D.2 Quality Assurance Surveillance Plan.pdf

FOR OFFICIAL USE ONLY

Quality Assurance Surveillance Plan Ground Ambulance Service for Sioux Falls VAHCS

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) is a Government developed and applied document used to make sure that systematic quality assurance methods are used in the administration of the Performance Based Service Contract (PBSC) standards included in this contract. The intent is to ensure that the Contractor performs in accordance with performance metrics set forth in the contract documents, that the Government receives the quality of services called for in the contract and that the Government only pays for the acceptable level of services received.

2. SCOPE

To fully understand the roles and the responsibilities of the parties, it is important to first define the distinction in terminology between the Quality Control Plan and the Quality Assurance Surveillance Plan. The Contractor, and not the Government, is responsible for management and quality control actions necessary to meet the quality standards set forth in the contract. The Contractor develops and submits his/her Quality Control Plan (QCP) for Government approval in compliance with his contract deliverables. Once accepted, the Contractor then uses the QCP to guide and to rigorously document the implementation of the required management and quality control actions to achieve the specified results. The QASP on the other hand, is put in place to provide Government surveillance oversight of the Contractor’s quality control efforts to assure that they are timely, effective and are delivering the results specified in the contract. The QASP is not a part of the contract, nor is it intended to duplicate the Contractor’s QCP. The Government may provide the Contractor an information copy of the QASP as an Attachment to the solicitation to support the Contractor’s efforts in developing a QCP that will interrelate with the Government’s QASP.

3. GOVERNMENT RESOURCES/RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities.

a. CONTRACTING OFFICER: The Contracting Officer (C.O.), ensures performance of all necessary actions for effective contracting, ensures compliance with the terms of the contract, and safeguards the interests of the United States in the contractual relationship. It is the Contracting Officer that assures the Contractor receives impartial, fair, and equitable treatment under the contract. The Contracting Officer is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

Assigned CO: Insert C.O./contract specialist’s name Organization or Agency: Department of Veterans Affairs, enter NCO-

b. Contracting Officer’s Representative (COR) - The COR provides detailed technical oversight of the Contractor’s performance and reports his or her findings to the C.O. in a timely, complete and impartial fashion. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. Any changes that the Contractor deems may affect contract, price, terms, or conditions shall be referred to the Contracting Officer for action.

Assigned COR: Insert COR Name

4. METHODS OF QA SURVEILLANCE

The below listed methods of surveillance shall be used in the administration of the QASP. In addition to specific instructions that may be mentioned, the appropriate and standardized form that is to be used for documentation of QA surveillance is the Surveillance Activity Checklist, included as Attachment A.

Customer Feedback – Customer feedback may be obtained either from the results of formal customer satisfaction surveys or from random customer complaints. Customer complaints, to be considered valid, must set forth clearly and in writing the detailed nature of the complaint, must be signed and forwarded to the COR. The COR shall maintain a summary log of all formally received customer complaints as well as a copy of each complaint in a documentation file. The COR shall also keep the tabulated results of all customer satisfaction surveys on file and shall enter the summary results into the Surveillance Activity Checklist.

(Copies of all records shall be submitted to the CO upon receipt for placement in the official contract file, and when necessary, determination of actions.)

100% Inspection – The COR shall monitor each patient delivery and enter performance results into the Surveillance Activity Checklist.

Periodic Inspection - Periodic inspections shall be conducted when specified in the contract/PWS. For the potential tasks that have been identified so far and included in this QASP, the COR performs the periodic inspection on a monthly basis.

Random Monitoring - Random monitoring shall be conducted if and when specified in the contract. For the potential tasks that have been identified so far and included in this QASP, the random monitoring shall be performed by the COR.

5. PERFORMANCE STANDARDS

The Performance Requirements Summary in the Performance Work Statement (PWS) includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL) and determine incentives.

Task PWS Reference

Standard Acceptable Quality Level

Method of Surveillance

Provide on-time ambulance services

Section 4.5.1.8.3

Scheduled patient pick-ups shall not deviate more than 15 minutes past scheduled pick-up time for scheduled orders

97% Customer Feedback

Incident Reporting

Section 4.8 The contractor shall notify the Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the Program Manager, Benefits Management, by the close of business of the next working day.

97% Customer Feedback

Invoice Reports

Section 4.9 Provide a monthly invoice including secondary documentation in accordance with Section 4.10 of the

PWS

95% 100% inspection of monthly invoices/reports

SS Performance Objective PWS Para Performance

Threshold Method of

Surveillance Met

Not Met

Remarks

SS 1

The contractor shall provide Ambulance service, 24 hours per day, 365 days per year, as required in accordance with the terms and conditions contained herein.

1 95% Compliance

100% Surveillance of each patient pick-up.

SS 2

The objective of Standards for Maintenance is to protect veterans and to cause no harm to all parties. The contractor shall maintain all vehicles in a clean and orderly condition, free from debris and accumulations which

4.4.3 95%

Compliance 100%

Surveillance

Performance

Threshold Method of

Surveillance Met

Not Met

Remarks may create an accident, injury, or fire hazard.

SS3

The contractor shall maintain (and furnish upon request) procedures that outline preventive maintenance and/or repairs on each vehicle in an individual vehicle file and in chronological order, latest service on top. A statement from the Contractor indication compliance of vehicle maintenance files is in place should be submitted at time of offer for evaluation purposes. Requested submission and verification of these documentation requirements will be a quality assurance procedure during the contract period.

4.4.3 95%

Compliance

SS4

The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.3.1 100% Compliance

SS5

Have completed training in accordance with the standards published by the Department of Health and Human Services with a

4.3.1 100%

Compliance

Performance

Threshold Method of

Surveillance Met

Not Met

Remarks minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93- 154, Federal Register 39:24304. (1974).

SS6

A licensed MTO shall ensure that sanitation procedures are provided to all personnel in a written document that conforms with current standards as set forth in occupational safety and health administration-blood borne pathogens protocol.

Attach ment B

100% Compliance

6. INCENTIVES

The Government shall use payment deduction as incentives for Contractors to maintain acceptable performance level. Incentives shall be based on meeting, or not meeting performance standards.

The CO and COR shall monthly progress meetings to assess performance and shall provide a written assessment. Should the CO experience marginal or sub-standard performance, they should consider more frequent progress meetings.

**ALL PARTIES SHALL SIGN THIS DOCUMENT AFTER AWARD AND PRIOR TO

PERFORMANCE**

Signature – Contractor Date:

Signature – Contracting Officer’s Representative Date:

Signature – Contracting Officer Date: