Stop Problems Before They Happen: The Importance of an effective quality assurance & improvement program

Taken from Public Safety Communications Magazine, November 2006
Written by Alicia Ihnken, training course instructor for APCO Institute


In a business full of acronyms, the letters QA/QI often send people running for the door.  Quality assurance and quality improvement (QA/QI) can be intimidating, boring, challenging or even frightening.  However, without such a program, a communications center, business or any entity that answers to another can get into deep trouble.  Unless administration is closely monitoring performance through QA/QI, managers may not be aware of performance issues affecting customer service and satisfaction, opening the door for liability concerns.  This article discusses the importance, purpose and common characteristics of an implementation ideas for a QA/QI program.

WHY QA/QI IS SO IMPORTANT
Do the same problems pop up time and time again in your comm center?  Is each and every calltaker and dispatcher where they need to be in terms of knowledge, skills and abilities?  Will the calltaker's actions hold up against public scrutiny should the call become newsworthy?  Does your agency perform emergency medical dispatch (EMD)?  If so, do you have policies in place to ensure adherence to program guidelines and procedures?  The answers to these questions will determine your need for a QA/QI program and underscore the importance of the program for ensuring the achievement of quality goals and objectives.

Without a formal QA/QI program, there is no system to document checks and balances, and there's no routine way to measure individual performance.  In agencies without a QA/QI program, problems are typically addressed only when someone complains or draws attention to short-comings.  This usually happens after the behavior has become entrenched in the offender.  With a comprehensive program in place, management - from frontline supervisors all the way to upper administration - has a better picture of how the operation is running, and errors and deficiencies in individual employee performance can be detected and corrected before they have a negative impact on agency operations.

The purpose of a QA/QI program is not to spy on the employee, but to enhance performance by identifying weaknesses as well as strengths.  When QA/QI is done properly, it can help the current employee and the trainee.  Good calls can be archived for training purposes and top performers rewarded for their efforts.  Bad calls can provide valuable feedback to the employee, trainers, supervisory staff and administration.

While conducting reviews, the evaluator can pick up on trends of acceptable and flawed methods and even gross deficiencies that may be overlooked because there was no corresponding complaint.  The information obtained can be used to revamp training methods and improve overall awareness.  If the program is successful, it can eliminate such excuses as "nobody told me" or "I didn't know we couldn't do it that way" because the program will emphasize continuing development and improvement.

A successful program is also a lifesaver (i.e., lawsuit-saver) when it comes to liability issues.  This works in favor not just of administration, but also of the line worker.  The line worker will have the tools, information and feedback required to perform at a higher standard.  Administration will have the proof that it's watching out for the success of its employees and the safety of the public.

WHAT SHOULD A QA/QI PROGRAM INCLUDE?
A QA/QI program should not be used for disciplinary actions.  It is a tool to ensure employees are following the policies and procedures that support the organization's mission.  Disciplinary actions should be left to complaints lodged and supervisor observations.  If the reviewer uncovers a problem, across-the-board remedial training should be the direct result.  If one employee has a problem area, others could very well have similar problems - or a less experienced employee may observe and learn the problem behavior - so no employee should be singled out during these training sessions.

A QA/QI program should be global in nature, while addressing specific policies and procedures on a continual basis.  Just as short-term solutions can lead to bigger long-term problems, long-term programs can prevent the need for short-term solutions.

Centers that follow EMD guidelines commonly conduct quarterly reviews, with parameters generally dictated by the medical director of the agency's program.  EMD guidelines should be followed stringently.

But what about the rest of the activity that goes on in the communications center?  First consider the main functions of the communications center.  Is it for only police, only fire/rescue or only EMS?  Is it a consolidated PSAP?  Is there a separate calltaking center?  What definitive areas exist for which guidelines can be established?  Are policies/procedures in place for each function of the comm center?  The structure and functions of your agency will determine the type of information to include in your QA/QI review.

Your QA/QI categories for review should be based on your policies and procedures.  No part of the QA/QI program should catch anyone by surprise.  It's not intended to "trap" anyone, but to provide an objective picture of what is really happening.  Encourage staff members to look at the whole process as a benefit to them and their professional development.  If there is to be any trapping, it should be focused on catching employees in the act of doing something right!  Categories for review can include fire radio procedure, police radio procedure, nonemergency calltaking, 9-1-1 calls, customer service - or any other area that has a defined policy.  The information for each will have similarities and differences.

