How do service providers ensure high-quality and safe support is delivered to every person they support, in every type of service, in every location, by every staff member, and on every occasion? This is the challenge that disability service providers face. If they get it wrong, poor quality support will limit the quality of life of people supported. In exceptional cases, serious harm—including death—can result for the people they support or the workers they employ.

In this chapter, the reader’s knowledge is built in stages, starting with a consideration of key terms and core concepts in quality and safeguarding... Stakeholders in quality and safeguarding are then identified and their roles are analysed. The concept of ‘levels’ for action is then introduced before diving deep into what provider organisations can do to ensure good quality service provision. To avoid confusion, it is important to clarify that the word quality can be used as an adjective (e.g., ‘high quality and safe supports’) or as a noun (e.g., ‘the NDIS Commission’s role is to promote quality and safeguards’). Safeguard can be used as a noun as in the previous example or as a verb (e.g., ‘Building a person’s confidence to speak out will help to safeguard them from abuse’). Safeguarding can also be a noun (e.g., ‘The NDIS Commission’s role includes safeguarding’) or a verb (e.g., ‘Safeguarding Rahul is a priority’).

Understanding the Key Terms

This section introduces four key terms: quality, safeguarding, system, and practice governance. Quality is the degree of excellence of something or the extent to which something matches a set of expectations or standards. It involves both the degree to which a person’s goals or objectives are met and the way in which they are met. For example, Australia’s NDIS Quality and Safeguarding Framework defines service quality as:

The extent to which a support being delivered by a provider is able to meet or exceed a participant’s needs and expectations; and the extent to which that provider is meeting or exceeding the relevant NDIS requirements as implemented under the scheme’s quality and safeguarding arrangements … (Department of Social Services, 2016, p. 101)

Regarding the first part of this definition, some people with disabilities and especially people with intellectual disabilities have become used to poor quality support and thus their expectations may be inappropriately low. Numerous reports by parliamentary committees, commissions of inquiry, and regulators have documented poor quality support resulting in people being harmed in service delivery. Historically, even when the supports delivered were safe, supports were often centred around the convenience of service providers or staff rather than being centred on the individual being supported.

Safeguarding refers to actions taken to keep people safe from harm. The NDIS Quality and Safeguarding Framework defines safeguarding as:

Actions designed to protect the rights of people to be safe from the risk of harm, abuse and neglect, while maximising the choice and control they have over their lives. (Department of Social Services, 2016, p. 102)

The concept of ‘choice and control’ used in the Framework denotes that the person being supported has genuine control of their life including choice of what supports are delivered and how they are delivered.

In this chapter, the term system is used in three distinct ways. The most relevant use is that of the quality management system, that is, the provider’s integrated management of strategies for delivering high-quality and safe supports. Another way in which the term is used is to understand whole-of-system issues, such as a nation’s overall approach to supporting people with disabilities to have a good life. A third use of the term is in information technology systems such as specialised applications to assist in quality management.

Finally, practice governance should be briefly explained as this term is increasingly used. This term is derived from ‘clinical governance’ in healthcare, which describes the governance and management of quality in clinical settings. However, for most disability service providers, the term practice governance is more appropriate as the majority of supports provided are non-clinical in nature. The term refers to the governance and management of practice—that is, how supports are being delivered—in disability service provision, with the aim that the supports are high quality and safe.

Core Concepts in Building Quality and Safeguarding

Having clarified the meaning of these key terms, this section outlines six core ways of thinking about and working towards the achievement of high-quality and safe support. These are captured in Table 14.1.

Table 14.1 Six core concepts underpinning high-quality and safe support
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As identified in Chap. 2, a human rights approach should inform a provider’s objectives and methods of service delivery. For example, Article 19 of the UN Convention on the Rights of Persons with Disabilities declares:

the equal right of all persons with disabilities to live in the community, with choices equal to others, and [that nations] shall take effective and appropriate measures to facilitate full enjoyment by persons with disabilities of this right and their full inclusion and participation in the community. (United Nations, 2006, Article 19)

A human rights approach stands in stark contrast to historical approaches to disability service delivery, sometimes called the ‘charity’ model, where supports were provided in ways where human rights were optional (Office of the High Commissioner for Human Rights 2010). Under the charity model, people with disabilities often reported that service delivery was controlling rather than offering choices equal to others in the community.

