Service Quality

Framework

February 2002
 Published by the Policy and Strategic Projects Division
Victorian Government Department of Human Services,
Melbourne, Victoria

Also published at:

www.KNet/PolicyStrategicProjects/QualityinServices

February 2002

(0560701)

© Copyright State of Victoria 2002

page ii
 Developing Quality Services > Service Quality Framework

Contents Forword
1. Introduction
iv
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 7
Key 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: Quality Improvement Processes 15

6. Implementing Department-Wide Service

Quality Infrastructure 17
Debating Quality, Developing Leadership 19
Department and Program Quality 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

page iii

Foreword
I am very pleased to introduce the first
Department-wide Service Quality Framework.
The Framework was developed by the Quality
in Services Flagship Project with contributions
from managers and staff across the
Department. The Framework is designed to
guide the development of quality systems and
initiatives across the Department’s program
portfolio and encourage the transfer of quality
management expertise between programs.
The goal of such efforts is to continuously
improve the quality of services to our clients
and patients.
The Executive of the Department formally
initiated the Flagship Project in June 2001. In
deciding to develop a Service Quality
Framework during 2001, the Executive was
keen to build on and improve the quality
management systems that already operate in
the Department. The Framework is intended
to encourage a more comprehensive and
consistent approach, rather than over-ride the
good work already underway.
The Framework establishes dimensions of
quality that define what we mean by service
quality. Drawn from the quality management
literature and case practice, the adoption of
these dimensions will ensure a consistent
language across the Department and provide a
frame for the development of standards and
measures of service quality.
page iv
The Framework identifies building blocks of
quality management—the categories of
practical action for quality assurance and
improvement—and provides suggestions for
measuring progress, and examples 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
organisational level. Over the next year,
Department-wide initiatives to strengthen a
culture of quality will include:
– Opportunities for information sharing and
discussion on quality management
initiatives and systems, including a seminar
series
– Establishment of a ‘Quality Executive’ to
drive implementation of the Service Quality
Framework at senior level across the
Department
– Development of the service quality element
of the Agency Performance Monitoring and
Review instrument for implementation from
2002/03
 Developing Quality Services > Quality In Service

Using the Framework Further work on Regional quality management

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 management 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 dimensions of quality and
building blocks identified in the Service
Quality Framework, where such
documentation has not already been
developed;
• Liaise with the Quality in Services Project
staff and Business Development Branch on
the development of a reporting format to be
incorporated into program quarterly
performance reporting to Executive from
June 2002. It is expected that the reports will
illustrate progress against milestones
identified in the plans or strategies.
issues will be a key element of the Quality in
Services Flagship Project during 2002. A
Regional Quality Management Group will be
established to guide this work.
Finally, this Framework is an important
quality management milestone for the
Department, but it is not an endpoint. Its
future development will be informed by the
work undertaken across the Department on
service quality policies, strategies and
improvement projects. Our direct service
management challenges, engagement with
external agencies and the work of the new
Operations Division will all provide essential
feedback for improvement of the Framework.
I commend the Service Quality Framework to
all Department staff.
PATRICIA FAULKNER

I am aware that many programs already have

specific quality management structures and
have developed service quality strategies, or
are in the process of doing so. Where such
initiatives have not yet been taken, program
managers may find it helpful to consult the
Quality in Services Flagship Project Group
members and staff.

page v
page vi

1. Introduction
The Department of
Human Services strives
to provide aged care,
health, housing, disability
and community services
of the highest quality.
The Department is
committed to constantly
seeking new ways to
improve its services,
consistent with its
mission:
“To enhance and protect
the health and wellbeing
of all Victorians,
emphasising vulnerable
groups and those most in
need.”
Developing Quality Services > Service Quality Framework
The Department’s service environment is complex, reflecting the
diverse needs and aspirations of the community to which it
seeks to respond. Continuous quality improvement will require
a Department-wide effort and a range of strategies carefully
tailored to the specific needs of programs and regions.
Many factors together determine the quality of provided or
funded services: quality depends partly on the skill of trained
human services professionals and support staff. It is guided by
documented service standards and the efforts made to monitor,
measure and continuously improve service performance. Good
quality service conforms not only to excellent technical
standards, but is also responsive to individual needs and
cultural norms. Efforts to protect clients and patients from error
are vitally important to service quality.
This Department-wide Service Quality Framework has been
developed to strengthen efforts to make measurable
improvements over time to the quality of services to clients and
patients.
page 1
 2. Commitment to Service Quality
The Department’s commitment to improvement in service
quality is reflected in its 2001–02 Departmental Plan: a key
Departmental objective is that the quality of human services
improves each year.

