• Table of Contents
• Parliamentary Secretary Foreword
• Purpose of this toolkit
• 1. Background
• 2. Introduction to quality improvement
• 3. Getting started
• 4. Management systems
• 5. Staff recruitment, retention, training and development
• 6. Advocacy access
• 7. Tailoring advocacy to individual needs
• 8. Decision making and choice
• 9. Complaints and disputes
• 10. Privacy, dignity and confidentiality
• 11. Participation and integration
• 12. Valued status
• 13. Protection of human rights and freedom from abuse
• Appendix 1: Concepts related to quality
• Appendix 2: Disability Services Standards and Supporting Standards
• Appendix 3: Draft Disability Advocacy Standards

National Disability Advocacy Program Quality Improvement Toolkit

• Previous: 2. Introduction to quality improvement
• Next: 4. Management systems

3. Getting started

3.1 Guide to using the Toolkit

3.1.1 Step-by-step guide to the Quality improvement process

3.2 What you will find in each quality theme section

The ten quality theme sections into which this manual is divided broadly cover the Disability Services Standards applicable to disability advocacy agencies, and the draft set of Disability Advocacy Standards.  The ten quality theme sections are:

• Management systems
• Staff recruitment, retention, training and development
• Advocacy access
• Tailoring advocacy to individual needs
• Decision making and choice
• Complaints and disputes
• Privacy, dignity and confidentiality
• Participation and integration
• Valued status
• Protection of human rights and freedom from abuse.

The Disability Services Standards are included as Appendix 2 and the draft set of Disability Advocacy Standards are included as Appendix 3.

Advocacy agency’s approach to the theme

In this section advocacy agencies describe how they think and talk about quality management and quality improvement for the theme; some of their practices; and how they ensure quality.

Things to consider

A list is provided for each quality theme highlighting some of the key considerations for ensuring quality.  Refer to the checklist when you are considering your current practices for this theme, and refer to it when drawing up your own checklist of considerations for quality that will be important for you to address in the quality improvement process.  You will select some of these points against which to assess your agency’s performance in the self-assessment completed at Step 2.

Self-assessment worksheet

To begin on the self-assessment worksheet, select up to five points from the checklist of considerations for quality that you want to concentrate on. You should select a mix of indicators – both aspects where you are currently doing well and aspects that you are aware you need to address.

Once you have selected the five points, working across the worksheet, rate your current performance for each, record evidence of your current practice, and ideas for improvement your agency might consider [see Box 3.1, following, for more information on the self-assessment process].

The worksheets prompt discussion about future quality management, and document your current strengths and weaknesses and areas where you lack clear evidence about your performance.

Completing the worksheet can be a way of getting everyone involved in thinking about quality and improvement processes.  You may want to complete the worksheet at a staff/ volunteer meeting or you may want to copy the worksheets and provide to staff/ volunteers individually.

Examples of evidence

The examples of evidence that you can use to demonstrate quality were developed based on feedback from NDAP agencies provided during consultations on a Quality Assurance system for advocacy in 2008.  The examples are not prescriptive and do not constitute a compliance checklist.  Some of the examples will be more relevant to you than others, dependent on your agency’s approach to advocacy; some apply across all approaches of advocacy; and others are specific to a certain approach.

Use the examples of evidence as a guide when completing the self-assessment worksheets.  You can use the examples of evidence as tools to help you gather and develop evidence to:

• use internally to assess your agency’s performance for each quality theme
• use internally to help find ways to continually improve and innovate.

Think of evidence not in terms of what your agency does, but how you can demonstrate what your agency does.  You should have documentation to substantiate your practice, such as policies, work instructions, protocols, promotional materials, checklists and plans.  You should also be able to demonstrate that staff understand and consistently apply documented policies, and have clients/ people with disability confirm your policies are consistently applied.

Quality improvement worksheet

To begin on the quality improvement worksheet, decide on the improvement actions you want to pursue from the suggestions made in the self-assessment worksheet and based on the key priority areas for your agency.  In deciding on improvement actions, the idea is not to select actions for every area.  Instead select the key changes you will concentrate on to improve your systems and practices.

Record the improvement actions you chose in the first column of the quality improvement worksheet.  Use the sheet to plan and document implementation of the improvement actions, recording who has responsibility for implementation, the resources that will be dedicated to implementation and a timeframe for actions and review.  For example, in the column for ‘budget considerations’ you might consider physical resources, activity expenses, facilitator/ external consultant expenses, and wages.

Resources

A range of resources is provided for each quality theme to support you in planning your quality improvement actions.  Again, these are not prescriptive and where you decide to use a resource to support your quality improvement actions you can adapt it based on your agency’s purpose and practices.  Where your agency has already developed your own resources, you may want to use the resources in the Toolkit to gauge your own systems and practices.

Sample policies and procedures

Sample policies and procedures are provided for each quality theme.  Some of these will be relevant to all approaches to advocacy while others may not be relevant to certain approaches to advocacy.

Where there are policies and procedures that are relevant to your agency and you don’t already have them in place, you may want to use these as a starting point for developing your own.  Where you already have your own policies and procedures in place, you may want to use the sample provided to check against the elements in your policy.