As set out in Fig. 14.1, quality and safeguarding should consider a person’s overall quality of life (see Chap. 2). Service providers need to ensure that they are providing good quality and safe supports during service delivery while also acting to promote the person’s overall quality of life. A person does not have a good quality of life if their needs are met during support delivery but not at other times or if their needs are met in one of the domains of quality of life but not others. In Australia, some of the National Disability Insurance Scheme (NDIS) Practice Standards are framed as whole-of-life outcomes, not just outcomes from the support provided. For example, the NDIS Practice Standard on risk management requires that ‘risks to participants … are identified and managed’ (NDIS Quality and Safeguards Commission 2021, p. 7).

Fig. 14.1
A relationship diagram of quality and safeguarding. The quality and safety of service delivery depend on the overall quality of the person's life.

The relationship between quality of life and quality and safeguarding in service delivery

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Despite the emphasis in Australia’s NDIS Practice Standards on whole-of-life outcomes, the NDIS is in many ways designed as a transactional system based on the hours of support provided. However, service providers should provide support in a way that helps the people they support to achieve quality-of-life outcomes. For example, a person with intellectual disability might ask for help with shopping and accessing community venues. If, in providing this help, the service provider supports the person to build their skills in shopping and assists in building relationships in the community, then the person’s quality of life is also likely to improve over time.

The processes supporting quality and safeguarding should be person centred and not merely centred around the service provider. Being person centred means focusing on the person being supported, understanding that different individuals will have different needs and preferences, and ensuring that processes start and end with the person being supported rather than with the organisation. A consistent theme in case studies in Australia’s Disability Royal Commission has been service providers thinking about quality and risk management in organisation-centric ways and being less focused on the needs of the people being supported (Royal Commission into Violence Abuse Neglect and Exploitation of People with Disability 2022a, 2022b). For example, there were instances of abuse of people with disabilities by staff members where service providers focused on reporting to police and regulators and on the investigation and dismissal of the abusers (such actions were, of course, appropriate) but did not apologise either to the victims or to their families and supporters.

As much as possible, supports delivered should be evidence-based. In the last decade there has been substantial progress on building evidence around what constitutes good support in disability service provision. For children with disabilities, there is now a strong evidence base to support family-focused practice, with the professional supporting the entire family in order to provide the best support to the child (McCarthy & Guerin, 2022). For adults with intellectual disability living in a group home setting, research has demonstrated that Active Support (see Chap. 7) is associated with an improved quality of life. For people with psychosocial disabilities, recovery-oriented practice is associated with improved outcomes (Winsper et al., 2020). The other approach which is increasingly adopted, trauma-informed practice, has at this time inconsistent results (Han et al., 2021) and the evidence base is still building.

A provider’s quality and safeguarding system should balance a purpose-driven approach with a management systems approach. When purpose driven, the organisation seeks to embed core concepts such as human rights and person-centred approaches and to ensure that the design of the quality management system reflects the needs of people supported and staff members, not just those of the organisation. However, management systems typically aim to standardise processes and practices to ensure consistency in the support provided. What is needed is—ironically—the standardisation of individualisation. For example, when planning service delivery, the service provider works with the person supported in a systematic way to understand the person, their needs and preferences, and potential risks to the person (see Chaps. 3 and 10).

One method of systematising the approach to quality is offered by the International Standard ISO 9001 on quality management systems (International Organization for Standardization, 2015). ISO 9001 uses an input, process, and output approach. The inputs to the quality management system under ISO 9001 are customer requirements (i.e., the requirements of the people supported), the needs and expectations of relevant interested parties (the stakeholders; see Table 14.2 introduced shortly), and the organisation’s context. The quality management system consists of leadership at the core, and planning, support, operations, and performance evaluation and improvement, using a Plan–Do–Check–Act cycle. The results of the quality management system are quality and safe services and the satisfaction of those supported. This model can be extended to the outcomes that people achieve from the support provided.

Table 14.2 Stakeholders in quality and safeguarding
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However, organisations should not place too much emphasis on management systems for the following reasons:

  • An excessive emphasis on standardisation can be contrary to the third key concept of being person centred, as the needs and preferences of individuals will vary,

  • What is important is what happens in practice, not the management system itself: the quality management system is the ‘means’ to the ‘end’ of good quality and safe supports—it is not an ‘end’ in its own right, and

  • Perceived compliance with standards is only marginally correlated with quality-of-life measures (Beadle-Brown et al., 2008). Paperwork may be compliant, but the people supported may have a poor quality of life.