In June 2001 the Department adopted organisational values and

behaviours to guide its day- to-day activities:

Acceptable behaviours that express the individual value of

Quality include:

• Looking for ways to improve 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 complex environment requires a

concerted strategic effort to support this underlying value and
the behaviours required of all Department staff.

page 2
 Developing Quality Services > Service Quality Framework

This first Department-level Framework builds

3. The Framework: Summary
The Service Quality Framework gives
expression to the Departmental Objectives and
Values, and is focused on the 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.
on the work of programs and regions. It is a
milestone, but not an endpoint. Program-level
service quality policies, strategies and Priority
Action Projects, and the Department’s
engagement with external standards agencies,
will continue to inform the future
development of the Framework. The work by
Operations Division and Regions on direct
service management, service planning and
agency partnerships will provide essential
feedback for continuous quality improvement.

Operations and regions:

service quality planning
and monitoring

Program-based quality
policies and strategies

Service Quality
Framework

Our Values

External framework: quality,

safety & accreditation

A comprehensive approach to Service Quality

page 3
The Service Quality Framework will: • Service user responsiveness.

1. Define the dimensions of quality, to • Quality staff and facilities.

ensure a consistent language in quality
• Quality assurance: service standards and
management and to provide a basis for the
monitoring.
ongoing development and maturation of
quality measures and indicators. • Patient/client safety and adverse event
management.
2. Provide a practical framework—the
building blocks—for program management • Quality improvement processes.

to achieve high standards in each of the 3. Propose Department and program

dimensions of quality: infrastructure, building on current
initiatives, to consolidate and report on
strategic quality management.

These elements of the Service Quality

Framework are depicted below:

Quality Management
Defining Service Quality
Building Blocks
Effectiveness & Service Use-
Capability Responsiveness
Quality Staff &
Safety Facilities Quality
Quality Assurance
Services,
Appropriateness including accreditation Quality
Dimensions of Quality

Effectiveness & Outcomes

Fairness Capability
Acceptability & Effectiveness &
responsiveness Capability

Accessibility &
timeliness
Department-wide infrastructure
Continuity
Building a Culture of Quality

Sustainability Debating Quality Planning for Reporting on Quality

quality, management Quality Quality Monitoring
developing structures and Review
Good management
leadership
& efficiency

Monitoring of the implementation and further

development of the Framework will be the
responsibility of the Quality Executive
outlined in section 4.4.

page 4
 Developing Quality Services > Service Quality Framework

4. Defining Service Quality

Management for service quality must give attention to the following
dimensions of quality:

• Effectiveness and capability: the outcome desired by the client is

achieved with the requisite standard of skill, knowledge and
tangible facilities.

• Safety: risks are accurately assessed, avoided or minimised.

• Appropriateness: justifiable intervention, relevant to the needs of

client/patient, are provided in the least restrictive way and based
on established standards.

• Fairness: services are provided according to the rules and to those

for whom they are intended, without partiality or favouritism.

• Acceptability/Responsiveness: a respectful and caring approach,

compliance with clients rights, the offer of useful information and
relevant choices, and the encouragement and genuine
consideration of feedback.

• Accessibility and timeliness: services are provided according to

need at the right time and place for service users.

• Continuity: continuity of care is assured across

agencies/programs, and over time.

• Sustainability: stable reliable provision and consistent

improvement of services, responsive to emerging needs.

• Good management/efficiency: services are planned and well-

organised, perceived to be cost effective and administratively lean.

