Programs Quality System Assessment

The QSA methodology is based on a risk management framework which aims to evaluate the systems and processes which organisations have in place to control risks to patient safety using self assessment and independent verification.

The QSA program has been specifically developed for the eight Area Health Service (AHS), Children's Hospital Westmead, the NSW Ambulance Service and Justice Health.

The QSA methodology

The methodology underlying the QSA is in part drawn from a number of other industries, including mining, petroleum and finance. In those industries there has been a shift to a risk-based approach to management of safety and quality. The international evidence supports an approach to safety improvement based on the identification and assessment of risks, followed by proportionate action to reduce those risks.

There are four components of the QSA. These are:

• Completion of a self-assessment survey at three levels of the organisation (the activity statement)
• Verification of the activity statements
• Feedback and reporting to respondents, the health system and the community
• Development of improvement plans at each level of the organisation. These would respond to the issues identified in the self-assessment process. The improvement plan will be subject to review in subsequent QSA assessments.

The QSA model

The QSA methodology includes a base line survey at year one and thematic surveys in the intervening years with a repeat baseline at five years. Following self-assessment a number of verification activities will be undertaken to determine accuracy of response, add further depth to information provided in the Activity Statements and collect information that will be used to inform subsequent assessments.

For full details around development of the QSA methodology and framework development see Quality Systems Assessment Final Report

What will the QSA do?

The QSA program will focus on the systems for quality and safety in organisations within the NSW Health System and not on individual performance.
 The QSA features a multi-level approach to quality systems assessment, with self assessments tailored to the different levels within Area Health Services, Ambulance Service and Justice Health as illustrated in the figure below:-

Multi-level Approach

This multi-level approach allows for responses at different levels of the organisation to be compared to assess the effectiveness of governing and reporting structures. It is anticipated that this will assist in:

• Identifying State-wide policy and program gaps;
• Providing a source of verification of self-assessment responses and
• Estimating the degree of effectiveness in the implementation of policies, performance monitoring and risk controls.

Anticipated benefits of the QSA program

State level

The QSA program will identify areas for improvement and areas of exemplary practice in relation to quality and safety arrangements in the NSW health system. In addition the QSA program will provide a level of assurance around the compliance with standards and policy requirements developed by NSW Department of Health.

The QSA is designed to complement the broad range of activities which are already in place to assess, improve or provide assurance on the safety and quality of patient care in NSW. These include:

• Clinical practice improvement (CPI) initiatives (e.g. collaborative projects)
• Accreditation processes
• Policy development
• Credentialing procedures
• Regulation of:
  • health service provider organisations
  • health professionals

Local level

• The information provided by the individual levels of assessment will provide managers and department heads with the opportunity to compare performance related to quality and safety and identify areas for improvement.
• Aggregated results from respondents across NSW will provide each AHS with important information about the status of their processes as well as the system as a whole in relation to the themes assessed each year
• The QSA will provide department heads and managers the ability to track their performance over time

The 2007 2008 Quality Systems Assessment

In 2007 / 2008 the Clinical Excellence Commission successfully completed the initial QSA baseline survey for all PHOs in NSW. The QSA state-wide report: Summary of Findings from the Area Health Services and the Children's Hospital Westmead represents the very first census in New South Wales of the quality and safety policies and their level of implementation. This report presents the results of the first QSA self-assessment survey conducted in late 2007. These results provide a baseline measure of the performance of AHS, Network/ Clusters, Facilities and Clinical Units in the implementation of various quality and safety programs and policies.

The Quality Systems Assessment baseline survey was also undertaken by the Ambulance Service of NSW and Justice Health in February 2008. The full reports for all services are available below.

The 2009 QSA self assessments

The initial QSA in 2007 provided a baseline measure for a comprehensive range of clinical quality and safety elements. It is planned to reassess these core elements every five years.

In the intervening years – commencing in 2009 - the QSA will focus on specific areas (or themes) which will be identified from a variety of means including the analysis of data from the previous survey responses.

There are four themes for review in each NSW public health organisation in 2009:

1. Medication safety
2. Communication in the Clinical Environment
3. Clinical Handover
4. Deteriorating patient

Use of survey information

Participants will be asked to provide information about the processes, policies and procedures that are in place which support the delivery of safe patient care around the four themes.

This information and all other information collected in the survey will be processed by an online survey host, on a secure server. The results of the survey will then be transferred to the QSA project team at the Clinical Excellence Commission for analysis. All information will be treated in the strictest of confidence.

For help with the survey download the instruction FAQ - DOC ~208kb

QSA verification program

The purpose of verification in the QSA program is:

• to determine accuracy of responses
• add further depth to information provided in the activity statements; and
• Collect information that will be used to inform subsequent assessments

The QSA methodology allows the use of five techniques to verify the activity statements responses:

• Same level verification
• Between level verification
• Source of evidence verification
• Desktop review verification and
• Targeted interview verification – telephone and onsite visits

The onsite visits will occur to a sample (20%) of facilities across the state with the focus limited to specific key issues and specific department / clinical units. This process ensures that each facility in each AHS will be visited during the 5 year cycle of the QSA.

Areas for Verification for each of the organisations for 2009:

Area Health Service (AHS), Children's Hospital at Westmead

• Infection control
• Correct patient/site/procedure
• Mortality review

NSW Ambulance Service

• Mortality review
• Infection control
• Patient transports

Justice Health

• Mortality review
• Credentialing and role delineation
• Infection control