Disaster Health Care Assistance Scheme (DHCAS) quality checking in QST 111-20051923

The Disaster Health Care Assistance Scheme (DHCAS) quality checking process aligns with Services Australia's Enterprise Quality Framework and the 7 quality principles.

See Resources for a link to the Enterprise Quality Framework.

The quality checking process:

• helps Team Leaders and Quality Checkers to identify DHCAS process improvements
• make sure consistency in quality checking

In scope

Disaster Health Care Assistance Scheme (DHCAS) in Processing and National Demand Allocation (PaNDA).

Quality control in the Disaster Health Care Assistance Scheme (DHCAS) is paramount. All transactions must be conducted in the Disaster Health Care Assistance environment.

Quality assurance is completed before a payment is authorised and quality checking is completed once the payment is finalised.

The DHCAS quality checking process aligns with Services Australia's Enterprise Quality Framework and the 7 quality principles. See Resources for a link to the Enterprise Quality Framework.

The quality checking process makes sure a systematic and planned approach to improvement:

• analysis of complaints and issues trends
• research of possible solutions
• planning and prioritisation of improvement activities
• listening to suggestions from stakeholders, customers and staff
• monitoring and evaluation of new solutions, processes and improvements

Managers/Team Leaders must make sure:

• quality checks are completed using the process for Quality Checker accreditation
• quality checkers hold appropriate skill tags in the Quality and Support Tool by sending an email to the Services Delivery Quality and Support Team
• timely error feedback is discussed with Service Officer as part of the coaching conversation. This supports any learning and development needs
• analysis of errors is completed, e.g. did the errors occur because of limited training, understanding of the business rules, environmental or system based issues
• positive quality checking results are discussed with the Service Officer
• analysis of data is completed to identify learning needs or process improvement opportunities
• quality checks are done as specified in the sampling plan
• they notify senior management of serious errors which places the agency's reputation at immediate risk
• they escalate systemic issues
• lodgement of quality checking outcome disputes

Quality Checkers must:

• carry out quality checks as outlined in the sampling plan
• update and maintain technical knowledge, procedures and policies
• maintain a correctness standard for personal accuracy
• complete root cause analysis and identify systemic issues
• report and escalate trends or concerns to the Team Leader
• give constructive and non-judgemental feedback. Include reference materials such as Operational Blueprint
• explain the impact of errors and action to be taken to correct the error (where applicable) when giving feedback
• examine system information/source documents to make sure Aged Care payment claims processes are in line with business rules, policies and procedures

Quality checkers must not check their own work. If own work is selected it must be given to another staff member who has been trained to conduct quality checks.

DHCAS Quality Portfolio must:

• reviewing monthly quality reports and arranging further analysis of errors as needed. In collaboration with the programme area, Team Leaders, and/or Program Support Officers and/or Subject Matter Experts, this may include:
• analysis of data over a period of time, to determine prevalence
• identifying contributing factors and possible solutions
• escalations or implementation of change solutions
• national implementation of DHCAS quality practices
• monitoring the Provider Services Support mailbox for QST feedback and providing feedback as required
• analysis of national quality reports to identify learning needs or process improvement opportunities
• escalation of national quality issues to the relevant programme area

Quality team must:

• provide support for quality checking in the Quality and Support Tool (QST)
• provide relevant reports as needed
• arrange QST training for quality checkers
• support the business with flexible and fit for purpose quality approaches

Staff performing quality checking must have:

• subject matter expertise – the staff member completing the check has product knowledge, understands the guidelines, procedures, business rules and/or knows where to source them
• maintain a high correctness standard in the program being checked
• completed the DHCAS Quality Checker training package. See User guides on Resources

Quality Checkers must complete refresher training (of the quality checking process) annually. See Quality Checker accreditation for Health Service Delivery Division for more information.

All DHCAS claims and registrations are quality checked prior to finalising DHCAS work items in the Processing and National Demand Allocation tool (PaNDA). The following responsibilities occur during the quality assurance process:

Service Officer:

• processes DHCAS claim or registration

Experienced Service Officer/Subject Matter Expert:

• performs initial quality assurance on claim or registration
• creates the payment run

Team Leader:

• completes quality assurance on claims
• completes quality assurance on the payment run
• notifies delegate that claims on the payment run are awaiting authorisation

Delegate:

• conducts final quality assurance of the claims on the payment run
• authorises payments to be released by finance

Note: quality checking completed in the Quality & Support Tool is separate to the above quality assurance guidelines.

