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                         University of Limerick

                 Quality Management System
                    Standard Framework
                             for
                    Support Departments

This document sets out the background to the development of quality
management systems at the University of Limerick. It describes a framework for a
UL universal quality management system upon which all support departments will
base their own customised versions. This framework draws on best international
practice and experience in the Irish university sector. Individualised systems will
be defined, documented, approved and published, for all support divisions and
departments, before the end of 2007. All quality management systems will be
substantially similar but with variants taking into account the unique service profile
of each division and their client base. The systems developed will be subject to
the approval of Deans’ Council and will be reviewed periodically to ensure that
adequate implementation and development is taking place.



                              CEQMS
 (Committee for the Establishment of Quality Management Systems)
                     at the University of Limerick
                           November 2006

Approved:
                           th
CEQMS                    13 November 2006
                           nd
Deans’ Council           22 November 2006
                                                 st
Document version:        UL QMS Framework (1 Edition – Rev 1)
          University of Limerick Quality Management System – Standard Framework for Support Departments




                                                        Contents

1         Statement of Quality by Executive .......................................................... 1
2         Statement by CEQMS ............................................................................ 2
3         Introduction............................................................................................. 3
4         Goals ...................................................................................................... 4
5         Basis of System ...................................................................................... 5
6         Establishing a Quality Management System .......................................... 6
    6.1      Steps to Establishing a QMS ...................................................................................... 6
    6.2      Gap Analysis ............................................................................................................... 7
    6.3      Review of Progress .................................................................................................... 7
7         QMS Guidelines ..................................................................................... 9
    7.1      Maintain Customer Focus ......................................................................................... 10
    7.2      Demonstrate Leadership .......................................................................................... 12
    7.3      Involve All Staff ......................................................................................................... 14
    7.4      Emphasise Continual Improvement.......................................................................... 16
    7.5      Use a Defined Process Approach to Services Provided .......................................... 18
    7.6      Use a Systematic Approach to Management ........................................................... 20
    7.7      Use Facts and Analyse Data in All Decision-Making ............................................... 22
    7.8      Develop Mutually Beneficial Supplier, Partner and Community Relationships ....... 24
8         References ........................................................................................... 26




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     University of Limerick Quality Management System – Standard Framework for Support Departments




Committee for Establishment of Quality Management Systems (CEQMS)

Membership November 2006


Professor Michael Wallace                    Chair, CEQMS

Dr Patrick Cashell                           Assistant Registrar

Professor Donal Dineen                       Dean, KBS

Ms. Anna Doughan                             Director of Human Resources

Dr John McGinn                               Director, CECD

Ms. Maja Niebrzegowska                       President, ULPSA

Professor David O’Beirne                     Dean, Science

Mr St John O’Donnabhain                      President, ULSU.

Ms. Ailish Quinlivan                         VP Finance

Dr Joe Skelton                               VP Planning and Administration

Mr Adrian Thomas                             Director, QSU

Dr Bernadette Walsh                          Director of Student Affairs

Mr Gordon Young                              Director, ITD




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    University of Limerick Quality Management System – Standard Framework for Support Departments




1        Statement of Quality by Executive
The University of Limerick (UL) has established itself at the forefront of Irish third-level
education and is widely recognised for the quality of its graduates. As the University grows
and competition from other institutions becomes more significant, UL is committed to the
highest standards of quality in the pursuit of its mission and the delivery of its programmes of
teaching, research and service to the community. Through its Strategic Plan, UL has charted
a course to establish itself as a university of world renown. UL intends to build for the future
on the solid foundation of its key attributes, particularly its traditions of innovation and
excellence, its outstanding campus and the high standing of its faculty, staff, students and
programmes.