Ideally, these dimensions provide a framework for the development of

standards and measures relating to service quality outcomes.

It is acknowledged, however, that the development of service quality

outcome measures and indicators in human service settings is in its
early stages, even in clinical sectors. While efforts to strengthen a focus
on outcomes will continue, the primary emphasis in the immediate
term is likely to be on milestones toward the development of service
quality systems and improvements in quality management.

page 5
 5. The Building Blocks of Quality
Management
For service management to achieve a high and improving level
of quality, as defined above, a full range of quality management
actions need to be employed.

The basics remain the development and maintenance of a

qualified, skilled workforce and development of detailed
standards and reporting arrangements, but effective quality
management now embraces mechanisms to promote clients’
interests and incorporate their views. Efforts to establish and
promote good practice in service delivery are now common
features of program management. The active prevention and
management of injury to clients and patients is integral to
service quality.

Quality assurance and improvement is the responsibility of all

sections of the Department: regions, corporate services and
program management. While policy, service standards
development and best practice funding are the responsibility of
program Divisions, these are not the only functions important to
quality management.

The feedback loop carrying data from program implementation

and service practice is vital for quality improvement, and is
substantially the responsibility of regions and those units that
manage critical incident reporting, ministerial correspondence,
complaints systems and performance information.

Further, the service quality literature emphatically supports

decentralised quality initiative at regional and service provision
level. In practice, there are numerous examples of local initiative
across all Department regions. The implementation of the
Service Quality Framework will seek to strengthen local
initiative and the potential for cross-Departmental learning. The
establishment of the Operations Division will strengthen this
effort with its critical mission to improve service delivery,
especially in directly managed services.

The key categories of quality management action are detailed in

the following pages.

page 6

Key Category 1:
Service User
Responsiveness
Measures 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 advocacy,
independent scrutiny
1.5 Client/patient
participation in program
planning and decision
making
Developing Quality Services > Service Quality Framework
Achievement Measures
The interests of the human services user are the primary focus of
service management. Practical efforts by programs to encourage
responsiveness may be guided by the following:
• The active and independent participation of service users in
decisions about their own care and treatment is encouraged
and enabled.
• Service users are fully informed about service options and
entitled to provide feedback and make complaints about the
quality of services at any time, without prejudice or
obstruction.
• Service users have access to independent complaints
mechanisms that meet the Australian Standard AS4269-1995.
• Service users, their families, carers and friends are encouraged
and assisted by the Department to participate in the planning,
delivery and evaluation of human services. Specific efforts
will be made to secure the involvement of Koori persons and
those from non-English speaking backgrounds.
• Programs and services systematically plan and implement
service users surveys, analyse and develop strategies to
address service user concerns.
Current Practice and Developments
Surveys of patient and client experience are widespread through
Department programs:
• The Community Health Client Outcomes Survey, which has
been trialled through four centres to date and will be rolled
out further through 2001–02.
• The Patient Satisfaction Monitor, in its second year of
operation, provides for regular, ongoing, monitoring and
reporting of patient satisfaction in key areas of service
delivery in Victorian hospitals. It enables the Department to
report results to hospitals on both an aggregate and
individual hospital basis.
page 7
• The Child Protection Client and Family
Survey focused on the client/ carer’s
• The Peer Facilitation Project is part of
experience of the service. It has been
provided to 450 clients and 450 family
members in 2001–02.
• The National Social Housing Survey is a
national random survey of social housing
tenants (approx. 1000 per State) which seeks
responses on client satisfaction, experience
of tenancy practices, estate management
• A Complaints Management Information
and security.
• The annual Drug & Alcohol Client
Satisfaction Survey seeks responses on client
experience, perceived benefits of treatment,
and barriers to outcomes, from users, family
and significant others. It is conducted by
independent surveyors, using a database of
consenting clients; specific and general
reports are provided.
page 8
Other initiatives include:
DisAbility Services Client/ Carer
Consultation and Information Strategy.
Thirty people with a disability have been
trained as peer facilitators. They will work
with program staff to assist clients to
participate in their services’ quality
improvement initiatives.
Program was established in the Southern
Metropolitan Region in April 2001. The
Department has recently initiated
improvements to its management of
complaint handling, including the
recruitment of a strategic management
position to facilitate efficient complaint
handling systems across the Department.