Finally, an organisation’s approach should be based on a commitment to continuous improvement. This philosophy recognises that achieving quality and safeguarding is not a ‘set and forget’ process (Braithwaite et al., 2007). New people being supported, changes in a person’s circumstances, new staff members, changes in the external environment, and evidence about new risks to quality and safe service delivery create new challenges. Further, expectations of organisations and staff members will continue to increase over time in response to new and emerging evidence about what works.

Levels for Action in Building Good Quality and Safeguarding

This section introduces the concept of levels of action, providing further insight into how to achieve good quality and safe services. Action can be at the individual level, the organisational level, or the whole-of-system level.

The individual level is focused on the interactions between the individual being supported and the individual staff member. For example, does the staff member understand the strengths and needs of the person being supported? Has the staff member been well briefed during a handover or had the time to read the key documents and plans relevant to the person? Has the staff member received adequate training in both generic capabilities and the skills uniquely required to support the person? From the perspective of the person being supported, the moment of service delivery is probably the most important time for quality and safeguarding to be realised. For example, does the support worker respond to and respect the needs of the person at that moment in time, and does the staff member check in with the person and ensure that they are meeting the person’s needs and preferences?

The organisational level refers to the provider organisation. For example, is the focus of the organisation’s leadership on financial performance or on good quality and safe support? Does the organisation’s culture genuinely value the ‘voice’ of people supported (see Chaps. 3 and 13)? Does the organisation follow evidence-based practice, such as Active Support and Frontline Practice Leadership principles (see Chap. 7)? What is the organisation’s investment in training and development? Is the quality management system and its associated policies and procedures implemented in practice? Of course, organisations consist of many different hierarchical levels and sub-units and these questions might be answered differently depending on which sub-unit is examined.

The whole-of-system level refers to the overall systems of support that impact people with disabilities and their quality of life. These systems include the employment, welfare, health, and education systems. For example, the employment system will influence access to paid employment and thus influence material well-being (see Chaps. 2 and 5). For those unable to find or hold a job, it will be the welfare system that determines their material well-being. To give another example, the wider health system can influence the physical well-being and emotional well-being (in the case of mental health) of the person (see Chap. 8). The design of the overall support system is obviously crucial for people with disabilities. Providers need to have a detailed knowledge of the disability support system and sufficient working knowledge of other relevant support systems.

The Varied Needs of Stakeholders

Having suggested the core concepts and levels for action, this section considers the stakeholders who have an interest in quality and safeguarding. The key stakeholders are listed in Table 14.2.

The discussion below focuses on the individual and organisational levels for stakeholder engagement, although this need applies equally at the whole-of-system level. As will be demonstrated, stakeholder needs usually align, but sometimes clash.

It is fundamental to the human rights–based approach that the person being supported helps determine the design of their services, day-to-day service delivery, and the review of services (see Chaps. 3 and 10). Inclusion at the individual level can be premised on the mantra of ‘nothing about me without me’. Some providers, especially those involved in supporting people with psychosocial disability, now use the term person led rather than person centred to emphasise that they want to ensure the person supported is in charge of all aspects of their support. At the organisational level, the people the organisation supports should be included in the design of organisational policies, procedures, and processes that most impact their interests.

Another important group of stakeholders is the family and friends of the people supported, to the extent that the person has social connections with them and is happy for them to be involved. Families and other supporters often have a deeper understanding of the person’s needs than do staff members.

Most jurisdictions have a system to appoint a guardian or other substitute decision-maker if there is a need for a decision to be made and the person is deemed to lack decision-making capacity. As discussed in Chap. 11, the laws in this respect are slowly changing, but in most English-speaking countries, a guardian or similar substitute decision-maker is required to act in the ‘best interests’ of the person with disability. The guardian can override the preferences of the person supported if they deem it to be in the person’s best interests.

Staff members are also important stakeholders. Frontline staff are tasked with achieving good quality and safe services on a day-to-day basis. Thus, their views should be considered when designing, implementing, and reviewing elements of support to individuals, especially when the person being supported has complex circumstances. The views of staff should also be sought at the organisation level when the quality management system and issues of general practice are being reviewed (Cortis & Van Toorn, 2022). Other important considerations are the appropriate supervision and support, remuneration and employment conditions of staff members, and job quality to enhance the likelihood that staff provide good quality and safe support (Per Capita, 2022).

There will be multiple other internal stakeholders at the organisational level. Executive, operational, quality management, human resources, rostering, learning and development, information technology, and even marketing and communications staff (where they exist) can all help promote the achievement of good quality and safeguarding. As discussed in Chap. 7, the extent to which executive management understand and value practice is one predictor of good quality support in group homes. Further, members of the boards of directors and executive teams should provide leadership, including by identifying that service quality and safety are their foremost concerns (Hough, 2022).

Outside the organisation, there will be funding bodies and regulators. Funding bodies determine the overall resources available to the person with disability in individualised schemes or, in the case of contracts and block grants, to organisations. These decisions influence the options available to individuals and providers. For example, Australia’s National Disability Insurance Agency makes funding decisions based on detailed assumptions in their costing model about the extent of support and supervision provided to frontline workers and the number of days of training that staff members receive.

Regulators set standards for service provision and can hold staff members and/or providers to account when things go wrong. For example, Australia’s NDIS Quality and Safeguards Commission has considerable power, including the right to issue infringement notices, to apply to courts for the imposition of civil penalties, or to ban staff members and providers from providing disability supports. Ideally, the relationship between providers and regulators is based on a mutual concern for good quality and safe service provision, where both parties have a healthy respect for each other and for all stakeholders.

In most instances, the views of stakeholders will align. However, where they don’t align regarding individuals, the requirements of the law will ultimately prevail, followed by the preferences of the person supported. For example, a person supported might not want a serious incident reported to a regulator, but this might be legally required.

It is also important to acknowledge that in some instances alignment of views among stakeholders can be problematic. Anecdotally, there are cases where managers of service providers become so focused on the regulatory requirements—whether real or perceived—that they fail to give sufficient attention to the fundamentals of good quality service provision. Another issue is that quality standards typically constitute minimum requirements that must be met, but some providers or staff members consider doing the minimum is enough.

Key Strategies for Providers

Having introduced the concept of three levels of action (the local, organisational, and whole-of-system levels) and the varied needs of stakeholders, two broad strategies for achieving quality and safeguarding, namely proactive and reactive strategies, are outlined. Proactive strategies should be emphasised as they create the conditions for quality and safe support delivery: as the (now very dated) adage states, ‘An ounce of prevention is worth a pound of cure’. However, reactive strategies are also needed when things go wrong or ‘near misses’ occur. When things have gone wrong, the harm caused needs to be corrected. For both near misses and actual harm, it is important to learn from the event and strengthen practice. However, the distinction between proactive and reactive strategies is often a fine one; for example, responding to a complaint is reactive, but providing a complaint mechanism is proactive.

Table 14.3 brings ideas about the different components of a quality management system together and offers some examples.

Table 14.3 Examples of proactive and reactive strategies for building good quality and safety
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Going Deeper: What Can Providers Do to Provide Quality and Safe Services?

This section considers in greater detail what providers can do to provide good quality and safe services at both the frontline and organisational levels. Both proactive and reactive strategies are outlined. The examples offered relate to support workers, although the general principles are also applicable to any allied health professionals employed.

Proactive Strategies

Organisational leadership is required. Leaders must demonstrate through their words and actions that they prioritise the delivery of good quality and safe supports and that issues such as strategy and financial performance—while very important—are secondary to supporting people to have a good life and to keeping people safe and well (Hough, 2022). Organisational leaders should focus on the overall experience of the people supported and of staff, not merely on compliance with standards (McEwen et al., 2021a, 2021b). Leaders must build an organisational culture that prioritises quality supports and safeguards (see Chap. 13). For example, Active Support is more likely to be achieved where organisational leaders have a shared understanding of the approach and embed enabling factors such as Frontline Practice Leadership (Bigby et al., 2020).

The importance of observing the core concepts outlined earlier in this chapter is reemphasised. In particular, executive leaders need to know what constitutes good practice by being informed about the research evidence.

The organisation must build, maintain, and resource the quality management system. In the past, quality management systems consisted of policies and procedures and registers, often paper-based. Contemporary understandings of quality management systems are much broader:

  • Scope: The quality management system must include links to the organisation’s learning and development, information technology, and communication functions.

  • The customer and staff experience: There is a greater understanding of the importance of the ‘customer journey’ and the ‘employee journey’ and of end-to-end mapping of related work processes and workflows. For example, communication with people being supported and staff and access to relevant information are increasingly systematised through information technology.

  • Audiences: There is increasing awareness of stakeholder needs. For example, handbooks or guides for people with intellectual disabilities should be prepared in easy English, combining text and pictorials. Policies and procedures directed at staff should be in plain English wherever possible.

