Quality checking dispute process for Health Service Delivery Division 111-23051519

Is the quality checking dispute for a staff member in training/consolidation?

• Yes:
• Direct the dispute to the facilitator/technical support Service Officer
• If reversal is required, attach all relevant details including the original feedback email from the quality checker and send to Quality, Performance & Technical Support - Quality
• Procedure ends here
• No:
• Service Officer/Processing Operator, see Item 2
• Team Leader, see Item 3
• Service Support Officer (SSO), see Item 4
• Quality Checker, see Item 5

• Discuss Quality Check (QC) feedback with a Team Leader
• After the discussion, complete the QC error dispute email template:
• Include evidence to support the dispute, such as the relevant Operational Blueprints (including the Table and Step number where applicable)
• Attach all relevant information including the original feedback email from the Quality Checker
• Email the completed email template to the Team Leader

The Team Leader:

• receives the QC dispute email from Service Officers/Processing Operators, and
• must consider the dispute appropriate before they send it to the relevant program area

Does the Team Leader consider the QC dispute email is appropriate?

• Yes:
• Forward the email to the relevant Health Service Delivery Division - Program area. Note: program areas only accept emails from a Team Leader
• Do not email the Quality Checker directly
• No:
• Send a reply email to the Service Officer/Processing Operator
• Include the reasons why the dispute email is not appropriate

SSOs in the relevant program area:

• Must document the dispute. See Resources for the QC dispute tracker template
• Investigate the QC dispute
• Liaise with the appropriate team/Subject Matter Expert (SME) for the investigation (as needed)
• Escalate any issues to the relevant team for business process improvements:
• Operational Planning Health, Integrity and Child Support Branch - Training
• Operational Blueprint (OB) - Policy and OB feedback
• Program, Policy and Quality team - QC Error codes
• Determine the final outcome. Note: if the dispute outcome identifies additional errors, follow the successful process

Successful dispute outcome:

• To get the error reversed:
• Complete the Service Support Officer (SSO) QST/QBBI QC reversal request email template
• Send the email to Quality, Performance & Technical Support - Quality
• When the reversal is actioned, email the reason for the decision to the:
• Service Officer/Processing Operator and cc their Team Leader
• Quality Checker and cc their Team Leader

Unsuccessful dispute outcome. If the error was given to the Service Officer correctly:

• Complete the SSO QST/QBBI dispute unsuccessful email template
• Email the dispute outcome to the:
• Service Officer/Processing Operator Team Leader
• Service Officer/Processing Operator

The SSO decision is considered final.

If the Quality Checker receives an email from a Service Support Officer (SSO) about a successful QC dispute:

• review the feedback and explanation provided
• if necessary, discuss with Team Leader and provide a reply

If the Quality Checker incorrectly receives a QC dispute, refer the staff member to either:

• Service Officer/Processing Operator, see Item 2
• Team Leader, see Item 3

Staff must:

• research Operational Blueprint before lodging a dispute. This is to make sure business process or policy supports their dispute
• submit this evidence when they lodge a dispute
• only lodge a dispute if the overall QOL/QMA accuracy is affected, that is:
• there are proficiency impacting errors
• the overall QOL/QMA decision, not individual errors within the check

Staff can get support from Tier 1 technical support:

• to understand a QOL or QMA result and feedback
• for advice about completing the activity

If required, request access to the Quality Checking Dispute Escalation Form.

Open the Quality Checking Dispute Escalation Form:

• Select Health Zone staff
• Complete all fields. Mandatory fields have an asterisk (*)
• Key these exactly as they appear in QOL or Process Direct:
• QOL, Activity (AMR) or QMA Work Item ID
• Date the activity was submitted
• Include supporting evidence
• Do not include any customer identifying details, such as Customer Reference Number (CRN) or names
• Select Submit for review

The system automatically sends the staff member a notification email when the Independent Reviewer finalises the dispute.

When the QOL/QMA dispute decision is finalised, no further escalation steps are available. However, if extenuating circumstances exist, Team Leaders can email the Aged Care Customer Program mailbox. The email must include clear reasons and evidence for the request.

Procedure for the staff member lodging the dispute ends here.