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 standards
(facility, cleaning,
equipment)
Developing Quality Services > Service Quality Framework
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 that:
• Staff and facilities meet publicly documented (including
mandatory) quality standards, with particular reference to:
– Staff qualifications and credentials
– Physical standards 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 were introduced to hospitals in
2000, followed by a comprehensive state-wide audit of acute
facilities. Other programs and standards 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
education, training and professional development activities
that complement the role of the Commonwealth. The
Initiative aims to enhance the capacity of the workforce to
provide quality services and improve the standing of Aged
Care as an attractive and valued career option.
• The DisAbility Services Learning and Development Strategy
is establishing a sustainable, competent workforce across the
government and non-government disability sector, in
collaboration with Higher Education (University) and VET
sector providers. The complementary DisAbility Workforce
Plan will also address recruitment, retention, reward and
recognition of disability staff employed by the Department.
page 9
• Legislated staff qualifications apply to child
protection workers, preschool teachers,
child care staff, health clinicians, juvenile
justice workers, secondary and primary
nurses.

page 10

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
standards, indicators,
performance measures
3.3 Client/patient Outcome
information
3.4 Quality monitoring and
audit: Department
3.5 Quality monitoring and
audit: external
3.6 Peer review
3.7 Self-assessment
3.8 Evaluation: program
3.9 Evaluation: service
3.10 External accreditation
Developing Quality Services > Service Quality Framework
Achievement Measures
Service users should be assured that the care and treatment they
receive will produce 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 standards have the following
characteristics:
• Evidence-based.
• Balanced between clearly defined minimum, objectively
verifiable standards and contingency-based standards that
promote continuous improvement.
• Developed in consultation with credible industry 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).
Input Process Output Outcome
Client Focus
page 11
3. Where appropriate, external accreditation of
services is supported. The Department will
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
• National Community Housing Standards
consumers.
Current Practice and Developments
• A Priority Action Project has been initiated
to develop operational standards
documentation and a practical system for
monitoring service standards in the Problem
Gambling program. While addressing the
aspirational statements and sample
indicators, and cover client rights, care
issues, access to health and educational
services, physical standards, built
environment and staffing/management
quality.
and an associated model accreditation cycle
have been developed for:
– Tenancy management.
– Asset management.
– Tenant rights and participation.
– Working with the community.

business needs of this program, the project – Organisational management.

is also intended to develop model standards
– Evaluation, planing and service
and processes for broader application.
development.
• Acute health programs have an ongoing
– Human resource management.
strategy to develop and implement
performance indicators to better measure • Victorian Disability Service Standards have
the accessibility, appropriateness, safety, been developed from national standards to
efficiency and effectiveness of healthcare which Victoria is a signatory. The Standards
services. provide the basis for self-assessment and
will be components of a comprehensive
• Residential aged services observe
monitoring and quality improvement
Commonwealth standards and are subject
framework to be rolled out over the next
to independent accreditation. A State
few years. Each of the 9 Standards
Ministerial Advisory Committee considers
comprises statements of client-centred
state regulatory safeguards for residents of
principle and a range of criteria which
high care facilities, particularly with respect
describe management and staff practices to
to nurse/ patient ratios and provision of
meet Standards.
information to the community, clients and
carers. • Legislated and non-legislated National
Standards apply to public health programs
• National Standards for Juvenile Justice
including environmental health, public
Custodial Facilities have been established
health, immunisation, pest control, tobacco,
by the Australasian Juvenile Justice
food and infectious diseases.
Administrators. These incorporate