  • Formats: There is growing recognition that the quality management system consists not just of documents but of visual content such as diagrams and videos. For example, for a person who requires positive behaviour support, there might be a short video recording of a behaviour support practitioner explaining the key strategies to support the individual.

  • Automated alerts and controls in information technology: Organisations are increasingly embedding processes and controls in information technology systems, such as automated alerts. These include, for example, alerts when medication must be given or that a person’s annual plan is due for renewal. Systems might have ‘forcing functions’, requiring essential quality and safeguarding data about a person to be entered. Systems can also embed controls, such as an electronic rostering system preventing a staff member without training in PEG (percutaneous endoscopic gastrostomy) feeding from being rostered to provide that support to a person who requires this. At the more sophisticated end, some organisations are starting to experiment with data science techniques such as data mining. For example, data mining might identify correlations between time of day and incidents of particular types, which might suggest preventative strategies.

The importance of understanding how to foster and maintain good quality and safe practice is also affirmed. This means that service delivery is being provided by the right person—that is, a person with the right values and the right competencies—who has access to the right information. In addition to the strategies already identified, strategies for entrenching good quality and safeguarding can include rigorous recruitment and selection processes that prioritise the assessment of attitudes and values; frontline and other staff members having a clear sense of job roles and boundaries; relevant learning and development; verification of the competency of staff members; two-way processes of communication with all stakeholders; and sound management systems. Further, good quality and safe practice requires that staff are assisted to reflect on their own practice, receive feedback on their practice, and are appropriately supervised and supported (see Chap. 7). It is also likely to mean that both people being supported and staff feel valued and experience physical and psychological safety.

Organisations need to understand and manage risks to people supported, staff, and the organisation. These risks include high prevalence risks (risks that are common but often have a low impact, for example, where missed medication is occasionally missed but missing one dose of the particular medication is not vitally important) and low prevalence but high-impact risks (risks that are not common but can have devastating impacts if they are realised, for example, risks of sexual assault). Incidents can have single causes or multiple contributing factors. Further, risk management needs to embrace the idea of building in multiple protections rather than a single protection such as relying on a staff member’s memory or supposed competence. However, for every protection put in place, there will also be ‘holes’ in those protections; unexpected incidents happen when the holes in those protections align; this is the basis of James Reason’s ‘Swiss Cheese’ model of incident causation and prevention (Reason, 1997).

Risks to people supported can be classified as risks of abuse (Collins & Murphy, 2022) or risks of neglect. The risks can be at the personal level, or they can be systemic, that is built into the service system at a local or whole-of-system level. An example of abuse at the person level would be violence by a staff member towards a person supported. An example of organisationally systemic abuse could be a service provider having low expectations about what the people they support can achieve and acting on those low expectations. An example of individual neglect would be failing to support a person with a profound intellectual disability to engage in or to attend to their hydration needs. Organisational systemic neglect would be designing the service system around the needs of the organisation and not the needs of the people supported.

Risks to staff will range from the classic ‘slips, trips, and falls’ to motor vehicle incidents. In addition, without wishing to overstate these risks, there can be risks associated with the challenging behaviours of people supported.

Risks to people supported and to staff create risks to the organisation. These include compliance risks (e.g., not complying with legal obligations) and reputational risks. Organisations can themselves create risks, such as when the organisation is growing too quickly, providing new types of supports, or providing support in new locations without remediation of the risks associated with changes to services.

The examples offered above have focused on the negative aspects of risk. However, some risks can be positive, such as when a person being supported is developing new skills or new relationships. Thus, there is a role for what is known as risk enablement. Consistent with the concept of dignity of risk, people have the right to take risks in their lives, provided that the individual team member and the providers’ duties of care are not breached. In most instances, both dignity of risk and duty of care can be achieved.

There need to be proactive strategies to understand how well support is being delivered. At the individual level, this may include checking with the individual supported about the quality and safety of the supports provided if they are able to provide feedback, or else observing the support or seeking perspectives of families and supporters. At the organisational level, strategies include internal reporting, standard performance measures such as the experience of those using services and their personal outcomes, staff experience, and matters such as the completion of essential training. Observation of actual practice is one of the elements of Frontline Practice Leadership (see Chap. 7) with feedback provided to staff members about their practice. Internal and external quality audits can be other valuable sources of information, although these will be more useful if they focus on actual practice and not merely on paper-based compliance (McEwen et al., 2014, 2020). Further, external quality audits can sometimes fail to identify abusive cultures (Murphy, 2020). External and regular evaluation of the quality and safety of supports being provided can be another useful strategy. Some countries have ‘official visitor’ schemes where an external visitor is appointed by the government to visit settings such as group homes. Some providers have established the internal equivalent of official visitors, including the use of peer quality checkers.