A review schedule should include information on the types of calls to be pulled and a schedule of when the reviews will be conducted.  Methods for pulling calls for review can include completely random, only 9-1-1, only nonemergency, only traffic stops, only chest pain calls or combinations of these.

Once the areas to address have been determined and the policies and procdures put in place, the QA/QI reviews should be built around these elements.

The most important element in a QA/QI program is that everyone involved have a clear picture of its purpose and how to proceed.  All QA/QI programs must include proper planning, proper review and proper enforcement.

Proper planning consists of a comprehensive analysis of the organization's goals.  Without this, evaluation guidelines can't be created.  During this analysis, determine the expectations of the administration, responders and the public regarding the employees, the standards to which the employees will be held, the evaluation method (standard of measurement) and the overall review process.

Proper review ensures the overall effectiveness of the program.  Even though all reviews should point back to the overall mission of the center by reflecting the policies and procedures, it's not enough just to ask, "Were the policies and procedures followed?"  The reviews should be comprehensive, but at the same time not so tediously detailed that the reviewer gets bogged down in the form instead of focusing on the information being reviewed.  Consistency is key; therefore, a schedule of reviews must be set.

Proper enforcement is the "payoff."  If the appropriate steps are taken in the review process, the organization should have a clear picture of employee performance.  As a result, strengths and weaknesses will be clearly defined and action plans can be created and implemented.

To assist you in understanding the process, review the sample policy and procedure, compiled from various SOPs, and the sample QA/QI form based on the sample policy.  They both will be at the end of this article.

Practical Application
When creating your review form, carefullly analyze the categories/questions you're including.  Are they quantitative or qualitative?  Will the evaluator understand the questions and how they should be answered?  Is there room to write comments and observations?  There are as many sets of evaluation questions and styles as there are communications centers.  Some comm centers will share information with you in the name of public safety.  The APCO Institute has resources that may help you create the desired format, including Web seminars on how to develop and maintain a successful QA/QI program.  Build in the experience of others, and tap as many resources as you can.

Another important element in QA/QI program is the people and their understanding of the purpose and process.  Who should conduct reviews?  Who should be reviewed?  How should the reviews be conducted?  The answer to these questions depends on the structure of the communications center.  A large center may have an individual designated as the quality assurance officer; a smaller center may assign the task to shift supervisors or trainers.

Don't forget about self-evaluations.  It has been said that we are our own harshest critic.  Let some of that criticism take a positive form with self-evalutaions.  Give employees the appropriate time (i.e., 30 minutes or so) to review their work objectively and according to the guidelines set forth.  If this is presented in addition to supervisors and trainers conducting evaluations, it can soften the blow when mistakes occur.  What cannot be stressed enough is that this process should not be used for disciplinary actions.  Similar to the daily observational report (DOR), the QA/QI review may, however, be used for tracking performance and evaluating opportunities for improvement.  The moment it is used to discipline an employee, is the moment its effectiveness as an evaluation tool is lost.  Performance evaluations, complaints and other types of information should be enough to find problems requiring disciplinary actions without resorting to call reviews.

Implementing a QA/QI Program in Your Agency
This is where the rubber meets the road.  Proper implementation of a program that can save you and your employees from liability and improve the overall performance of public safety telecommunicators is crucial to a successful operation.  First, make sure you have a well-defined mission with clear-set goals.  These goals should be reflected comprehensively in policy and procedure.  Only after you have these important pieces in place can a fair evaluation system be created.  The right people and proper training are also crucial to successful implementation.  Do you have individuals, either supervisors or line personnel, who have the capacity to motivate and support others?  Can they be, or have they been, trained in mentoring techniques?  Take a closer look at current employee potential and follow best practices when hiring.

Develop a tracking system that will hold employees accountable to the program.  Several methods can be used to track call reviews (e.g., paper in a notebook with dividers, paper in a filing cabinet), but by far the most space-saving method is electronic.  Example: Names, dates and case/run numbers can be documented in MS Office Excel for easy reference and tracking.  Results of call reviews can be e-mailed to the appropriate parties.  This process does not have to be cumbersome.

