PEER AUDIT TOOL (PAT)

1. PEER AUDIT TOOL (PAT) Malcolm Scott, Team Leader Community Integration Program and Extended Care Services Disability Services Directorate Royal Rehabilitation Centre Sydney Implementation assisted & supported by Clara Barton, Deputy Director DSD & Christina Vulic, Manager Policy and Behaviour Support DSD

2. Peer Audit Tool Background • Disabilites Service Directorate (DSD) currently has 21 community based service outlets spread throughout the Sydney Area with services ranging from ‘drop in’ semi independent living support to 24 hour support services • Client group primarily ‘Weemala’ devolution with complex and multiple disability and new referral eg/ dual diagnosis • DADHC funded service uniquely attached to a rehab hospital – Royal Rehabilitation Centre Sydney

3. Peer Audit Tool • Team Leader role – office based not site based although out in the field at least 2 days per week • Investigation • Risk management • DSD Policies and Procedures based upon NSW DSS – how do we assess the deliverance of services?

4. Peer Audit Tool • The audit is based upon service delivery over four domains • Equip Function ‘Leadership and Management’ Criteria 2.2.1 An organisation-wide risk management policy ensures that safety is considered in all activities • Self Assessment and Peer Review – Quality Driven Processes

5. Peer Audit Tool Four domains in quality process 1:Client support standards • Eg/ Is there a documented daily routine in place for all the clients? • Do all clients have a current (annual) documented Individual Plan/Service Agreement?

6. Peer Audit Tool 2: Unit administration and systems • Eg/ Is there a medication checklist completed for the unit each week? • Where required are individual incident response plans in place?

7. Peer Audit Tool 3: Carer support standards • Eg/ Are there regular Team Meetings (min every 6 weeks)? • Is there provision made for staff study leave?

8. Peer Audit Tool 4: Living environment and home safety • Eg/ Are medications stored in locked cupboards? • Do staff knock on the front door before entry into the house?

9. Peer Audit Tool Quality Assurance • All activities that contribute to defining, designing, assessing, monitoring, and improving the quality of services and products (Equalis www.equalis.com). • Four core principles of quality assurance • 1/ Focus on the client: services should be designed so as to meet the needs and expectations of clients and communities.

10. Peer Audit Tool • 2/ Focus on systems and processes: providers must understand the service delivery system and its key service processes in order to improve them. • 3/ Focus on measurement: data is required to analyse processes, identify problems, and measure performance. • 4/ Focus on teamwork: quality is best achieved through a team approach to problem solving and quality improvement.

11. Peer Audit Tool Method • The DSD - CIP rollout of PAT • December 2003 – April 2004 • 10 questions were selected for each of the four domains by the Deputy Director (Operational Manager) from a pool of questions: 27 – 45 questions for each domain

12. Peer Audit Tool • Team Leaders were trained in scoring methods using a ‘likert’ scale: important for inter-rater reliability! • 5 = yes or always • 4 = usually or recognised practice by most staff • 3 = sometimes, rarely or by some staff • 2 = unclear expectation or practice being developed • 1 = no, never or need to start • Scoring for each service outlet then based on four scores out of 50 – doubled to convert to percentage score

13. Peer Audit Tool • Team Leaders firstly conducted self assessments on their own service outlets and scores were tallied • Team Leaders were then assigned to their ‘buddies’ to conduct peer assessment upon their service outlets – scores were then tallied and the data analysed for trends, action priorities, and task delegation (who and when) • Report then created and sent to DD DSD and D DSD for review and reporting

14. Peer Audit Tool Results

15. Peer Audit Tool Result – analysis of variance • PAT scores were significantly higher when assessed by peers than first self assessment • Indicates that Team Leaders and CSW’s used the PAT to improve existing/implemented new systems into their service outlets eg/ Agency staff orientation folders

16. Peer Audit Tool Discussion • The results of these interventions allow service management and senior staff to identify any broad trends, or areas of risk/concern to be addressed by action plans • PAT allows services to target interventions appropriately in an environment where off site management means service delivery risks require close monitoring • Community Support Workers and Team Leaders can tailor interventions which are measurable, evidence based and allows staff to think quality systems approach – new questions can be selected and the process repeated

17. Peer Audit Tool • Purchased from Equalis (www.equalis.com.au) and tailored to DSD requirements • Tool was originally designed for disability accommodation services with discrete structure, however DSD developed the tool to be flexible and responsive with application to others services and service needs.

18. Peer Audit Tool Questions • Quality is an ongoing process – feedback loop from Director DSD to support staff - then included in business planning

19. Peer Audit Tool • Thank you for your time!  • Contact us: • Malcolm Scott, Team Leader DSD • Scottm@doh.health.nsw.gov.au • Clara Barton, Deputy Director DSD • BartonC@doh.health.nsw.gov.au

20. Peer Audit Tool THE END