Reactive Strategies

There are two main sources of reactive strategies: first, complaints and other feedback and, second, incidents. Complaints provide information on where the service provider is perceived not to have performed well. Of course, feedback can also be positive, providing information on where the staff member or the organisation is perceived to have done well. While staff and organisations sometimes respond defensively to negative feedback, it is better to start with the assumption that such feedback is an opportunity to learn and improve. Likewise, whistle-blower disclosure mechanisms can give the provider information that it might not otherwise receive through usual lines of reporting.

The second use of reactive strategies is in response to incidents, including incidents that must be reported to regulators. Incident reporting discloses significant events that have occurred for people supported, staff, or any other people involved which can relate to the quality and safety of the support being provided.

For both complaints and incidents, the first response is to check that people are safe and, if not, to ensure their safety. If police or regulators must be notified immediately, this is the organisation’s next step. Next, the provider needs to establish the facts of what occurred, which might be done in lesser or greater detail depending on the seriousness of the incident. Sometimes it is enough to establish merely the core facts, but at other times a formal investigation might be commissioned, for example, if an allegation is made that a person using services has been assaulted.

Other reactive strategies vary and may overlap with one another. Australia’s NDIS Quality and Safeguards Commission recommends practice review as one response. Some commentators believe in the importance of ‘root cause’ analysis, using methods such as the ‘five whys’: asking ‘why’ something happened five times in succession to establish the root cause. This is illustrated in Table 14.4.

Table 14.4 An example of applying the five ‘whys’
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Some commentators believe that processes such as learning teams, bringing frontline staff members and technical experts together to learn from experience, are more useful (Dekker & Conklin, 2022). One option for learning teams is to review what caused good practice, not merely what has resulted in poor practice.

Consistent with the philosophy of being person centred, one of the requirements of Australia’s NDIS Quality and Safeguards Commission for both complaints and incidents is that the people with disabilities involved or affected must be involved in the resolution of the issues. Further, the Commission requires periodic reviews of issues arising and reviews of the effectiveness of the management systems supporting complaints and incidents.

When things do go wrong, one of the dilemmas that providers must confront is the degree to which their focus is on the attribution of blame or on learning. This is not necessarily an easy dilemma to resolve. On the one hand, if a person who receives services is harmed by the deliberate actions or neglect of a staff member, then the person harmed and the community rightly expect that the staff member will be held accountable. On the other hand, if staff are blamed—or perceive that they will be blamed—for errors that arise from the system of work or at the organisational level (e.g., inadequate training), or because of judgments that had to be made on the run in difficult circumstances, this will have the unintended consequence of reducing the staff members’ willingness to report incidents and near misses. This will ultimately reduce the capacity to learn from events (Reason, 2000).

Conclusion

Let us end where we started. Every year, people with disabilities and staff members are seriously harmed and even die because of poor quality or unsafe service delivery. This harm is often preventable. The challenge that service providers face is that they must attempt to ensure that every occasion of service delivery is of good quality and is safe, despite working in dynamic environments where the needs of people can quickly change. As the saying goes, ‘Wisdom in hindsight is the least useful form of wisdom’. The puzzle that service providers and managers must attempt to solve is how to build ‘wisdom in anticipation’. The authors’ hope is that this chapter and the other chapters of this book have contributed ideas towards such wisdom in advance.

Take Home Messages

  • Six core concepts should underpin good quality and safeguarding: the human rights approach; a focus on quality of life; person centredness; a commitment to evidence-based practice; a balance between purpose-driven and management system approaches; and dedication to continuous improvement.

  • In many areas of disability support provision, we now have research evidence about what constitutes good practice.

  • Building good quality and safeguarding into disability service provision requires both proactive and reactive approaches at the individual, organisational, and service system levels.

  • Stakeholders’ needs about quality and safeguarding usually align; however, sometimes they vary. Where they vary, the ultimate determining factor is what is legally required of the provider and staff member.

  • Many different strategies are needed to achieve good quality and safeguarding, including leadership, and building an appropriate organisational culture.

  • The common approach to managing quality in organisations is to build and implement a quality management system. Quality management systems should have processes that are user-friendly for the people being supported, their families and supporters, staff members, and organisations.

  • Quality management systems can contribute to good quality and safeguarding but are not adequate to assure these in and of themselves.