Once DHCAS work items are finalised in the Processing and National Demand Allocation tool (PaNDA), they are selected for quality checking in the Quality and Support Tool. Quality Checking is completed once a payment run has been finalised, within approximately 5 working days.

All quality checks for the month must be actioned within 4 calendar days of the following month. After this time, remaining work is abandoned.

Pre-checks

Pre-checks include checking documents have been verified against the submitted claims or registrations prior to finalisation. Pre-checks are:

• applied to work completed by Service Officers receiving initial training
• completed within 5 business days of processing
• made against applications held in the Processing and National Demand Allocation (PaNDA)

The results of pre-checks are captured in the Quality and Support Tool, but are not included in any quality reports.

Post-checks

Post checks are used to determine the level of accuracy for finalised work. All work completed the previous business day is identified in PaNDA for checking. Post checks are completed against source documentation in PaNDA and system records.

The results of post checks are used to measure accuracy standards, which are captured in the Quality and Support Tool and included in quality reports.

Targeted Checks

These apply to:

• staff when there is a substantial new process introduced or an identified quality issue
• Aim for Accuracy process (Check the Checker) which is completed every 12 months. This confirms the accuracy of quality checking results. The process involves rechecking a sample of previously checked work to decide if quality checking procedures have been followed correctly

The quality checking sample for DHCAS is 100%. This includes:

• Service Officers in training and undertaking consolidation
• processing Service Officers
• experienced Service Officers / Subject Matter Experts
• team leaders
• delegates
• all staff who undertake quality assurance

Staff in training must achieve 90%+ accuracy in order to be deemed proficient.

Timeframes

Quality checks are undertaken daily on a random sample of work:

• Pre-checks - quality checks are normally done within 1-2 business day of the work being completed
• Programme checks - where possible quality checks are completed within 4 calendar days of being allocated in the QST. At the end of the month any program check not completed is automatically abandoned after 4 calendar days
  Note: work will not be abandoned for 100 % quality checks

Resources

Quality checkers must have access to the following to do quality checks:

• program specific processing systems
• Processing and National Demand allocation (PaNDA)
• Quality and Support Tool (QST)
• skill tags added on the Quality and Support Tool
• relevant internet and intranet sites, e.g. Operational Blueprint

An error is information processed or keyed that does not match the documents supplied, or the supporting documents uploaded on the system.

Error codes are categorised as critical and non-critical.

Critical errors

An error is defined as critical when there is a potential risk to:

• a customer's:
• privacy
• eligibility
• payments
• finalisation of an application assessment
• record
• the reputation of the agency

Non-critical errors

An error is defined as non-critical where it does not meet the above criteria. Generally, this relates to administrative errors.

Note: only critical errors will be used to calculate the accuracy of processing results.

Each time a quality check is completed, the Quality Checker records the outcome in the Quality and Support Tool (QST). A system-generated email is sent to the Service Officer and their Team Leader advising them of the outcome. Individual results are captured in QST.

Feedback is emailed to the Service Officer and the Team Leader. It gives details about the"

• check
• result (including any errors identified)
• quality checking dispute process

During coaching sessions, staff can:

• contribute to collective understanding of why errors occurred
• assist in identifying underlying causes, such as process gaps, system faults or limitations, or other environmental issues

Method for managing and storing feedback

Feedback is recorded/stored in the Quality & Support Tool. Discussion notes about the feedback should be detailed in coaching sessions.

Correcting Errors

Critical errors - Quality Checkers must correct critical errors immediately as they are found

Non-critical errors - Quality Checkers provide instruction in the feedback email. Service Officer’s correct non-critical errors.

Quality checking procedures are reviewed and updated by the programme in consultation with policy area and the Services Delivery Quality and Support Team. The review makes sure the error codes are current and the approved changes to programme business polices are included.

Any changes that require immediate action will be advised and updated accordingly. Any changes not critical to quality will be incorporated in the review of the procedures.