page 12

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,
management, analysis.
5.3 Program (or higher)
review of adverse events
5.4 Formal risk
management systems at
agency level
Developing Quality Services > Service Quality Framework
Achievement Measures
A major objective of human service management is to assure
service users of safe progress through all components of the
service system. Efforts by programs to minimise the risk of harm
from the care provided and the environment in which 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 training of staff on the basis
of this analysis.
Current Practice and Developments
• In 2001–02 the DisAbility Services Division will commence a
Priority Action Project to:
– Strengthen management and reporting of adverse events at
service level.
– Establish a sustainable quality improvement cycle
providing robust analysis and feedback on adverse events
at program, regional and service provider levels.
– Consider cross-program adverse event issues.
Critical incident reporting (CIR) is the main Departmental
central adverse event management system. The Department
has recently revised the system, which is intended to facilitate
analysis and prevention. The DisAbility Services Priority
Action Project will address the effective operation of the
system in this program.
• Management of adverse events in public hospitals has been
strengthened through the new Clinical Risk Management
program. The Quality Council and Consultative Councils
supplement long-standing, diverse hospital-based procedures
and review arrangements.
page 13
• Supported Residential Services regulations
require that records of any accident, injury
or mishap to residents are maintained for
inspection by Advisors and Community
Visitors. Prosecutions have been pursued on
the basis of inadequate records.

page 14

Key Category 5:
Quality Improvement
Processes
Programs 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 Department/
agency) to develop and
promote evidence base/
best practice
6.5 Benchmarking program
6.6 Other quality
improvement programs
Developing Quality Services > Service Quality Framework
Achievement Measures
Continuously 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
innovation and service effectiveness. Programs also facilitate and
monitor the development, application and evaluation of good
practice guidelines or other forms of advice based on that
research. Ideally, a quality improvement strategy will:
• Develop a systematic approach to improvement incorporating
a documented cycle of measurement, comparison, action and
review.
• Ensure that high quality, comparative practice information is
actively marketed to human service providers and the public,
to inform service improvement efforts.
• Share information about good practice with service providers
and other stakeholders.
• Promote cross-program and multidisciplinary work to
develop 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 awards,
grants and incentives for practice development. Good practice
projects funded in placement and support were recently
documented in the publication Achieving Service Quality
Improvement.
page 15
• The Breakthrough Collaborative in
Emergency Care trialled evidence-based,
measurable practice improvements in a
strongly focused project to improve services
and reduce waiting times. Workshops,
forums and electronic formats are
commonly utilised in Breakthough type
initiatives to disseminate the findings of
quality improvement projects and plan
further work.

page 16
 Developing Quality Services > Service Quality Framework

6. Implementing Department-
Wide Service Quality
Infrastructure
It is important that quality initiatives and Service Quality Framework: Summary
systems improvement be strengthened by Actions
leadership action to drive and promote a
• The Department will sponsor
service quality culture.
opportunities for information sharing and
The principles and practices of continuous discussion on quality management
quality improvement should underpin initiatives and systems.
Department-wide support for program and
• A ‘Quality Executive’ will be established
regional initiatives.
to drive implementation of the Service
Individual quality initiatives are more likely to Quality Framework at a senior level
be effective when introduced in a service across the Department
organisation that functions according to
• Department programs will develop
continuous quality improvement (CQI)
quality plans broadly consistent with the
principles and practices.
Framework, and appropriate structures to
The characteristics of organisations that adopt implement them.
CQI may be briefly summarised:
• By June 2002, Department programs will
• The use of problem-solving approaches develop a reporting format incorporated
based on statistical analysis and relevant into quarterly performance reporting, to
‘soft’ data. illustrate progress toward quality plan
CQI involves the ongoing gathering of data milestones.
to provide quick feedback, and analyse and • The service quality element of the Agency
monitor processes, outputs and outcomes. Performance Monitoring and Review
Decisions are based on the data and instrument will be developed for
improvement is measured over time. By implementation in 2002/03.
using broadly based data sets that have
widespread acceptance as indicators of
quality, there less likelihood of dominance
by any particular element and more chance
of whole-of-organisation support for
improvement.

