External Breast Prostheses Reimbursement Program (EBPRP) quality checking in QST 111-22050000

The EBPRP quality checking process aligns the Enterprise Quality Framework and the 7 quality principles.

The quality checking process:

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

Managers/Team Leaders are responsible for ensuring:

• Quality Checkers complete the process for quality checker accreditation
• Quality Checkers hold appropriate skill tags in the QST by sending an email to Quality Operations & Technical Support
• timely error feedback is discussed with Service Officers as part of the coaching conversation to support any learning and development opportunities
• analysis of errors. If errors were due to factors such as limited training, understanding the business rules, environmental or system based issues
• positive quality checking outcomes are acknowledged with Service Officers
• analysis of data to identify learning needs or process improvement opportunities

Quality Checkers:

• carry out quality checks as specified in the sampling plan
• update and maintain technical knowledge, procedures and policies
• maintain a correctness standard for personal accuracy
• identify root cause analysis and identifying systemic issues
• report and escalate trends or concerns to their Team Leader
• give constructive and non-judgemental feedback including appropriate reference materials such as Operational Blueprint
• explain the impact of errors and action to be taken to correct the error (where applicable) when providing feedback

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

Quality Team:

• provides support for quality checking in the QST
• provides relevant reports as required
• arranges QST training for quality checkers
• supports the business with flexible and fit for purpose quality approaches

Staff members selected to undertake quality checking must:

• have knowledge of relevant policies and procedures and/or know where to find them
• maintain a personal correctness standard in the program they are checking
• review EBPRP quality checking procedure/agreed standards
• meet accreditation standard annually

Team Leaders email Quality Operations & Technical Support to request a skill tag be added in the QST for the staff member.

Pre-checks

Pre-checks will be applied to new starters and when there are new processes for the Programme. Staff will have their work 100% reviewed and corrected until deemed proficient. These results are not included in accuracy of processing results.

Letters

Letters are to be checked for the correct customer and scenario before being sent to the claimant.

Programme/ Post-checks

Programme/ Post-checking randomly selects work completed the previous business day in PANDA. The results are provided to management and external stakeholders as needed.

Targeted Checks

Targeted checks for EBPRP are completed for:

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

New starters will have:

• Pre-checks: 100%`of their work checked until they reach the program accuracy Key Performance Indicators (KPI), with at least 30 activities checked
• Letters checked for the correct customer and scenario before sending to the claimant
• Programme/ Post-checks completed daily on a statistically valid sample of incentive transactions. The results are used to report on the health of the program. All discretionary claims are to be checked, and always sent to the Programme Management Team for assessment
• Targeted checks
• Team Leaders are to send an email to Quality Operations & Technical Support to request the staff member's details, the reason and the time needed for the targeted check
• Aim for Accuracy to be developed as a separate process

Source documents

EBPRP transactions are randomly selected for quality checking in the QST from work types allocated through PaNDA. Source documents will be obtained through FileNet.

Quality checking is performed on the EBPRP claim form, letters and receipts (if applicable).

Note: if a notation has been made, this becomes part of the source (supporting) documentation that is subject to quality checking. This will be in the form of notations in PaNDA.

Timeframes

• Pre checks: quality checks are expected to be completed within one business day of work completion
• Programme/ Post checks
• If possible, quality checks are completed within 4 calendar days of being allocated in the QST. High-risk work is prioritised for daily action
• At the end of the month, any programme checks not completed are automatically abandoned after 4r calendar days

Resources

Quality checkers must have access to PaNDA, QST and program specific processing systems

Quality checks

Enquiries about the sample of work being checked can be emailed directly to the EBPRP Processing team.

Quality checking

Checkers must consult their subject matter experts for the issue encountered if they have any questions about quality checking.

Enquires about quality checking process or issues with submitted checking results that cannot be resolved on site should be emailed to Quality Operations & Technical Support.

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

The error codes are categorised as.

• a critical error when there is a potential risk to:
• a customer's, privacy, eligibility, payments, record or application assessment being finalised
• the agency's reputation
• a non-critical error when it does not impact the above criteria. Generally, this relates to administrative errors

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

The Resources page lists error codes.

Each time they complete a quality check, the Quality Checker records the outcome in QST. This sends an email straight away to the Service Officer and their Team Leader advising the outcome. Individual results are captured in QST.

After performing quality checking on selected transactions, an email is sent to the Service Officers and Team Leader's email box. The email includes details about the check and the result, including any errors identified.

Feedback on errors must:

• be direct and to the point, non-judgemental and constructive
• describe the error, and what was incorrect
• explain the impact the error has, for example to the recipient/claimant, Services Australia
• explain the action to be taken to correct the error (where applicable)
• include any relevant reference material that supports the action, such as an Operational Blueprint file
• provide the opportunity for development and not be used for punitive purposes

Method for managing and storing feedback

Record feedback in QST.

Detail discussion notes about the feedback in coaching sessions.

Error analysis is conducted by the:

• Team Leader or Local Peer Support (LPS) as required for local issues
• Assistance Programmes Branch for analysis of the programs

If errors have been identified, the original processing Service officer (where required), must take action to correct them.

When corrections cannot be made by the original processing Service Officer, the Team Leader is responsible for ensuring an escalation process is in place for corrections.

If the error requires a file fix, the Quality Checker must send the request for the file fix. See Processing claims for EBPRP.

Quality checking procedures are regularly reviewed and updated by the Programme in consultation with Learning Development and Quality. The review ensures the error codes are current and applicable and that approved changes to Programme business policies are included.

Issues with the Quality Checking Procedure are recorded and escalated to Quality Management via email.