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If you’re in this industry, you know audits are as certain as death and taxes. But guess what? After 25 years of audit adventures, we’ve discovered that mastering a few key strategies can turn audit dread into a walk in the park. Ready to win the audit game? Check out our quick tips for success below. For a deeper dive, don’t forget to download our extensive guide!
SIR DOCUMENTATION
Is your organization required to file some form of a Special Incident Report (SIR) or communication to either a funding or licensing source? We have found that an important component of an effective QA system is the regular and thorough review of these incidents and their documentation with the most critical piece being the follow-up action implementation. Our funding source has a specific form to be used when reporting these special incidents and we automated it within our data management system to make our internal process more effective. Recording incidents in our electronic database enables us to find information quickly, sort the data in multiple ways for trending purposes, and track follow-up action completion. We sort SIRs by service recipient, service area, supervisor or facilitator, manager, incident type, and by nature of follow-up action needed. Your QA system should establish how often these Special Incidents are reviewed, by whom, and what accountability practices will ensure follow-up actions are both completed and effective. Special Incidents could be reviewed on a monthly or quarterly frequency for immediate response and again at year-end. Your QA system should address the process for taking trend information and affecting internal policy and procedure when needed.
ONBOARDING PROCESS
We have found that having a detailed and consistent onboarding process for both people served and employees is a key element for a quality foundation. We have developed written guides and checklists, and we complete regular internal audits to ensure every box is checked.
MOCK AUDIT
A thorough and effective quality assurance system will go beyond document review and include some kind of in-person component as well. Ideally, there would be an occasional unannounced or loosely scheduled quality check that tests the success of everyday systems. Consider using some form of a mock audit. This could include a self-audit process done by teams or managers or managers could internally audit each other. If you have developed relationships with other providers, you could even audit each other.
CREATE QA HABITS
If you have not read Atomic Habits by James Clear, I would highly recommend you pick up a copy today and make time to read it (another example of a Q2 activity). In the book, the author states “Success is the product of daily habits- not once-in-a-lifetime transformations”. He warns that we shouldn’t get wrapped up in goal setting only but focus on systems. James Clear points out that winners and losers have the same goals- the difference is the habits we have. The tips we offer on developing a Quality Assurance system that makes you audit confident are only as good as actually implementing them consistently.
Here are some examples of Atomic Habits’ simple laws to help you set and maintain good habits around quality assurance.
Cue Examples: Make it obvious (Use habit stacking)
Connect QA to a current successful habit such as the annual planning system required for most people receiving services. This annual plan is frequently connected to the authorization for services and subsequent payment for services rendered and most of us have found a reliable rhythm for the process. Gradually add QA checkpoints to your annual process to ensure reliability. Use a “Do not archive” stamp, list or painfully obvious system so important historical documents are not accidentally archived. These documents can be instrumental in quality individual services and be requested for review during a future audit.
Craving Examples: Make it attractive (Make a habit pleasurable or connect it to another pleasurable activity to make it stick.)
While we enjoy meeting and getting to know new clients, few of us look forward to the paperwork that accompanies onboarding. We incorporated the necessary paperwork into the connection process by creating a partnership packet that is reviewed during the assessment and onboarding process. It includes an introduction to our organization, philosophy, client rights, our grievance procedure, emergency planning, information on abuse prevention, circle of support connection, and consents. We had a very talented team member create an eye-catching leaflet with everything in one place and we feel a sense of pride when we pull it out and hand it to a new client and their circle of support. We have consistently received positive feedback from funding source representatives and have found it improved audit results. We see the benefit of a spring cleaning of sorts for QA related elements. To make it attractive, we combine it with connection and food. We have a team event at least once per year where we order in food and tackle a QA related project together.
Response Examples: Make it easy (Friction prevents habits from forming) (Automate)(Consistency beats intensity)
Consider electronic signatures for documents that must be updated and signed at specific intervals. Our data management system has a customizable dashboard available upon login. We have certain QA-related metrics depicted in color-coded scoreboard format available on the dashboard, so we see it immediately and know constantly where we stand on these metrics. Use a data management system that offers electronic alerts for setting QA expectations. Our system sends alerts related to training requirements and milestones, annual plan requirements, timekeeping expectations that support service provision evidence, QA review action item completion, and many more.
Reward Examples: Make it satisfying
Have a QA system that celebrates the good that is happening. Our QA team publishes an electronic communication each month that highlights some of the good seen during their reviews. A team member is chosen every month to receive a gift card and details of their effective work are shared with peers. In addition, positive stories are shared which creates a culture where QA is not about finger-pointing but rather personification of our values and mission.
HARD CONVERSATIONS
Another less concrete component of effective quality assurance related to accountability is to have hard conversations. This could include addressing employee performance concerns even when you feel like you can’t afford to lose another body. It could mean having a sensitive conversation with a service recipient who is making choices that endanger themselves or others. Maybe QA reveals a pattern that is contrary to an organizational value but you have no idea how to address it and having the conversation with other leaders won’t be easy. Our commitment to quality assurance is also indicated in the way we respond to potential complaints about service delivery.
Quality assurance is more than having a great checklist. It is a living and breathing process that requires consistent investment and tinkering to make strides toward desired results. A related Atomic Habit principle is to do the little things. A 1% change may not feel significant at first, but 1% over time will make a big impact.
