Quality Systems: Consistent Ways of Producing Crap?

Lots of disability providers have been pushed into adopting complex quality systems to respond to complex government compliance requirements. It seems ironic that they battle to provide quality services while meeting the additional demands placed on them by their quality systems that can add little value to the real work.

It is always really telling when you see Quality systems and the people who manage them sitting apart from the organisations they work for.  The Quality staff get busy prior to the external audit, manage the audit visits and clean up any non-compliance issues raised. No one except the Quality staff really know the when, where or what of the quality procedures and the system. The whole approach is not integrated and is very often just another burden for already overworked staff. Yet after the audit, everyone briefly celebrates the organisation passing this self-serving accreditation hurdle. The whole thing is a little weird and this approach to quality simply sucks.

A not so recent presentation from a leading Australian CEO who had been overseas analysing the latest in quality assurance systems has really stuck in my mind. His conclusion was that many of the bigger quality systems when fully implemented, delivered ‘consistent ways of producing crap’.

In one very big disability organisation, we did a survey of frontline staff of all the support services head office offered, from IT to HR and QA.  In that organisation, on a scale of 0 to 5, the average rating that staff gave their (very expensive) QA system was 0. The QA system can be a hungry beast that just devours organisational resources to feed its insatiable appetite with little result. We need to do better than that in the NDIS.

So, will it be different with the new Quality and Safeguarding Framework emerging in the NDIS? Will we achieve better outcomes with lighter touch compliance?

With the new Framework, many existing providers are being promised a significant reduction in the volume of compliance work they need to do compared to state-based systems. For new providers looking to enter the NDIS marketplace, they appear to have a much more straightforward and less laborious registration process (especially for the delivery of so-called 'lower risk' services). Looks good so far.

But I wonder if the new system really will be simpler? Whenever I have been involved in a system where government tells us it is cutting red tape and reducing the admin burden, it results in the opposite. The simpler systems are not so, and the paperwork just keeps on building. Any time something bad hits the media (from abuse to system rorts), government responds with a new layer of compliance to demonstrate how they have fixed the problem (but they don’t).

The challenge will be for the new NDIS Quality & Safeguards Commission to hold its nerve and focus on the real drivers of quality and safety in disability services.

The Commission is on the right track, the suite of Quality and Safeguarding measures that will take effect in some states in July this year has some requirements that are reminiscent of the old, block-funded, outputs-based contracts that the sector is moving away from. But the relatively light-touch approach of the Framework overall points us to a big central idea: that mountains of paperwork and 20-page procedures are not the things that are currently keeping people safe. We are in a people sector, and what keeps people truly safe is other people. It is and always will be a business based on relationships and trust.

There are lots of reasons that the NDIA wants a nationally-consistent, more straightforward quality system. I hope that one of the more significant reasons is that they understand the old systems of quality were resource intensive for everyone involved and were not always that effective.

So, if complex quality and compliance measures don’t stop terrible things happening to vulnerable people, what does?

The evidence is in. ‘Closed systems’ such as institutions result in poorer quality services and greater rates of abuse. We need open systems, community based services where people are interested if curtains are still drawn at lunchtime, where people care if the participant hasn't turned up for three days in a row with no notice and people ask questions if something seems 'off'. It's great if this extra interest is taken by paid staff, and even better if the surrounding work is done to have informal, natural, unpaid supports in important areas of a participant’s life. 

The strongest safeguard is simply having more people that care and can see what’s going on. In every case I've heard about in the last few years where something awful has happened to a participant, that organisation has had their quality boxes ticked and their policies & procedures lined up. The breakdown was at the personal level. 

Quality outcomes require partnerships with the people who regularly interact with the participant; family, neighbours, regular workers, friends, advocates, support coordinators, checkout workers, baristas, gardeners, volunteers, bus drivers. All these people can give a provider the foundation to achieve shared goals and do it in the safest way. We are seeing successful providers in NDIS taking a partnership approach to quality and risk, not a top-down one.

The new Quality & Safeguarding Framework cannot simply replace too much compliance in state based systems with too much compliance in a national system. The very last thing providers need right now in the NDIS is more admin and compliance hassles. We have a golden chance to reframe the way we think about and deliver quality services in the NDIS.

The opportunity is to build an open system that is genuinely people and partnership focused. The question becomes: will the Quality & Safeguards Commission be up to this very big challenge?