It is heartening that UL has a number of quality assurance mechanisms in place and that
quality improvement is now an integral part of the University’s 2006–11 Strategic Plan. The
external examiner system, the academic programme review process, formative teaching
evaluations and quality reviews of all departments by peer groups have become accepted as
normal and very necessary parts of UL. All academic departments have now been peer
reviewed once and a summary of common themes is being prepared. In recent times, the IT
Division has gained ISO9000 certification and most other support departments have made
good progress towards the establishment of a quality management system (QMS) modelled
broadly on ISO9000. The work of the recently formed Committee for the Establishment of
Quality Management Systems (CEQMS) in preparing this framework document provides an
opportunity for each UL support department to develop its own customised QMS. The plan to
encourage divisions to model their own QMSs within a common university framework
provides freedom for innovation while ensuring that common, and challenging, goals are met.

The University of Limerick Executive Committee applauds these initiatives and will strive to
support all divisions embarking on the challenge of developing custom-designed quality
management systems during the coming months. The quality of service provided by the non-
teaching departments is a major contributor to the reputation of the University, and it is
important that we not only maintain the excellent services provided to students, employers,
schools, parents and the many other local stakeholders, but work relentlessly to improve
those areas where we have not yet reached full potential.

I wish all involved every success with this important endeavour.




John O’Connor
President, University of Limerick




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    University of Limerick Quality Management System – Standard Framework for Support Departments




2        Statement by CEQMS
Deans’ Council places huge significance on the development of a quality culture across the University
and has been pleased with the positive outcomes of the regular quality reviews performed by peers of
international standing. In 2000, the University decided that the establishment of a quality management
system (QMS) in each support department would provide a means of systematically improving both the
range and quality of services provided by that department while progressively improving the department’s
working environment and team spirit.

During the period 2000–2006, a number of support departments have developed their own QMSs based
on the concepts set out in ISO9000:2000. In 2005, the Information Technology Division (ITD) gained
ISO9000 certification. While certification was never intended to be a goal, it certainly is a laudable
achievement and sets ITD firmly on the road of continual quality improvement.

In 2006, Deans’ Council established the Committee for the Establishment of Quality Management
Systems (CEQMS) to oversee the development of QMSs in all non-teaching areas of the University and
to establish a timetable for the review of progress. CEQMS rapidly concluded that where a QMS was
well established in a particular area, there was greater harmony and a more structured approach to
foreseeing, avoiding and solving problems. CEQMS considered the use of ISO9000 as a template for
the development of individualised QMSs in each of the divisions and departments and concluded that a
customised QMS, based on international good practice models, might be best able to take into account
the wide variance in styles and functions across UL.

This document is the outcome of a project by CEQMS with assistance from Scannell Solutions, leaders
in quality management services in Ireland, and provides all UL’s non-teaching departments with a
template upon which to base their own customised QMS. Departments and divisions will be expected to
use this framework document as a template for the development of their own QMS, which will be
submitted to CEQMS for review and published on the divisional web-sites.

It is intended that all divisional QMSs, while unique and individualised, will be of a high standard, meet
the requirements set out in the guidelines contained in this framework document and be recognisably
similar in most respects. Significant divergence from the guidelines will require authorisation from
CEQMS and will be monitored for impact and effectiveness.

The guidelines will become effective from the end of 2006. All divisions will be invited to develop their
own interpretations in the form of a parallel document, mirroring the guidelines and identifying specifically
how the division intends to address each issue. These divisional systems will be considered by CEQMS
with a view to approval and publication of QMS documents for all divisions by the end of 2007.

The Universities Act 1997 places an obligation on the University to conduct peer reviews of all support
departments by the end of 2007, and CEQMS will be overseeing the schedule for the timely completion
of these reviews. The routine and requirements for the reviews have already been established and are
described in a document approved by Deans’ Council (Guidelines – Support Departments draft 4a). This
document will now be republished in concise format following the successful pilot reviews of the Library
and Information Services Division (LIS), Student Academic Administration (SAA) and the Cooperative
Education & Careers Division (CECD).




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    University of Limerick Quality Management System – Standard Framework for Support Departments




3        Introduction
Quality management systems and quality reviews in all of UL’s non-academic departments have been in
a developmental phase for some time, and there is a recognised need to establish concrete and
challenging goals for the future of quality systems in each division.

