At Empathia Group, we often ask ourselves, “is the existing NDIS quality framework actually making a difference in customers’ outcomes?”. We’ve concluded similarly to Seligman’s back at the dawn of positive psychology. If our quality process focuses strictly on minimum requirements and risk aversion, we may lose the transformative part of our work that makes a difference and engages our staff.

We strongly believe that NDIS quality processes are necessary and effective for establishing minimum requirements to support people in the scheme safely. Although, some people view that these measures don’t go far enough, and of course, we have seen instances where accredited providers have caused actual harm to their participants. 

However, it is clear from the experience of organisations that we have assisted through the audit process that regulators take their responsibility seriously. 

Most NDIS providers are only meeting the bare minimum requirements

The regulation of the sector through correspondence to broad practice standards, mediated by professional policy generation services (Centro-assist and others), has led to a general standardisation of most processes and policies across the sector. 

We believe this trend has led to a robust “ceiling effect” in the sector, where most providers are meeting the bare minimum requirements, with very few providers taking the additional steps to build quality processes that result in real change for customers.

There is a good reason for this phenomenon. Researchers in the disability space note that the disability sector is subject to the problem of counterfactuality. Since no two people experience their disability in the same way or within the same physical and social environment, establishing rigorous quantitative measures can be tricky.

Despite this, emerging research demonstrates that processes, culture, and leadership in our organisations can substantially and differently impact the outcomes of the people we support. 

While we can’t say “this outcome would or would not have occurred, with practice leadership in place,” it is possible to observe that sound practice leadership, coherent cultures, and practical training can have a meaningful impact on quality-of-life outcomes.

To generate real value, you must go beyond the standard

Quality processes that can generate real value take a step beyond the basics. We’ve observed numerous quality processes that are effective and efficient at achieving the following:

• The support worker produced a note at the end of their shift that was sufficiently long
• The restricted practice process was adequately followed and used as a last resort, with all actions well documented
• The recruitment process was followed correctly by the manager
• The customer has the required plans in place, and they are current
• Incident reports were completed promptly by the supervisor.

While there is no doubt these processes are necessary, they reflect a quality process that misses the quality-of-life upside that the positive psychology revolution hinted at in behavioural science. Nevertheless, we’re beginning to see quality processes emerge that ask more profound questions. 

Here’s the questions you should be asking about customer outcomes

We’ve developed a bank of additional quality measures that can add substantive upside to customer outcomes. Some questions are quantitative, while others require seasoned professionals to be circumspect. 

Here are some of our favourites:

• Does this customer have access to genuine opportunities to increase their social participation? If they did, did they work? If they didn’t, what actions did we take?
• What is the average number of non-work, non-family friends our customers have? What was the average frequency of contact?
• What was the total care plan achievement rate last quarter? How significant do our customers believe their care plan goals are?
• How many care plan goals did we recycle from previous plans?
• What was the rate of effective responses to incidents in the last quarter? What is the major determinant of ineffective responses?
• How many different staff members did the customer work with in the last quarter?
• What percentage of staff have received specialised training in response to customers’ unique needs, or what was the net number of days customers had untrained staff on shift?

From a staff perspective, these probing quality questions can be scaled and reveal much about the effectiveness of our teams.

•  How many pieces of direct, in situ feedback did our staff receive on shift?
• What is the average amount of supervision time staff receive? Is there a correlation between supervisory time and engagement? (this can be measured rapidly from payroll data)
•  What is the average span of control of our supervisors? Is there a correlation between engagement and lower spans of control?

Take a deeper dive into the critical issues central to your organisation

The key to unlocking the positive processes of your business is to ask yourself serious questions about the quality of your quality process. For example, are they increasing the probability of your business’s and your customers’ preferred outcomes? When your quality processes probe a layer deeper, you can start to ask questions about critical issues central to the effectiveness of your organisation, primarily:

1. Do our customers achieve their goals and care about them?
2. Are our staff engaged by our leaders? Does it affect our outcomes?
3. Do we manage incidents effectively?

If your organisation can confidently answer yes to the above three questions, then you are well on your way to building a scalable reputation for effective service delivery. However, if you, like most larger providers, cannot answer these questions, then an expanse of optimising quality data is waiting for you.

Of course, thorough reviews of each client file are not a feature of the DSWCM (Disability Support Worker Cost Model), so intelligent metrics and sampling techniques are required to scale these processes in a sustainable way that adds value to your operations team. Meanwhile, seasoned quality professionals also understand the customer’s context. As a result, they don’t frustrate operations teams by insisting on outcomes that aren’t possible or are outside of the capacity of an NDIS offering.

Optimised quality processes drive word-of-mouth referrals

The organisations we work with that have been able to scale “positive” quality processes have noticed an improvement in their word-of-mouth referrals once they optimised for customers’ outcomes. By this, we mean engaging and enabling front-line teams to deliver their customers’ goals in a manner that may be outside of standard practice. 

The accurate measurement of your upside quality allows you to treat it as an investment, assess your interventions for return and potentially substitute marketing expenses as service quality becomes a significant driver of referral – a strategic tradeoff that you should take seriously.

If you want to discuss optimising your quality process or engage an audit team with the experience and metrics to accurately capture your positive processes, reach out to our team.