page 17
• The focus of analytical processes is on
underlying organisational processes and
systems rather than blaming individuals.
The CQI organisation adopts systems
analysis as its first response to solving
problems. Most quality problems if not
caused by faulty systems are amenable to
changes in systems. Human error is
inevitable and supportive systems need to
be developed to minimise it. A culture of
personal blame detracts from the productive
analysis of systems.
• The use of cross-functional employee teams
in continuous improvement activities.
Successful, systems-based innovation and
problem-solving requires the involvement
of all who contribute to the system. Cross-
functional teams also mitigate any one
particular professional or functional view.
They provide some assurance of balance
when problems are being identified and
solutions sought. The collective ownership
of new strategies is necessary for successful
implementation.
• Employee empowerment to identify
problems and opportunities for improved
care and to take the necessary action.
Empowering employees to both identify
opportunities for improvement and to
implement appropriate responses has a
track record of success in CQI. Leadership
at all levels is characteristic of a successful
CQI culture: the capacity of teams to
independently identify methods of inquiry
(such as data parameters and collection
techniques) and implement appropriate
page 18
responses with an emphasis on systems
development.
• An explicit focus on both internal
stakeholders and external consumers.
Internal stakeholders are those within the
organisation who play a role, direct and
indirect, in the delivery of the direct service.
External consumers include the direct
service user, friends, family and other
providers, and to a varying extent, broader
communities of interest. An explicit focus
on the consumer ensures that analysis and
decision-making about system changes
include consumer research and preferences.
• Sustained management support for this way
of working is a foundation for success in all
quality improvement strategies.
A clear commitment to quality, backed by a
high level of knowledge and thorough
understanding of quality management
principles, is required at senior management
level. This commonly involves a change of
emphasis to value quality equally with
throughput and budget control, and to
recognise interconnections between quality
and financial elements of service. There
must be a commitment by management to
act on the reasonable recommendations of
professional staff for system change to
improve services.
The development of a culture of quality in a
large and complex organisation is necessarily
staged with regard to priorities and available
resources. The following initiatives will
provide an immediate term boost to
Department-wide quality management.
 Developing Quality Services > Service Quality Framework
Debating Quality, Developing
Leadership
It is necessary for those working in human
services to take responsibility for the standard
of their own practice and share responsibility
for creating and maintaining a system that
provides high quality, safe service. The
Department will sponsor opportunities for
improved information sharing and discussion
and raise the profile of service quality
management among Department staff.
Methods for doing so will include:
• A seminar series for staff, incorporating a
quality and innovation conference in early
2002–03.
• Recognition for quality management effort
by program or regional units, including
through internal Departmental awards.
While this Framework is focussed on service
quality assurance and improvement, it is
acknowledged that the Department’s own
business processes are key drivers of quality.
Quality management literature indicates that
effective process control or variation arising from
poor process management are considered lead
indicators of good or poor quality down the line.
Existing quality frameworks in human services
and other industries incorporate consideration
of, for example, leadership, strategy and
planning, business process management, and
supplier/partner relationships. Individual
programs, regions and services have current
involvements with, for example, service
accreditation agencies and the Australian
Quality Council, and will be supported in local
efforts to implement internal process quality
improvement projects.
Department and Program Quality
Management Structures
Essential to quality management are structures
at senior management level to drive, monitor
and sustain quality strategies. All Department
programs will develop quality strategies,
assign people to implement them, and report
against the milestones appropriate to each
program within a broad common framework.
Appropriate organisational structures to drive
quality improvement will vary across
programs and Divisions. Some have
developed strategies or frameworks and have
established specific quality structures, or are
currently doing so. Examples include:
• Aged residential services: the Victorian
Public Sector Residential Aged Care Quality
Action Plan 2001–02 has been developed,
and a specialist Quality Improvement Unit
was established in September 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 provide
leadership on clinical quality and safety
matters and respond to recommendations
from various expert bodies and councils.
• Dental Public Health Services: the Strategic
Plan for Quality Improvement in Dental
Public Health Services addresses objectives