Develop your preferred method of tracking before the first call review is conducted, and make sure the evaluators are very familiar with the system you plan to use.  It helps to have one person assigned to monitor the activity and compile reports for administration.  If everyone knows who is doing what, it makes it easier to hold employees accountable to the program and their duties.  With the right elements in place, including people who understand the process, the program should run smoothly.

Once the program is developed and you have the right people in place, how do you proceed?  If none of the employees were in the planning stage of the program, inform them of the process.  Everyone who works for an organization should be well-versed in its mission and goals.  Let them know who will be doing the evaluating and for what purpose.

Designate training times to familiarize those involved with the entire process.  "Roll call" training is a tool often implemented when the opportunities for classroom or meeting time are scarce.

Inform everyone of how and when the process will be implemented beforehand.  Give them a chance to digest the process and the opportunity to ask questions.  Even if an employee will not be conducting a review, he or she will still be subject to review and should be familiar with the entire process.

Set up a schedule and post it in an accessible area.  If there are no deadlines or the reviews can be conducted whenever the employees desire, the reviews will most likely not be done.  Give the employees the time and the tools to proceed, and hold them accountable.  Monitor the process to ensure timely results.

Summary
A quality assurance/quality improvement program should not be scary, daunting or overbearing; instead, it should be enlightening, helpful and beneficial to the organization and its employees.  To ensure your program meets these objectives, be sure you:

• Establish a clear mission with supporting goals;
• Have policies and procedures that support the operation;
• Have quality, well-trained employees; and
• Hold employees as well as management accountable to your clearly established QA/QI guidelines and methods.

The time you take in advance to build a solid foundation will eliminate the need for quick fixes and short-term solution.


Sample Policy & Procedure:
Nonemergency Calltaking

Policy: The purpose of this policy is to address proper nonemergency call handling within the communications center.  The seven-digit phone number to the communications center is 555-2525.  This number allows local access to the communications center for the public, responders and other area agencies.  Calltakers shall hold to the mission of the communications center and be professional and polite when dealing with all customers including responders, co-workers and callers.  Technical telephone training that addresses the operational aspect of phone use is provided in the initial training phase before the calltaker graduates to the on-the-job training.  This training and its corresponding policy and procedure are addressed separately.

Procedure:

1. Nonemergency lines shall be answered within three or fewer rings.
2. All nonemergency calls shall be answered, "Anytown Police, how may I help you?"
3. If an emergency call comes in on a nonemergency line, it shall be handled following the policy addressing 9-1-1 emergency calls.
4. Calltakers shall remain alert and ready to handle any incoming call.
5. Calltakers shall speak clearly and distinctly at all times.
6. All calls for service within the service area shall be entered into CAD in a timely manner.
7. The calltaker shall make every effort to enter the correct nature/event code.
8. The calltaker shall verify the location, cross streets and business name, if applicable.
9. The calltaker shall attempt to obtain the name and phone number of the caller.
10. If the call is transferred to another department, no event record is required.
11. Calls not involving law enforcement or those not within the service area shall be referred to the appropriate agency or transferred, depending on the request.
12. Although calltakers are not expected to endure abusive callers, the calltaker is not permitted to use abusive language, and courtesy must be maintained.
13. It is appropriate in cases of abusive callers to refer the call to the supervisor.
14. Calls shall be handled in a business-like fashion, and the caller shall be advised of what to expect (e.g., a phone call from an officer, a visit, an appointment or whatever the case may require).
15. All nonemergency calls are subject to review.

Sample QA/QI Call Review Form Information

Nonemergency Calls for Service
Name:                                                  Review Date:
Reviewer:                                             Case/Run/Event#:
Time of Call:                                         Time of CAD entry:               (N/A)
Was the appropriate greeting used? (Y/N) If no, explain:

Was the appropriate nature code entered? (Y/N)

Was the location information verified? (Y/N)

If caller did not have an address or if the locations provided did not register in CAD, how did the calltaker proceed?

Did the calltaker ask for the name and phone number of the caller? (Y/N)

If the call was not within the scope of the service area, was the caller provided with information on how to obtain the requested help?  What was done? (N/A)

If the caller was abusive, how was the call handled? (N/A)

Was the calltaker professional and polite at all times? (Y/N) Explain: