Failing services is failing to understand – the emphasis is on continuous quality improvement

Australian Children’s Education and Care Quality Authority (ACECQA) Chief Executive Officer Karen Curtis addresses the importance of continuous quality improvement under the National Quality Framework (NQF).

One of the most important aspects of our system of assessing and rating the quality of education and care services is its emphasis on continuous improvement. This is deeply embedded within the NQF, starting with the requirement for all services to have a Quality Improvement Plan in place.

ACECQA’s latest published Snapshot, based on data as at 30 September 2016, shows that, of the 15,429 services approved to operate under the NQF, 83% have been assessed and rated, with 71% rated at Meeting the National Quality Standard (NQS) or above.

As you can see from the information above, most jurisdictions have assessed and rated more than 80% of services in their state or territory and the focus for some, particularly those that have assessed and rated more than 90% of services, is increasingly upon reassessing services.

When state and territory regulatory authorities undertake quality assessment, the goal is to drive the quality improvement of services, improve outcomes for children and make meaningful information available to families and communities.

To make the best use of available resources, regulatory authorities take a responsive, risk-based approach, focussing on services in need of quality improvement. This typically results in more frequent assessments of services that do not meet the NQS, as well as potential reassessments of services that have experienced significant changes or adverse events. As at 30 September 2016, a total of 1332 reassessments had taken place. Almost two thirds of these resulted in a higher overall rating being given, with the most common improvement being services moving from Working Towards NQS to Meeting NQS.

The NQS is made up of a series of standards and elements and it is at the element level where we get a comprehensive picture of quality improvement. To date, 75% of reassessments have resulted in a higher number of elements being assessed as met. On around 100 occasions there has been a very notable improvement in performance, with 21 or more elements on aggregate moving from being assessed as not met to met.

In contrast, just over 10% of reassessments have resulted in a lower number of elements being assessed as met. On seven occasions, there have been marked deteriorations in performance, with 21 or more elements on aggregate moving from being assessed as met to not met.

More than half of reassessments have resulted in between one to 10 elements on aggregate moving from being assessed as not met to being assessed as met. My previous article, which looked more closely at the nature and diversity of the Working Towards NQS rating, is relevant to this, in particular the high proportion of services that are rated at Working Towards NQS due to not meeting a low number of elements.

When looking at changes in performance at reassessment, it is also informative to examine individual elements to see which are most and least likely to exhibit improved performance. We can do this by looking at the number of times an individual element has changed from:

• not met to met
• met to not met, or
• continued to be assessed as not met.

Of  the 10 elements most likely to exhibit improved performance at reassessment, two each are from standards 5.1, 6.2 and 7.1:

• Element 5.1.2 (children’s interactions with educators)
• Element 5.1.3 (support for children to feel secure, confident and included)

• Element 6.2.1 (recognition of families’ expertise and shared decision making with families)
• Element 6.2.2 (availability of current information about community services and resources to support families)

• Element 7.1.2 (comprehensive staff induction)
• Element 7.1.3 (continuity of educators and co-ordinators)

At the other end of the spectrum, of the 10 elements least likely to exhibit improved performance at reassessment, three are from Standard 2.1, and two each are from standards 2.3 and 7.3:

• Element 2.1.1 (support for children’s health needs)
• Element 2.1.3 (effective hygiene practices)
• Element 2.1.4 (infectious disease control and management of injuries and illnesses)

• Element 2.3.2 (protection of children from harm and hazard)
• Element 2.3.3 (incident and emergency planning and management)

• Element 7.3.1 (storage, maintenance and availability of records and information)
• Element 7.3.5 (effectively documented policies and procedures)

Unsurprisingly, in the list of the 10 elements most likely to continue to be assessed as not met are five of the most challenging elements of the NQS:

• Element 1.2.1 (ongoing cycle of planning, documenting and evaluation)
• Element 1.2.3 (critical reflection)
• Element 3.3.1 (sustainable practices)
• Element 3.3.2 (environmental responsibility)
• Element 7.2.2 (staff evaluation and individual performance development plans)

Also included in the list of the 10 elements most likely to continue to be assessed as not met are two of the elements from Standard 1.1:

• Element 1.1.3 (program maximised opportunities for children’s learning)
• Element 1.1.4 (availability of children’s documentation to families)

Reflecting upon these elements and considering why they appear in the respective lists will help prioritise and direct future quality improvement efforts. For example, it may be that efforts to improve performance against some standards need to be more intense, targeted and prolonged.

I also want to highlight that the consistent picture over the last four years is that Quality Area 1: Educational program and practice is the most challenging of the seven quality areas, with Standard 1.2 (focused, active and reflective educators and co-ordinators) and Standard 1.1 (curriculum enhances each child’s learning and development) the most challenging of the 18 standards, and Element 1.2.3 (critical reflection) and Element 1.2.1 (ongoing cycle of planning, documenting and evaluation) the most challenging of the 58 elements. Devoting dedicated time to discussing, reflecting on and prioritising aspects for improvement around the educational program and practice, particularly reviewing the feedback received as part of the assessment and rating process, will provide a solid foundation for continuous quality improvement efforts.

In my final blog post next month, I look forward to sharing with you my reflections on the last five years, a period of momentous change for our sector.