GAUTENA
Index
1.- Introduction
2.- Plan for quality and continual improvement:
2.1.- Why?
2.2.- What for?
2.3.- How?
2.3.1.- External consultantship. ISO norm 9002
2.3.2.- Participation in the process:
directive team, families, remainder of the staff
3.- Where are we going?
4.- Strong points and weak points of the process undertaken in Gautena
4.1.- Strong points
4.2.- Weak points
5.- Summary and conclusions
1.- INTRODUCTION
Over the next few minutes, I am going to explain the initiative
that GAUTENA is carrying out in the area of Quality. This report
is structured under the index above.
Before getting down to business, allow me to give you a bit of
background information that will help to know our institution
a bit more, and therefore shed more light on our process towards
Quality.
(Transparency 1)
GAUTENA is an Association of parents created in 1978 in San Sebastián
which works throughout the county of Guipúzcoa. Guipúzcoa
is a province situated on the North coast of Spain on the French
frontier. It is approximately 50 x 60 km., with a relatively
dispersed population density (663,000).
Guipúzcoa is one of the three counties of the Basque Autonomous
Community, which is governed under a Statute of Autonomy that
confers full competences in terms of Health, Education and Social
Services. The Diputaciones Forales (county councils) have their
own regulations of taxation in their respective historic territories.
GAUTENA, a non profit making Entity of Social Initiative, is basically
public funded. However membership fees cover approximately 9%
of the expenditure. Around a hundred staff (of which 60% are
full time workers) are employed to help in services provided to
almost two hundred families in Guipúzcoa.
At present, GAUTENA provides the following services:
This Program is run by the Technical Team of GAUTENA -Child Psychiatrists
and Psychologists- and covers diagnosis and treatment of the population
we attend.
Composed of 12 classrooms, 10 of the which are to be found integrated
into ordinary school centers throughout the county, while the
other 2 classrooms are located in a Special School in San Sebastián.
A Program for over 20's which is of both an educational and occupational nature.
The function of this program is to provide Community Housing in
way of Home Units integrated into the community, to supply lodging
for the more severely affected people.
On one hand the activities included in this area are directed
towards leisure and to the promotion of the individual development
of the clients of GAUTENA, while on the other hand, the family
can "get a break" in these short term lodgings -bank
holidays, week-ends and vacations-.
2.- PLAN FOR QUALITY AND CONTINUAL IMPROVEMENT: WHY?
WHAT FOR? AND HOW?
The Quality, from our point of view, and without entering in questions
of definitions, seeks the best for the people to whom we direct
our attention and for their families. This search for the excellence
in our work, is a permanent process of improvement.
We have reached the conclusion that the objective of Quality and
Permanent Improvement in GAUTENA is well worthwhile, because in
1996 GAUTENA has over 18 years of experience and a dimension,
which justifies the necessity of channelling all the intents of
Quality improvement on a formally established structured plan.
The current initiative of GAUTENA in pro of the Quality, subscribes
to the methodologies of Quality Assurance which by overcoming
the vision of the Quality as meaning only inspection and control,
constitutes a necessary step towards our objective of Total Quality.
For us, the Quality in services for people with Autism and other
related problems is understood as the conjunction of two lines
of complementary work.
(Transparency 2.- "Complementary framework for quality")
Having a specific body of knowledge in the field of autism on
one hand, and the managing of the organization according to the
guidelines of the methodologies of Quality on the other. In this
way we are able to apply as a "state of art" the best
practical protocols at any given time, to lead us towards a more
effective and efficient work.
In our opinion, the two points are indispensable and complementary.
The joining of both will bring us nearer to the aims of Quality.
2.2.- WHAT FOR?
Here in GAUTENA we have started a process of Quality, that follows
the standard procedures of Assurance Quality.
It is therefore a methodology that obliges us to put our thoughts
down on paper, that is to say, to be concrete about how things
should be , -from the ethical, technical, and administrative point
of view-, that is to say, our idea on the Quality at any given
moment.
The Quality Assurance plan contemplates a series of procedures
that by being applied will provide a better service, guaranteeing
the users and their families clear procedures that assure them
a very definite itinerary, in which there is no doubt about the
contents and the responsibilities, that is to say, the what, the
how, the when and the who of each matter.
The idea is to give each family the possibility of knowing the
individual program of their child in writing, of knowing who the
tutors are , or the person in charge of each specific program,
education, treatment and leisure. How often and with what frequency
contact with the families will be kept , what type of written
material should be received by the family and when, etc.
