Quality assurance is a long-standing part of how Texas Adult Protective Services measures performance for all levels of staff. By combining quality assurance information with quantitative data from the case management and human resources information systems, APS leadership constructs a meaningful understanding of how APS functions.
Purposes of Texas APS QA
Texas law (Human Resources Code 40.0515) requires APS to implement a quality assurance program, but the reasons for maintaining a QA program go far beyond statutory compliance. At its core, the Texas APS QA program provides direct feedback on individual cases to caseworkers and supervisors. When staff ask policy and practice questions to management, the answer is often, “It depends on the facts of the case.” When Texas QA analysts give individual case feedback, it is specific to the case at hand. A brief word of caution is necessary at this point: be careful that your staff do not overapply a QA analyst’s feedback to future cases. What is right for one case may be totally wrong for another.
In a broader context, the Texas APS QA program helps APS leaders gain a more nuanced understanding of workforce performance. When scores for a supervisory unit or geographical area are studied, trends reveal themselves. While the statistical significance of samples can be an issue for small subsets of caseworkers, quality assurance data almost always tracks with other available data.
Texas has a robust data set from a proprietary case management system. We can track many things by running reports on the underlying data tables. However, no system query tells us whether we should have done more for a client in a state of abuse, neglect, or financial exploitation. This information only comes from reading the case.
We have found quality assurance to be so critical to understanding casework practice that we added portions of our case reading standards to our key performance metrics and supporting performance metrics. Qualitative metrics – obtained from systemic case reading -- make up one-third of the key performance metrics we routinely monitor.
Who Are Texas APS QA Analysts?
If you’re looking to start a quality assurance program in your jurisdiction, one of the most critical components is who you select for quality assurance jobs. In Texas, our QA analysts are experienced former APS caseworkers, supervisors, and trainers who have deep knowledge about casework policy and practice. When hiring for these roles, we look for people who are detail-oriented and have strong written communication skills. The job is a particularly good fit for frontline supervisors who want to get out of management but don’t want to go back to working cases.
QA analysts must be able to work independently and collaboratively. Most of their time is spent reading and scoring closed cases. In addition, QA analysts collaborate with management analysts and middle managers to identify causes of insufficient practice and to develop action plans.
Texas APS currently employs six quality assurance analysts. The size of the group has varied somewhat over time. As a frame of reference, Texas has around 510 APS caseworkers within a total staff of about 730. QA analysts are managed out of state office but are physically located across the state. They work from home unless they need to attend meetings or run large printing jobs from a local field office.
Regular Case Readings
Though QA analysts perform other functions as well, regular case readings are the bread-and-butter of the Texas APS QA program. QA analysts are assigned a random sample of cases to read and score each month. They enter their scores into a Microsoft Access database. When they are unsure about how to score an item on the casereading standards, they seek input from their teammates and from APS policy staff when necessary.
QA analysts use a standard scoring matrix for each case. As APS makes policy changes, QA staff make corresponding changes to the casereading standards. The six casereading standards are listed below:
- Client Safety
- Case Documentation
- Services & Outcomes
- Reasonable Effort
Each standard corresponds to one or more essential job functions on the caseworker performance plan and evaluation, and each standard is made up of several items. Items within standards 1 through 5 can be scored the following ways:
- N/A = Not applicable
- 0 = Policy requirements not met
- 1 = Policy requirements met
- 2 = APS caseworker went above and beyond policy and practiced mission-based work
QA analysts must provide written feedback when scoring an item 0 or 2. Standard 6 measures whether the caseworker made reasonable efforts to avoid leaving the alleged victim in a state of abuse, neglect, or financial exploitation. QA analysts score standard 6 as Yes, No, or Unknown. When scoring No on standard 6, the QA analyst may send the case to local management for potential reopening.
The Texas APS QA program has existed for about 15 years, so we’ve learned some lessons along the way. When you start your QA program, anticipate resistance. People sometimes have an unfavorable reaction to their work being judged by staff outside their chain of command. Caseworkers may ask, “Why do you need to read my case when my supervisor already approved it?” You’ll never overcome all resistance, but you can mitigate it by proactively communicating – being as transparent as possible and getting buy-in -- before, during, and after you roll out your QA program.
When you haven’t had QA data before, you’ve probably fallen into the management trap of pushing staff to reach a number on critical task. In Texas, we’ve found that if we tell staff to “hit the number” they’ll do it. But we may not like the unintended consequences. QA data can shed light on why your staff aren’t reaching a given performance metric. You may find poor work habits, misapplication of policy, unreasonable management expectations, something else, or a combination of issues. Instead of harping on a number, you can address the real problem and therefore reach the desired performance metric without incentivizing shortcuts or bad casework practice.
There are plenty more lessons learned to discuss. I’ll cover them at the 2020 National Adult Protective Services Conference in a workshop entitled “QA the Texas Way: Assessing Quality in APS Casework.” I hope to see you there!
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