documented
4. will always be evaluated to ensure that the intended result has been achieved.
Are you a fan of one or the other? Feel free to give your argument in the comments.
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Now that you know when to call a finding a non-conformity, the next step is making sure that the non-conformity (or issue or observation) has been closed out. This will usually fall to the internal auditor to do, as being someone who can provide an independent assessment of the effectiveness of the action taken.
I believe best practice is not just to note if an action has been taken, but to also assess if that action has been effective, thus minimising the risk of future non-conformances. This might involve some time spent on a follow-up audit or desktop review. To me it's time well spent - I would rather continue to follow up an issue than write about the same issue occurring in report after report.
The first step in the process is to give people a clear idea of what the issue is and why it's an issue. A statement like the following makes things really clear: "The service is not currently reviewing client support plans within the timeframes set out in the Client Review procedure, i.e. every six months, as monitoring of review timeframes has not taken place regularly."
At this stage you might like to give a direction for action - at the very least, you should give a timeframe for completion, such as: "The service should ensure that all clients that are overdue for review have one completed in the next four weeks."
You could extend this to ensure minimisation of ongoing non-conformity: "The service should ensure that the client review report is monitored weekly and reminders set in relevant staff calendars to ensure that reviews are conducted on time."
You then need to let the service know how their non-conformity will be closed out: "Manager to provide the client review report to the internal auditor by (date)."
Now the most important part is actually following up - mark it in your calendar and keep your word. Sticking to your own rules is a fundamental part of being an internal auditor.
If someone has not been able to close out a non-conformity, set a new follow up time and keep going back until the issue is resolved; also ensure that you follow your escalation processes, particularly if you feel the issue is high risk.
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No matter what activity your organisation is undertaking in regards to quality standards – whether it be internal audit, self-assessment, reviews – at some point someone is going to have to make a call as to whether a finding is a non-conformance to a standard / indicator / expected outcome. When you’re
starting out in internal audit, this can be a difficult point – if you make a conformity call and then an external auditor says it’s a non-conformity, it can have a big impact on your credibility. Same for vice-versa.
If you’ve had auditor training you will know that part of the audit process is that we look at information objectively, so if another auditor came in and looked at the same information, they would come to the same conclusion. That is a good theory, but in my experience it doesn’t always mean that you and another auditor
are going to agree – we are human, and standards are not always written in black and white. You just have to look at the large amount of evidence guides out there attached to standards – they’re in place to try and reduce the degree of interpretation, but sometimes they can complicate things further.
As an internal auditor, your job is to assess your organisation’s information against quality standards to a highly critical degree – you are there to lower risk. But if you’re not sure when an issue is a non-conformity, you’ve come to the right place! Let’s take an example and walk through it.
Human Services Quality Framework – Standard 3, Indicator 3 – The organisation has processes to ensure that services delivered to the individual/s are monitored, reviewed and reassessed in a timely manner.
In every indicator there are key words that will help you determine what conformity is really based on, and what evidence has to be measured against. The key words in this indicator are ‘monitored, reviewed
and reassessed’. Notice that it doesn’t say ‘or’—what this indicator is telling you is that the organisation needs to have processes in place for all three of those things before you can be considered to achieve conformity.
Having processes in place doesn’t necessarily mean that you have a documented procedure—what it does mean is that the organisation must have determined what its requirements are, that all staff involved know
these requirements, and that it’s actually being done. So, a documented process does help, but it’s not an indicator of conformity in this case—that the process actually happens is the indicator.
So, in this case, I would consider a non-conformity to be:
1. Not having defined a process to monitor, review and reassess services within a reasonable timeframe—it might be occurring, but it’s at the discretion of staff.
2. Staff not being aware of what the defined process is, and/or developing their own processes.
3. There is no process in place for either monitoring, review or reassessment, it is not occurring, and this is evidenced by reviewing client records and/or through client interviews.
4. There is a process in place for monitoring, review or reassessment, however it is not occurring as defined, for example, the process is for reassessment to occur every six months, but systemically this is not happening until 12-18 months.
Breaking down indicators in this way helps in two major ways. Firstly, it gives you a framework by which to audit—you’ll be looking at the right things and asking the right questions. Secondly, you will have a logical and understandable way to explain why you have made a non-conformity call.
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The Quality Nerd loves all things Quality Management and Internal Audit...too much is never enough!