The idea is therefore to guarantee an integral and individualised
approach to the disabled person, and to avoid errors such as lack
of co-ordination among the different services, vagueness in the
contents of the diverse programs, and the identification of interlocutors.
By way of these methods, it is possible to guarantee the communication
between staff and families, and the participation of the latter
in all the phases of the process of attending their children.
2.3.- HOW?
2.3. 1. - External Consultantship. ISO norm 9002
GAUTENA decided to approach the objective of the Quality, from
a formally established point. That is the ISO 9002 norm, adopted
by the European Union, and the principal international agents
that deal with Quality.
To do this, we decided to seek the advice of specialists in Quality,
Arthur Andersen Business Consulting, who are supervising and guiding
the process.
In short, it is a system to Assure Quality, having as a reference
a predetermined established norm.
The ISO norm 9002 requires the composition of a Quality Manual
and of a Procedures Manual, with arrangement to the following
indexes:
(Transparency 3.- "Quality Manual")
The Quality Manual contains the most theoretical aspects related
to the philosophy and objectives of the Association, as well as
to the identification of our own definition of Quality in our
work environment, based on technical and ethical approaches adopted
in GAUTENA.
The Quality Manual, contains aspects relative to the culture -the
way things are done-, and the values -the frame of reference-,
of GAUTENA.
The Procedures Manual regulates the sequence of proceedings required
to be met by all those who come into contact with our Organization.
(Transparency 4. - "Procedures Manual")
In this sense, the Manual of Procedures details the full process,
from the moment of welcome to the programme, the initial diagnosis,
until the referral of the case to its corresponding service of
GAUTENA, for the development of an individualised programme of
intervention, and the adequate follow up and updating.
The chapter on the Training of the Human Resources in the company
deserves a special consideration, not only due to its enormous
importance in all modern organizations, but also, for its direct
incidence in the Quality of the service provided. Therefore,
the annual composition of a Training Plan is referred to as obligatory.
Both documents -"Quality Manual" and "Procedures
Manual"-, are supplemented on one hand, with an "Informative
Manual" and with some "Pages on Procedures". The
Informative Manual picks up the main part of specific techniques
about Autism in the Organization, on how we understand the Quality
of the services for people with Autism in GAUTENA. That is to
say, the Informative Manual picks up the "state of the art,"
adapted to GAUTENA's environment.
(Transparency 5. - "Service Information Manual ")
The "Pages on proceedings" allows us in practice, to
follow and accomplish each step of each procedure.
2.3.2.- Participation in the process: Directive team, Families,
remainder of the Personnel
In accordance with the definition set down by GAUTENA, in this
process of Quality and under the responsibility of the Management,
we have considered the part played by the Technical Team and of
Supervisors of GAUTENA and of the Medical Adviser as essential.
They have, right from the beginning, undertaken the managing
of the process and have transmitted it correctly to the staff
under them.
In this sense, in GAUTENA, we try to boost the following characteristics
which we consider as essential in a Directive Team.
(Transparency 6. - "Characteristics of the Directive Team")
On the other hand, a Committee of Quality, composed of a representative
of the families,- member of the Board-, the Management, the Medical
Adviser and the Medical Director has been set up to look after
the execution of the plan.
The plan establishes mechanisms for the systematic surveys of
opinions from clients, families and staff.
A special attempt to imply the families to whom we provide services
and the members of staff who are in direct contact, has been carried
out not only through personal contact but also through family
satisfaction surveys and staff satisfaction surveys. Armed with
the results of these surveys and with an eagerness to complete
and enrich the information therein contained, group meetings have
been held for families and staff of the different sections.
On the whole, one could conclude from the survey to families,
that the majority express a reasonable degree of satisfaction
with the Association, underlining its flexibility to adapt to
the demands of each situation.
We now know in which areas the families reclaim an improvement
in the service. In first place the demand of a more personalised
attention, followed by a demand for more services. Another demand
is the improvement in the information that they receive from the
Association.
(Transparency 7. - "Family Demands")
The families, nevertheless, recognise a general reluctance -80%
of the poll-to participate more actively in the Association's
commissions for follow-up and control.
The staff note a "pleasing and positive" atmosphere
of work and point out the following factors of improvement:
- greater readiness of human means and materials
- Training
- Collaboration of the families
- Co-ordination among the staff
(Transparency 8.- "Staff Demands")
3.- WHERE ARE WE GOING?
We understand the implanting of a system to assure Quality, as
an instrument that will allow us to improve in all that is relative
to how we organise our proceedings, but, on the other hand, we
also see it as the means to introduce ourselves in the culture
of the Quality, the search of excellence in the provision of services.