identified by the Government in its Election
Policy. The Quality Reference Group (QRG)
was established in 1999.
page 19
• A specific unit to manage quality
monitoring, review, improvement has been
established in Disability Services, and is
developing a strategic approach to quality
management across disability services.
A senior Department-wide structure will be
established to drive implementation of the
Service Quality Framework and strategy. The
structure will be led by an Executive Director
and comprise Program and Regional Directors
nominated by Executive.
The ‘Quality Executive’ will oversee program
quality strategies and their implementation,
especially as reported in the quarterly
Executive milestone reports. It will coordinate
Department-level efforts to consolidate a
culture of quality and promote policy
development in cross-program quality
management issues.
page 20
Planning for Quality
Increasingly, service agencies are required by
the Department to prepare Quality Plans (or
similar), including for example all Community
Care funded agencies, public hospitals, and
disability services agencies.
As noted above, some programs, Divisions
and regions have also developed quality plans,
strategies or frameworks, or are doing so.
Although sufficient allowance must be made
for the great diversity in service contexts, it is
important for practical reasons (including the
interdependence of activities required for
quality service to clients) that a consistent
approach to terminology, concepts and key
elements of implementation be adopted.
A Priority Action Project is proposed to
develop an overall quality strategy to draw to
together the diverse strands of quality
assurance and improvement currently in place
in the Child Protection program. While
meeting the requirements of the specific
service environment, it is intended that the
strategy be broadly consistent with the
Department-wide Service Quality Framework.
It is envisaged that the project will encourage
and provide guidance for similar efforts in
other programs delivered by the Department.
 Developing Quality Services > Service Quality Framework
Reporting on Quality
An essential adjunct to the management
structure referred to above is a robust
reporting arrangement designed to provide
regular information on the implementation of
quality strategies as well as data from quality
measures and indicators.
• Executive set reporting: from June 2002 a
reporting format based on the Service
Quality Framework will be incorporated
into program quarterly performance
reporting to Executive, to illustrate progress
against quality management milestones.
• Regional Accreditation, Quality and
Governance key indicators for reporting on
regional performance to the Executive will
be developed by Business Development
Branch in collaboration with the Quality in
Service and Regional Benchmarking projects
through the Future KPI Development
Program.
Service Quality Performance
Measurement
The service quality element of the Agency
Performance Monitoring and Review
instrument (APM&R) will be developed in
2001–02:
• A milestone approach will be adopted,
based on the mechanisms of quality
management identified above
• Funding and policy plans will articulate the
Framework and program level quality
strategies, and nominate priorities for
quality management development in
2002–03.
• 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 through the KPI Development
Program.
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ATTACHMENT
ATTACHMENT:
Outline of the
Quality in
Services Flagship
Project
The Quality in Services
Flagship Project was
initiated by the Executive of
the Department to develop a
cross-Department Service
Quality Framework for all
services provided or funded
by the Department and take
timely action to address high
priority quality management
issues.
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Current Approaches to Service Quality
A key early task for the Project was to undertake an Overview of
the Department’s quality management systems and initiatives.
This revealed a high level of effort and diversity of good practice
across all programs. It identified key quality management
challenges:
Challenges for Service Quality Management
Service standards consistency and monitoring effectiveness
Documentation of standards relating to quality varies in
format and operational value. Systematic monitoring of
standards is key to public confidence and service
improvement.
Need to clear program policies on accreditation There is
growing pressure for extending accreditation to a wide range
of sectors, as well as a range of issues with current
accreditation arrangements. The diversity of views within the
Department suggests the need for considered policy views at
program and Departmental levels.
Consistent approaches to safety Good systems to prevent,
monitor, report and manage adverse events to clients and
patients are widely recognised as a key part of quality
management. Most programs acknowledge the need for
substantial improvement.
Reducing the impact of systems complexity on quality
Unnecessary complexity inhibits quality management, with
particular reference to funding and accountability systems,
program arrangements and information management.
The need for effective program-level quality strategies As is
increasingly required of funded agencies. all Department
programs should have a current service quality policy and
strategy, and an effective structure to implement it.
 Developing Quality Services > Service Quality Framework

