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Continuous quality improvement

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Better regulatory focus on improving the quality of NDIS supports is needed to achieve the best outcomes for participants

In addition to changes to pricing and payments, there is an opportunity to enhance the role of the new National Disability Supports Quality and Safeguards Commission (National Disability Supports Commission; see Action 19.2) in improving quality.

Quality is the extent to which supports meet or exceed a person’s needs and expectations.194 Quality may look different for different people, but key aspects of quality typically include the satisfaction of consumers, the efficacy of support delivery and outcomes achieved, as well as a provider’s responsiveness in addressing issues.

Safe support is the bedrock of quality support. But quality support clearly goes far beyond safety. Quality support is key to both good outcomes for people with disability, but also importantly to preventing harm and safeguarding people with disability. This is why we believe quality is best driven by an integrated approach with safeguarding. This is supported by literature on best practice regulation and the approach taken in similar human services regulation - for example, the Aged Care Quality and Safety Commission in Australia and the Care Quality Commission in England.195

Despite this best practice approach, since its conception, the NDIS Quality and Safeguards Commission (NDIS Commission) has needed to focus largely on establishing and operating its regulatory functions and processes, with limited efforts to improve quality. The NDIS Commission’s constrained resources have been prioritised to the significant task of transitioning to a national regulatory approach to safeguard participants. As a result, we have seen quality improvement take second place.

…the focus needs to be on quality and outcomes, rather than simply price... Quality should be the bottom line for eligibility to provide services.

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There is an opportunity to provide more support for providers and workers to engage in quality improvement

More recently, the NDIS Commission has begun to implement a number of positive quality improvement initiatives. These have been focused on provider and workforce capability building, including a Workforce Capability Framework setting out the expected attitudes, skills and knowledge for all workers, a new online repository of resources regarding behaviour support, and practice alerts on best practice support delivery.197

We have heard from many workers and providers, however, who feel there is still not enough targeted and focused information, training and resources to help them understand what good quality support delivery looks like and how they can implement this in practice.

Capability building is more than just a website article but instead requires training, education among the sector and building information awareness through a proactive means.

- The CEO Collaboration 198

Providers have also told us their efforts to improve quality would be assisted by the NDIS Commission sharing insights from the data it collects about what is working well and where change is needed.

Greater use, interrogation and interpretation of data … could allow for deep and authoritative insights into the state of quality and safeguarding across the country.

- National Disability Services 199

Incentives for providers to engage in quality improvement are limited

Registered NDIS providers must undergo an external third party quality audit to assess performance against relevant NDIS Practice Standards and associated Quality Indicators. While this is intended to support quality improvement, we have heard that there is too much focus on paperwork, procedures and policies and not enough focus on the quality of support delivery and the experience of participants.

Audits are too preoccupied with items that relate to administration, policy compliance and reporting requirements that reveal little association to factors that influence the actual quality of service.

- Family Advocacy 200

A lack of transparency about quality and performance means providers have no way of understanding how they are performing relative to other providers.

…a single source of truth for publishing provider performance data is required to better build provider capability, monitor performance and improve the supply of high-quality supports.

– Anonymous 201

This lack of visibility of provider performance and inadequate guidance for choosing supports and providers also means participants face challenges in understanding what quality looks like and how their provider’s performance stacks up. This further undermines incentives for providers to maintain good performance or improve when performance is poor.

… carers [are] often put in difficult situation of trying to navigate and find services. This is a hit and miss lucky dip scenario, where one has no idea of the quality of service.

– Anonymous 202
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