Continence Aids Payment Scheme (CAPS) quality checking in QST 111-23090850

The CAPS 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 process improvements
• ensures consistency in quality checking

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 and Skill Tags team
• reviewing and updating the relevant Operational Blueprint files and training materials
• reviewing suggestions and working collaboratively with the Quality and Skill Tags 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 ensure:

• quality checkers complete the process for Quality Checker accreditation
• quality checkers have the right skill tags in the Quality and Support Tool. Email Quality and Skill Tags to get more information
• error feedback is discussed with the 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
• lodgement of quality checking outcomes disputes
• they escalate serious quality issues, such as reporting all privacy breaches using the Privacy Incident Notification form on the Report a privacy incident intranet page. See Resources for a link

Quality Checkers must:

• 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
• 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 providing feedback
• examine system information/source documents to make sure CAPS are actioned in line with CAPS business rules, policies and procedures
• complete Quality Checker accreditation
• consult subject matter experts for procedural or policy related queries
• report results of quality checks in the QST
• 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 must:

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

To attain accreditation, Quality Checkers must:

• have knowledge of relevant policies and procedures
• maintain a high correctness standard in the program they are checking
• have an understanding of the quality checking procedure
• meet accreditation standards annually

For more information, see Quality checker accreditation for Health Service Delivery Division.

Pre-checks

New starters/New Process

Apply to new starters and/or 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.

Program/Post-checks

Program/Post-checking randomly selects work completed the previous business day. The results are reported to executives and relevant stakeholders each month.

Targeted Checks

In addition to the pre and post-checks, targeted checks provide an opportunity to look at other areas of the process.

Targeted checks for CAPS may be:

• checks on staff members with identified quality issues
• Aim for Accuracy

Pre-checks

New starters/New process proficiency requirements:

100% of their work checked until program accuracy Key Performance Indicators (KPI) is reached with at least 20 work items checked.

Program/Post-checks

2% of the monthly total of CAPS work types are randomly selected for quality checking.

Targeted Checks

To arrange targeted check(s), Team Leaders send an email request to Quality and Skill Tags with the:

• staff member’s details
• reason and the length of time required for the targeted check

Timeframes

Quality checks are undertaken daily on a random sample of work. Quality checks are completed within 1-2 business days to ensure timely feedback. All quality checks for the month must be actioned within 3 calendar days of the following month. After this time, remaining work is abandoned.

Resources

Quality checkers must have access to the following to undertake 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

When quality checking, an error is information processed/keyed into the system, which does not match the documents submitted or the supporting documents uploaded to the systems.

Critical errors

Quality Checkers must correct critical errors immediately, as they are identified.

Non-critical errors

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

Critical and non-critical errors

Error codes are categorised as critical and non-critical.

• An error is defined as critical when there is a potential risk to a customer's:
• privacy
• eligibility
• payments
• application assessment being finalised
• record
• the agency's reputation

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

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

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

An email is sent to the Service Officer and their Team Leader advising of the quality check outcome. Individual results are captured in QST.

Quality checking feedback is sent by email to the Service Officer and their Team Leader. The email includes details about the:

• check
• the result (including any errors identified), and
• the Quality checking dispute process for Medicare

Managing and storing feedback

Feedback is sent to individual Service Officers and Team Leaders by email. Feedback data is recorded/stored in QST.

Quality Checkers must contact their Local Peer Support (LPS) for any technical enquiries.

Enquiries about quality checking process or issues with checking results that cannot be resolved on site should be directed to the Quality and Skill Tags team by email.

Quality checking procedures are reviewed and updated by the business and program in consultation with the Quality and Skill Tags team. 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.