In order to guide us along this road we used the objectives of
the Total Quality as our reference.
(Transparency 9. - "The Definition of the Total Quality")
In order to reach our objective, our guide has been the principles
of Total Quality Management.
(Transparency 10. - "Principles of Total Quality")
On our way toward the Total Quality, we took the European Model
of Management, the European Foundation of Quality Management,
as our guideline because it summarises the most advanced knowledge
and the most practical improvements in management of existent
organizations in the European Union nowadays.
(Transparency 11. - "The European Model of Management")
lt is, in fact, this model that picks up the above mentioned principles
of the management toward the Total Quality, and marks nine criteria
to define the areas in which reflection or analysis should be
carried out.
This model assembles the nine criteria in two boxes, giving each
one of them a determined punctuation. The AGENTS or aspects that
should manage the direction of the organizations and the RESULTS
that are the consequences of the management of the agents and,
at the same time, permit feedback.
To work along these principles implies being in a "never
ending process" of permanent improvement in which "nothing
or nobody" should be left out, and which constitutes the
centerpiece of the Organization based in "CUSTOMER SATISFACTION."
4.- STRONG POINTS AND WEAK POINTS OF THE PROCESS UNDERTAKEN
IN GAUTENA
4.1.- Strong points
(Transparency 12.- "Strong Points of the Process")
1) In first place, one could say that the identification of the
objective constitutes in itself, a very positive aspect in the
life of an organization of this nature, because it implicates
dynamics and a will to improve.
The central idea that spurs us on is that we provide a service
for the disabled and their families and it is with that in mind
that we use our energy to improve, and this is, on its own, an
important issue to underline.
2) In second place recognize that the entities that are devoted
to the attention of the disabled are not essentially different
to any another entity that provides services to the people, and
that therefore the same methods of Quality are applicable.
3) On the other hand, we recognize that an External consultantship
of specialized characteristics is necessary. This is, from our
point of view, another factor which offers guarantees in the process
undertaken in GAUTENA.
4) Another positive aspect of this process is the amount of systematic
feedback of opinions and comments forwarded by both staff and
families.
4.2.- Weak points
(Transparency 13.- "Weak points")
1) Perhaps the main "weak point" in the implanting of
methodologies of Quality Management in GAUTENA undertaken at the
moment, is the fact that these are seen to be "strange"
and "irrelevant" in the daily work in the services,
due to the unfamiliar techniques.
In this sense, from our experience, we would permit ourselves
to recommend that before setting up a plan of this nature, it
is important that both family and staff be informed and educated
concerning the philosophy and the methodology of Quality System
to apply,
2) Another aspect that has not worked out too well in GAUTENA,
has been the demands of time and of rhythms of work that the set
up of the Plan requires. To do this at the same time as other
obligations is something that certainly doesn't result easy.
One way to resolve this might be enthusiasm and self motivation.
Never the less these motives are hard to achieve
3) Another drawback to all these initiatives, which fortunately
has been overcome, was the feeling of "bogged down in papers."
In this respect our experience told us to "stick to the basics"
and not take on too much.
4) All processes which imply the introduction of changes, come
up against resistance. We have also come up with them, however
we can say that the more we advanced in the programme the weaker
the resistance.
In all, it has been with no doubt, a positive experience.
5. - S SUMMARY AND CONCLUSIONS
The Quality of the service to the people with autism and their
families is the authentic reason of being of our Organization.
In GAUTENA, with our specific knowledge in the field of Autism,
we have decided to apply a methodology of Quality Assurance, in
which the trigger has been the will to improve our work.
(Transparency 14.- "Summary and Conclusions")
With the aid of an external specialized consultantship - Arthur
Andersen Business Consulting-, we are designing and applying a
system to Assure the Quality.
This means a big step forward in our work, and the more we incorporate
systems of control, revisions and permanent updating, the more
we are convinced in that it will serve to channel future energies
to improve the quality of our services.
In this permanent process, we follow the guidelines under the
principles of the Total Quality, just as it is in the European
model of Management (E.F.Q.M.).
In GAUTENA we have introduced the Culture of Quality. Our aim
now is to improve day by day to be able to offer the best possible
service to the people with Autism and their families.
