PBS Safety Net quality checking in QST 111-21031003

The PBS Safety Net quality checking process aligns Services Australia's Enterprise Quality Framework and the seven quality principles.

See Resources for a link to the Enterprise Quality Framework.

The quality checking process:

• helps Team Leaders and Quality Checkers identify process improvements
• ensures consistency in quality checking

The Service Delivery Support team is responsible for:

• analysing national quality reports to identify learning needs or process improvement opportunities
• escalating national quality issues to the relevant program or policy area and/or to the Quality, Performance and Technical Support team
• reviewing and updating relevant Operational Blueprint files and training materials
• reviewing suggestions and working collaboratively with the Quality, Performance and Technical Support team to improve Operational Blueprint quality checking process and resources
• identifying strategic and operational risks or issues that impact customer outcomes

Managers/Team Leaders must make sure:

• Quality Checkers complete the process for Quality Checker accreditation
• Quality Checkers hold appropriate skill tags in the Quality and Support Tool by sending an email to Quality, Performance and Technical Support team
• error feedback is discussed with Service Officer as part of the coaching conversation. This supports any learning and development needs
• they analyse any errors, for example, did the errors occur because there is limited training, understanding of the business rules, environmental or system-based issues
• positive quality checking results are discussed with the Service Officer
• they analyse data to identify learning needs or process improvement opportunities
• quality checks are done as specified in the sampling plan
• they notify senior management of a serious error which places the agency’s reputation at immediate risk
• they escalate systemic issues
• Quality checking dispute process for Health Service Delivery Division are lodged

Quality Checkers must:

• conduct 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 their 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 Safety Net cards issued and/or claims processes are in line with PBS business rules, policies, and procedures
• make sure they do not check their own work. If a quality checker’s own work is selected, it must be passed to another accredited checker to check

Quality Team must:

• provide support for quality checking in the QST
• provide relevant reports as needed
• arrange QST training for Quality Checkers
• support the business with flexible and fit for purpose quality approaches

To be accredited, Quality Checkers must:

• have knowledge of relevant policies and procedures
• maintain a high correctness standard in the program they are checking
• understand the quality checking procedure for PBS Safety Net claims and cards
• meet accreditation standards annually

See Quality Checker accreditation for Health Service Delivery Division for more information.

Pre-checks

Pre-checks apply:

• to new starters
• when new processes are introduced

New starters have 100% of their work reviewed and corrected until deemed proficient. Any errors made in pre-check must be recorded as errors. Results are used to support ongoing training.

Programme/post-checks

Programme/post-checking randomly selects work completed the previous business day in Processing and National Demand Allocation (PaNDA). The results are provided to management and external stakeholders as needed.

Targeted checks

Targeted checks 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

Pre-checks

Staff have 100% of their work checked until they become proficient. As a guide, new starters are considered proficient when:

• 20 - 30 PBS Safety Net claims (with 80 - 200 cards in total) are 95% error free
• 10 PBS Safety Net card applications are 100% error free

This can include real or simulated work.

These numbers can be reduced. If this occurs staff must pass a skills assessment in lieu of the residual requirements.

Programme/post-checks

0.5% of PBS Safety Net claims and 2% of PBS Safety Net cards of the monthly total across the two work types are randomly selected for quality checking.

Targeted Checks

To arrange a targeted check(s), Team Leaders send an email request to Quality, Performance and Technical Support team with the:

• percentage of work type to be checked. For example, 100%
• staff member’s name and logon details
• quality checker's name and logon details
• the reason and length of time required for the targeted check
• details of how often a targeted check report is required. For example, weekly

Timeframes

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

• Pre-checks - quality checks are normally done within one business day of the work being completed
• Programme checks - where quality checks are completed within four calendar days of being allocated in the QST.

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

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
• skill tags added on the Quality and Support Tool
• relevant internet and intranet sites, e.g. Operational Blueprint
• Schedule of Pharmaceutical Benefits
• FileNet

Quality pre-checks are manually assigned as part of the learning program in line with the PBS Safety Net sampling plan quota. Records of these checks are maintained in the QST.

Program quality checks are completed using the QST. This randomly selects work completed in PaNDA in line with the PBS Safety Net sampling plan quota.

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

Critical and non-critical errors

Error codes are categorised as critical and non-critical.

A critical error is when there is a potential risk to:

• a customer's:
• privacy
• eligibility
• payments
• application assessment being finalised
• record
• the agency's reputation

A non-critical error is when it does not impact the above criteria. This relates to administrative errors.

Only critical errors are used to calculate the health status of the program.

Quality Checkers send an email to Pharmaceutical Benefit Scheme (PBS) when:

• an error does not fit the description, or
• the most appropriate error code cannot be determined/applied, or
• an update to the error codes and/or descriptions is required

The email must include the following:

• description of the error
• impact of the error on the program and/or customer, to determine whether the error is critical or non-critical

Quality Checkers then send an 'FYI feedback' to the Service Officer with:

• a description of the error, and
• corrective actions required

Each time a quality check is completed, the Quality Checker records the outcome in the Quality and Support Tool (QST).

An email is sent in real time 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 their Team Leader. It gives details about the:

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

For more details about how to quality check a work item in QST, see Quality Checking using the Quality and Support Tool (QST).

Method for managing and storing feedback

Feedback is recorded/stored in the Quality and Support Tool (QST). 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 Officers correct non-critical errors

Quality Checkers must consult their subject matter experts for questions about PBS Safety Net claims and card processing.

Enquiries about quality checking process or issues with checking results that cannot be resolved on site should be emailed to Quality, Performance and Technical Support team.

Quality checking procedures are reviewed and updated by the business and program in consultation with Quality, Performance and Technical Support. The review makes sure error codes are current and approved policy changes are included.

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