Open the Quality Checking Dispute Escalation Form:

• Select the Edit icon
• Select the Health Zone staff to review the QOL or QMA dispute
• Review the information entered by the staff member
• Add:
• the Independent Reviewer logon ID
• comments supporting the decision
• action needed (if appropriate)

If the Independent Reviewer does not have the technical expertise to review the dispute, seek technical advice from the:

• SSO network
• Service Delivery Support team, or
• SSO Program Support Manager co-ordinator. They will escalate to the Aged Care Customer Program mailbox to locate an appropriate business or policy team

The Independent Reviewer must overturn the decision if:

• QMA: the proficiency impacting errors are incorrect, resulting in only non-proficiency impacting errors or no errors
• QOL: the return with feedback is incorrect, resulting in release with feedback or no feedback

In the Quality Checking Dispute Escalation Form:

• SSO determination field, select one of the following:
• QC dispute decision overturned (agree with dispute)
• QC dispute decision upheld (agree with the original check result)
• QC dispute decision upheld (upheld for a different reason)
• Note: if the QMA Replay function is not available, uphold the dispute if the customer outcome is correct.
• Record the Date of decision
• The Status will update automatically based on the SSO determination
• Select Submit

If the recommendation is:

• QC dispute decision overturned:
• The system sends an automatic email to the original Quality Checker with details about their right of reply options
• Set a reminder for 7 working days to finalise the review
• If the original Quality Checker does not respond within 7 working days, finalise the dispute in the Quality Checking Dispute Escalation Form
• QC dispute decision upheld:
• The system sends an automatic email to the staff member explaining the outcome

If the Independent Reviewer identifies errors:

• update the customer record in line with the decision as soon as possible
• do not wait for the outcome of the right of reply process

Note: if the dispute is lodged more than 30 days from the date it was quality checked, the original QOL decision will be upheld.

Will the Independent Reviewer send the Quality Checker feedback (not covered by the QOL/QMA process)? For example, feedback about the quality of the QOL/QMA feedback

• Yes, go to Step 5
• No, procedure ends here

Use the following to provide feedback to the original Quality Checker:

• Staff Feedback Tool. See Resources for the link
• relevant feedback template, see Resources for the templates

In Feedback Details > Service Details, select:

• Programme & Business Assurance
• Quality Management then the relevant tool and feedback type:
• QOL
• QMA

The original Quality Checker must:

• review the QC decision overturned - right of reply email
• within 7 working days of the Date of Decision, record the decision on the Quality Checking Dispute Escalation Form
• send an email to the Aged Care Customer Program mailbox:
• if unable to respond within 7 working days (for example, due to leave), and
• they disagree with the dispute recommendation

Note: if the original Quality Checker does not respond within 7 working days, the Independent Reviewer who completed the dispute can finalise the outcome.

If the Quality Checker decides to:

• agree with/accept the overturned recommendation (dispute is upheld):
• they ask their Team Leader to update the Status field to Finalised QC decision overturned in the Quality Checking Dispute Escalation Form
• the Team Leader can enter supporting comments in the dispute form (optional)
• procedure ends here
• disagree with/not accept the overturned recommendation:
• they give their Team Leader a detailed explanation, including operational resources, explaining why they do not accept the outcome
• they ask the Team leader to enter these supporting comments in the Quality Checking Dispute Escalation Form and select Submit
• the dispute status changes to Escalated when the Team Leader submits the supporting comments
• they ask the Team Leader to email the Aged Care Customer Program mailbox asking for an independent review
• procedure ends here for the original Quality Checker

Read the response email with the original Quality Checker’s response.

Does the Independent Reviewer agree with the original Quality Checker's comments?

• Yes, uphold the QOL/QMA result:
• In the Quality Checking Dispute Escalation Form, update the comments and change the Status field to Finalised - QC decision upheld
• Procedure ends here
• No, go to Step 3

Contact another SSO using the Microsoft Teams team chat. Discuss the decision and response from the original Quality Checker.

Do not alter a decision coded by another SSO in the Quality Checking Dispute Escalation Form without completing the required consultation.

The status of the dispute stands until the Independent Reviewer and independent party (SSO) reach agreement or a third party review is finalised.

If the Independent Reviewer and independent SSO:

• agree the decision should be overturned, update the Quality Checking Dispute Escalation Form:
• Add a note that the Independent Reviewer escalated the dispute to an independent party (SSO)
• Record the mutual decision reached between the Independent Reviewer and independent party (SSO)
• Update the Status field to Finalised - QC decision overturned
• Procedure ends here
• cannot reach agreement:
• Seek a third party review from the relevant program, policy team or Level 2 Helpdesk to get a resolution
• If unsure who should complete this review, email the details to the Aged Care Customer Program mailbox

When the program, policy team or Level 2 Helpdesk respond:

• review the response
• add comments to the Quality Checking Dispute Escalation Form

Did the program, policy team or Level 2 Helpdesk agree with the Independent Reviewer’s recommendation to overturn the decision?

• Yes, finalise the dispute as QC dispute decision overturned
• No, finalise the dispute as QC dispute decision upheld

The system automatically sends an email to all parties.