PROCEDURES MANUAL
1. Diagnosis & assessment 11. Extemal information
2. Admission 12. Annual plan follow-up
3. Initial plan 13. Families satisfaction surveys
4. Annual program 14. Staff satisfaction surveys
5. Client agreement 15. Self-assessment surveys
6. Quality documents control 16. Complaints and suggestions
7. Client documents control 17. Quality register
8. Client identification 18. Intemal quality audits
9. Model record 19. Staff development plan
10. Listing of record documents' 20. Clients satisfaction survey
QUALITY MANUAL
INDEX (ISO 9002)
1. Management responsability 12. Inspection and test status (N/A)
2. Quality system 13. Control of nonconforming
product
3. Contract review (N/A)
4. Design control 14. Corrective action (NIA)
5. Document control 15. Handling, storing, packaging
6. Purchasing (N/A) and delivery (NIA)
7. Purchaser supplied product (N/A) 16. Quality records
8. Product identification and traceability 17. Internal quality audits
9. Process control 18. Training
10. Inspection and testing (NIA) 19. Servicitig (NIA)
11. Inspection, measuring and 20. Statistical techniques (NIA)
test equipment (NIA)
SERVICE INFORMATION MANUAL
1. INTRODUCTION
2. MISSION STATEMENT
3. INTRODUCTION TO AUTISM AND RELATED DISORDERS
4. CHARTER FOR PERSONS WITH AUTISM (IAAE)
5. HUMAN RIGHTS ASSESSMENT
6. A COMPREBENSIVE VIEW OF OUR CLIENTS NEEDS
7. OUR MODEL OF SERVICE DELIVERY
8. HISTORY OF THE SOCIETY, PRESENT DEVELOPMENT AND FUTURE
NEED
9. FUNDING ASPECTS
10. RELATIONSHIP WITH PRIVATE AND PUBLIC INSTITUTIONS
11. MEANS OF PARTICIPATION IN THE SOCIETY
12. GENERAL POLICIES AND PROCEDURES
13. DETAILED DESCRIPTION OF OUR SERVICES
14. OUR COMMITMENT TO CONTINOUS IMPROVEMENT
CHARATERISTICS OF THE DIRECTIVE TEAM
l.- Cohesion in the substancial
2.- Individual commitment to the importance of management of Human
Resources
3.- Ability to accomplish personal activity in the development
of the general aims
FAMILY DEMANDS
· MORE SERVICES
· MORE PERSONALIZED ATTENTION
· IMPROVEMENT IN INFORMATION
STAFF DEMANDS
· GREATER READINESS OF HUMAN RESOURCES AND MATERIALS
· TRAINING
· FAMILY-COOPERATION
· INTERSTAFF COORDINATION
DEFINITION OF TOTAL QUALITY
A GLOBAL STRATEGY WHICH IS UNDERTAKEN BY THE ORGANIZATION,
AND IS DESIGNED TO:
"MOBILIZE AND INVOLVE ALL THE RESOURCES OF THE ORGANIZATION
TO ACHIEVE PERMANENT SATISFACTION OF THE EXPECTATIONS OF THE CUSTOMER/CLIENT
IN A CONSTANT EFFORT OF CONTINUAL IMPROVEMENT
PRINCIPLES OF TOTAL QUALITY
1. Orientation towards the client
2. Implication of all
3. Continuous improvement
4. Process control
5. Document control
6. Leadership
STRONG POINTS OF THE PROCESS
1.- THE MERE IDENTIFICATION OF THE OBJECTIVE
2.- APPLICATION OF STANDARD METHODS OF QUALITY TO OUR ORGANIZATIONS
3.- IMPORTANCE OF A SPECIALIZED EXTERNAL CONSULTANT
4.- SYSTEMATIC FEEDBACK FROM BOTH STAFF AND FAMILIES
WEAK POINTS OF THE PROCESS
1.- "STRANGE", UNKNOWN METHODS UNFAMILIAR TO STAFF AND
CLIENTS
2.- TIME LIMITATIONS. PRESSURE OF DAILY DEMANDS
3.- FEAR OF BEING "BOGGED DOWN IN PAPERS,
REMEDY."STICK TO THE BASICS " AND "NOT
TAKE ON TOO MUCH"
4.- RELUCTANCE TO CHANGE
SUMMARY AND CONCLUSIONS
SPECIFIC KNOWLEDGE ON AUTISM ACCORDING TO
"THE STATE OF ART" IN EACH PERIOD
SYSTEM OF ASSURING QUALITY
(ISO NORM 9002)
ADVANCE TOWARDS WORKING UNDER
TIHE PRINCIPLES OF TOTAL QUALITY
TO OFFER BEST SERVICE TO PEOPLE WITH
AUTISM AND THEIR FAMILIES