3.3 Tips for success

Agencies participating in quality improvement processes have found the following factors as important for their success⁵.

• Create a supportive environment:  Be clear in your purpose and plan how it will occur.  It is important that the process benefits your agency and enables it to better serve people with disability.
• Gather a team together:  Engagement in learning groups from broad areas across your agency (including volunteers, Board members, clients and people with disability) is highly valuable.
• Use the quality improvement worksheet:  Record evidence of your quality practice, using the examples of evidence as a guide and improvement actions you will take where these are identified.
• Action plan:  This will help you clarify your priorities.
• Go the extra mile:  Record examples of where staff members/ volunteers have gone beyond expectations to meet the needs of people with disability and improve the quality of advocacy delivery.
• Compare yourselves with others:  Contacting similar agencies to see how they approach different systems and measures can be useful. 
• Continuous improvement:  Quality improvement is not a one-off; it is an ongoing commitment.
• Celebrate success:  Share success with your staff/ volunteers and clients/ people with disability through newsletters, posters, meetings and the media.

3.4 Getting staff and volunteers involved in quality improvement

Sample exercise for engaging staff in quality improvement⁶

This activity warms staff to the continuous improvement process. You might want to introduce this activity in a regular staff/ volunteer meeting or in another forum where all staff/ volunteers are present.  The exercise is called the ‘five in five’ game. You can use it to:

• encourage staff/ volunteers to generate ideas for improvement
• link ideas and suggestions to continuous improvement plans
• increase overall agency ‘ownership’ of continuous improvement.

Step one:  play the ‘five in five’ game

1. Everyone in the room has five minutes to think of five things that they would change to improve your agency.  The changes could relate to internal issues (facilities, ideas for staff training) or to providing advocacy to people with disability.
2. Each person must announce their list of five improvements to the room.
3. Staff/ volunteers cannot repeat an idea that has already been mentioned, but can refine or develop ideas mentioned by others.
4. Encourage and motivate staff/ volunteers by giving out rewards and small prizes for good ideas.
5. Designate one or two people in the room to write the ideas up onto a whiteboard or butcher’s paper.

Step two:  review the results

1. Type up the results from the game into a list, with the idea recorded next to the name of the staff member/ volunteer who recommended it.
2. Review the results.  The structure of your agency will determine who reviews the results (for example, CEO and regional managers).  It needs to be someone with the capacity to implement decisions based on the review. As part of the review:
   1. assess the practicality of the ideas
   2. for ideas that are practical, designate a person from a relevant area of your agency to be responsible for action/investigation, and a reasonable timeframe
   3. for ideas that are not practical, note that the idea will not be followed-up, and the reason why not
   4. record all decisions made, as well as timeframes and responsible people, on the list of ideas.
3. Reviewers designate a person responsible for maintaining the list.

Step three:  re-circulate the list

1. Re-circulate the list to all staff/ volunteers, so that they can see what will happen with their idea and who is responsible for it.

Step four:  action and review the ideas

1. As items on the list are actioned or investigated, the person responsible should notify:
   1. the staff member/ volunteer who thought of the idea originally
   2. the person responsible for maintaining the list.
2. At the next staff/ volunteer meeting, the list should be reviewed.  Any ideas which have not been actioned or investigated should become priority matters.
3. Start the process again for more improvement ideas!

Step five:  use your records

1. The list of improvement ideas linked to documented actions can be used as evidence of continuous improvement activities.

3.5 Getting people with disability involved in quality improvement

Your agency is responsible for ensuring that people with disability are able to provide feedback and be involved in providing feedback on your agency.  Depending on the nature of the advocacy your agency undertakes, people with disability may or may not be your direct clients.

When considering how you will involve clients and people with disability in the quality improvement process, there are a number of methods you might use:

• feedback forms or questionnaires
• telephone interviews
• face-to-face or group interviews
• a suggestion box
• focus groups.

The ‘tools’ you use in involving people with disability will differ between agencies, based on your approach/es to advocacy and the needs of the people with disability involved.  When developing your assessment tool, remember that the purpose is to find out about clients’/ people with disability’s perceptions of the systems and processes your agency has in place and what can be done to maintain and/or improve these.  Broader feedback may also be used to develop and improve opportunities for people with disability to participate in the activities of your agency.  Consultation is not intended to provide general feedback or personalised complaints – although where this occurs, your agency will need to address the concern.

You might want to trial your assessment tool with a few clients/ people with disability initially to see that it is relevant and that they understand the questions.

To encourage clients/ people with disability to participate in the processes you have selected, you might consider:

• explaining to them why their contribution is important and how it will have an effect on agency operations
• integrating feedback gathering into other activities you currently operate
• providing incentives for participation, such as linking feedback activities to an event like an afternoon tea
• linking the internal feedback to an event like afternoon tea to show your appreciation of the contribution clients and people with disability make.

5. Adapted from the South Australian Department for Families and Communities, http://www.dfc.sa.gov.au/pub/tabid/267/itemid/808/Tips-for-success.aspx
6. Disability Employment Services Quality Strategy Toolkit, Prepared with the assistance of NOVA Employment and Training, NSW, Disability Employment Network and Business Services.

• Previous: 2. Introduction to quality improvement
• Next: 4. Management systems

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