ATTACHMENT

Better use of practice information and systematic evaluation

for quality improvement purposes Quality management
practices in most programs (surveys, complaints systems,
incident reports) generate valuable information that is
currently under-utilised. There is room for more extensive and
better use of impact evaluation and continuous quality
improvement methodologies.

Consistent approaches to understanding and responding to

client experience While Department programs have
responded to the growing emphasis on service user
perspectives of quality, approached to capturing and
analysing their views and experience vary greatly in

Priority Action Projects

In October 2001 the Executive considered the Overview and
analysis, approved the development of three Priority Action
Projects and endorsed in principle a package of Department-
wide measures to drive and promote a culture of service quality.
The Priority Actions Projects are:

• Child Protection Development of a comprehensive quality

management strategy to draw together and strengthen the
range of quality assurance and improvement activity in the
program.

• DisAbility Services Strengthen the management and reporting

of adverse events at service level and develop a sustainable
quality improvement cycle of analysis and feedback on
adverse event.

• Problem Gambling Develop model operational service

standards and a practical means to monitor the achievement
of service quality.

By June 2002, three Priority Action Projects will be completed or

have made substantial progress against project briefs.

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ATTACHMENT
Endorsement of the Service Quality
Framework
In November 2001, the Executive adopted a
Department-wide Service Quality Framework
designed to assist programs to strengthen their
quality assurance and improvement efforts.
The Framework will be published in electronic
and document form in January 2002.
Future Milestones
In February 2002 further recommendations
will be made to the Executive about the
development of Department-wide
infrastructure to drive implementation of the
Framework and promote a culture of quality.
The centrepiece will be a senior ‘Quality
Executive’, chaired by a nominated Executive
Director.
By June 2002 all Programs will complete 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.
page 24
Key Outstanding Issues
Regional Quality Management
Further work on Regional quality management
issues will be a key element of the Quality in
Services Flagship Project during 2002. The
following factors require consideration:
• Quality assurance in most human service
programs is the operational responsibility of
the Department’s regions. The effective
conduct of these responsibilities is a vital
consideration in the design of quality
systems and initiatives. Regional quality
management systems will be integral to the
development 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 continuous quality
improvement strongly support such
decentralised initiative and the
development of a systematic approach to
dissemination and cross-Departmental
learning.
• The feedback loop carrying data from
program implementation and service
practice is vital for quality improvement.
These functions are substantially the
responsibility of regions, together with
those units that manage critical incident
reporting, ministerial correspondence,
complaints systems and performance
information. The contextual analysis of
practice information and action to respond
to it rests mainly with regions.
 Developing Quality Services > Service Quality Framework

ATTACHMENT

It is important therefore that the Service It is recognised that to ensure effectiveness in

Quality Framework seeks to strengthen local
initiative and the potential for cross-
Departmental learning. The establishment of
the Operations Division, will strengthen this
effort with its critical mission to improve
service delivery, especially in directly managed
services.
Work between the Operations Division,
Regions and Flagship Project staff will be
initiated to strengthen these elements of the
Framework over the remainder of 2001–02.
Accreditation
service monitoring, the sector must have
confidence in the process and that
accreditation strategies will vary with the
service environment. Any development or
enhancement of current mechanisms should
occur in close cooperation with service
provider management and service user
representatives.
The Flagship Project and Program
management will further consider this issue in
the course of developing quality plans and
Department-wide strategies during 2002.

External service accreditation is a potentially

important quality assurance device provided it
is robustly administered, incorporates explicit
standards across all dimensions of service
quality and involves direct observation,
verification and consultation with consumers.
The most robust approaches employ a
combination of self-assessment and external
review and balance minimum quality
assurance with encouragement to continuous
quality improvement. Accreditation agencies
vary in these characteristics.

While in isolation accreditation activity does

not guarantee quality, it has a role in
reinforcing public confidence in services. All
health programs mandate external
accreditation and there is support for this
approach in some other service sectors. The
comprehensive use of external accreditation is
under consideration in other jurisdictions.

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