Day 2: Quality and Safety in the NDIS conference, 20-21 August 2019 in Sydney

Day 2: Quality and Safety in the NDIS conference in Sydney 20-21 August 2019 – developing a customer centric organisational culture based on active support and excellence in practice management

Belinda Drew, CSIA gave the keynote address on Day 2 of the conference, about understanding the role of collaboration in meeting the customers’ needs. The Productivity Commission (2017) stated “Early evidence suggests that many (but not all) NDIS participants are receiving more disability supports than previously, and they have more choice and control”. Based on the current rate of participant intake, the estimated 475 000 participants will not be registered with the NDIS by 2019-20 as planned. The majority of disability service providers are making a profit in the new operating environment, but workforce, financial management, technology, pricing and regulation continue to pose challenges for the successful transition to the full NDIS scheme. Implementation of the Market, Sector and Workforce Development Strategy so far has not properly dealt with the systemic, strategic changes required to ensure success of the scheme. A paradigm change is needed as per the 5 steps of the Kuhn Cycle shown below.

She also described the Human Services Value Curve developed by the Harvard Kennedy Leadership School “Leadership for a Networked World”. Leadership for a Networked World (LNW) helps leaders improve outcomes and value through organizational adaptation and transformation. LNW’s applied research, learning programs, and advisory services are focused on the global “capacity challenge” – an environment in which every pressing challenge we have – generating better government outcomes, creating efficient markets, ensuring economic development and security, sustaining the environment, redesigning healthcare, improving education, etc. – requires melding together organizational and technological innovations in ways that transform our societal capacity to respond and act.

Kerry Stubbs, CEO of Northcott described the NDIS as “the biggest social change in Australian history and we are still grappling with it – we are making a new destiny in our work with PWD. Northcott is 90 years old – one of the longest running providers in Australia. She described how over a 3 year period they had to re-think what was offered and decided to concentrate on the “complex end” of the spectrum as cheaper models like Hire Up and Mable emerged. They developed the Northcott Innovation Hub where they do design thinking work to re-design services bringing Professors from overseas to run workshops. They mapped all of their processes and made interventions in a methodical way relying on project management skills – understand your business from top to bottom and cost everything that matters. They closed down their DES services and closed the Dubbo office after 40 years. They started new programs around sexuality and relationships. She remembered the Sisters of Charity “ no mission without margin”. Northcott used technology to reduce duplication, error, cost and rework – people were freed up to provide service with systems and processes designed to help them.

They use a variety of systems with dashboards including a CRM, Riskman for incidents, Orion for HR and Carelink plus. They are talking with the NSW Department of Industry about a Human Services Training Plan as NSW needs 30,000 disability workers and 100,000 aged care workers. She said there is a conflict between choice and control and risk – “be clear about what risk you are prepared to take as an organisation”. The Royal Commission provides an opportunity to lead to great improvement though there is a “risk that it exacerbates the move to over regulation and total risk avoidance”.

Professor Christine Bigby[1], Director of the Living with Disability Research Centre at La Trobe University - spoke about her research into defining quality from different perspectives saying that eventually there will be a “Leagues Table of Service Quality”

[1] mailto:c.bigby@latrobe.edu.au

Figure 8 Professor Christine Rigby, Director Living with Disability Research Centre

14 organisations, 134 services and 461 residents were involved in the research project over 10 years. Looking at quality in supported accommodation services, the research found that:

High levels of compliance with standards – tells us very little about quality

Despite compliance - continuing abuse - major incidents Australia and overseas

Quality in supported accommodation services is highly variable

• between organisations - similar model and funding

• within organisations - similar models and funding

• variable over time (see over)

• precarious

Service quality is generally fairly poor particularly for people with higher support needs

• measured by outcomes and staff support - high levels of disengagement

Increasing imperative for organisations to demonstrate quality

• for consumers informed choice depends on knowledge about quality

• funders/regulators stewardship of the market - decide what funds can purchase - potential to drive

quality by benchmarking and comparison

Quality systems that combine outcomes and processes overseas:

̶ Care Quality Commission UK

̶ Adult Social Care Outcomes Framework (ASCOF) (Department of Health, 2017)

̶ Personal Outcome Measures (POMS) ( Council for Quality and Leadership (CQL, 2017)

Comparing and contrasting these systems (McEwan, Bigby, Douglas, 2019)

• Remain primarily process orientated

• Limited range of outcome domains – POMS for example, missing emotional wellbeing, material

wellbeing and personal development

• Only CQC uses observation of staff practice

• POMS issues with use of internal staff to gather direct feedback from service users - problems

similar to those with satisfaction

• Beginning to help understand significance of quality of support and connection between the quality processes and outcomes

Paperwork is an unreliable indicator of quality of what has actually happened

Claire Quilliam PhD - in depth study of how staff use paperwork (Quilliam, Bigby, Douglas, 2018 a,b,c)

Increasing volume of paperwork and prescription about timing, content and place means that staff manage rather than follow the paperwork rules using their discretion

• when they consider it irrelevant to practice,

• feel uncomfortable with recording what happened

• it takes too long to complete

Finds it is often unreliable as a source of information about practice or client outcomes as staff often

prefill paperwork - predicting what should happen rather than actual events –loses detail of what did happen

“It can take you an hour and a half to get five afternoon shift [reports done]… I always start ahead… I’ll create [a report] for the next day the night before, and I’ll just write, “[a resident] went to [placement],” or something, or “they went to such and such.” And then the next morning I'll fill [the report] in.

By backfilling the paperwork - suggests things have been done on time

“[Paperwork] can get overlooked. Weeks fly [by]… And if someone gets thrown off stream with other issues, something [paperwork] can be two weeks late. …We didn’t have time to do a resident meeting this Thursday night…we had [medical] appointments. And it was in the diary that it was to be done. So I actually did it on the Friday but backdated [it] to the day it was supposed to be done”.

Priority Factors For Good Practice and Good Quality Services

• All staff trained in Active Support

• Every individual support worker and team receives strong Practice Leadership.

• practices of support workers are regularly observed

• they receive feedback and coaching

• discuss Active Support in team meetings and individual supervision

• know what is expected of them on every shift.

• a focus on the quality of life of the people they support is at the core of everything they and managers do. The LDRC has created an Active Support measurement tool that has been put in an app that people can use. There are fantastic resources about Active Support and other topics on the LDRC website at https://www.latrobe.edu.au/lids/resources

Kate Rush, Anglicare SA spoke about leading change and the quality improvement process – change involves loss and letting go of the old to embrace the new – where you focus is where you will go – need to have a BIG BOLD vision that is meaningful and to engage in mental time travel “what does success look like”. The point of difference in our organisation is our staff.

Neil Sing, Golden City Support Services – with 160 staff, revenue of $10 million and 1240 clients. They developed the Observation Tool app themselves and used Power BI to analyse the data – cost was $15000 to make the app. They found there is no alignment between qualifications and “no qualifications” in determining who is best at the job as a support worker.

Neil said that the benefit of dedicating the organisation’s structure to supporting practice leadership focuses all the agency’s efforts to providing just enough support, so those that they support can live an ordinary life, in the communities they choose and have relationships and interests they choose. When there is so much noise & focus in & around the organisation, as it adjusts to the demands of the market driven NDIS, a grounding in practice that delivers outcomes is essential. “The more we understand about what it takes to deliver sustainable quality services, the more we understand that we are not there yet & that realisation & humility are important to continuous improvement. Our Board has a mission to help the sector understand what it takes to deliver improved outcomes to people with a disability, especially those with intellectual disabilities – we are fulfilling our Board’s mission”.

Teresa DaoSeptember 10, 2019quality, NDIScommission, NDIS, safety, compliance