Some years ago, the University decided that all support departments should work towards putting in
place a quality management system (QMS), and ISO9000 was identified as an appropriate target. The
project then entered a pilot stage. ITD and CECD led the way, with ITD working towards ISO9000 and
CECD towards a customised system to suit their own needs. LIS and SAA have made excellent
progress towards establishing a QMS, while Buildings and Estates, the Research Office, Human
Resources and Finance have commenced work on the process. It was apparent to the University that
significant long-term benefits would accrue to those divisions that had engaged with the QMS
development process.

To encourage other departments and divisions to develop QMSs and with respect to the Universities Act
1997, Deans’ Council adopted a proposal to superimpose a parallel system of quality reviews, similar to
those completed by the academic departments, on the support departments. A draft schedule to review
all support departments before the end of 2007 was developed and approved, although there has been
some slippage due to funding constraints. This system of reviews has two purposes:

         (i)    To stimulate progress and assist with the development of a recognised QMS in all
                support departments and management structures

         (ii)   To satisfy the requirements of the Universities Act (1997) and to meet the expectations of
                the Higher Education Authority (HEA) and the Irish Universities Quality Board (IUQB).

LIS and SAA both participated enthusiastically in quality reviews in late 2005 under this pilot scheme,
and the resulting reports have been presented to Deans’ Council and published. CECD completed a
similar review in September 2006.

The work of CEQMS includes the development of a framework QMS that will give all divisions an
opportunity to adapt the template to their own particular needs for approval by the CEQMS. The end
result of this will be the publication by late 2007 of customised individual QMS documents, based on this
framework document, for all UL support divisions. The committee is also charged with overseeing the
completion of the quality reviews of all support divisions by the end of the calendar year 2007; a schedule
for this has been published by the CEQMS.

In the longer term, CEQMS will monitor and support implementation of the new QMSs and the
recommendations from the routine internal and external reviews, specifically with the aim of developing
improvements. Training and expert support will be provided in those areas where most beneficial to the
organisation; a budget will be established for this purpose.




NOTE: Throughout this document, the terms “division”, and “organisation” are used to describe groups of
staff working together for the purpose of developing a QMS or undertaking a review and may in fact
comprise a department, group of departments, or thematic group.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




4         Goals
It has long been recognised at UL that all departments must strive to ensure that the University meet
recognised educational performance excellence. To achieve such a goal, criteria must be agreed to
allow each department to strengthen their customer focus through the development of their team and
through interaction with all other departments.

The QMS framework is designed to help each department to use an integrated approach to performance
management that results in:
          delivery of ever-improving value to students, stakeholders and other university departments
          improvement of overall effectiveness and capabilities
          organisational and personal learning

Furthermore, the QMS framework is designed to ensure that the University can grow as a world-class
educational institution and is built on the following set of recognised interrelated values:
          Strategic long-term leadership
          Learning-centred education
          Organisational and personal learning
          Valuing faculty, staff and community partners
          Ability to adapt
          Managing for innovation
          Management by fact
          Social and environmental responsibility
          Focus on results and creating value
          Systematic approach to all services
          Continual Improvement

Each department and division has the opportunity to adopt the guidelines contained in this framework
document in their current form or within the scope of the flexibility shown in each section. Ultimately, all
divisions are expected to define their own QMS in sufficient detail and in line with the guidelines. In the
case of ITD, the continued development of its systems along ISO9000 lines is perfectly acceptable and
within the scope of this framework.

It is extremely important to recognise that the flexibility inherent in this approach is not intended to
provide divisions with an easy option. Rather, it is intended to provide divisions with the opportunity to
stretch themselves in ways that maximise their ability to deliver excellent services to the UL community.
This need not involve huge volumes of additional work or documentation but may require a shift in
attitude to change and continual improvement.

Systems developed on the basis of this framework will be expected to develop as the division adapts to
new approaches to organisation and decision-making, as teams strengthen and as targets are raised to
more demanding levels.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




5         Basis of System

    “Long-term commitment to new learning and new philosophy is required of any management that
    seeks transformation. The timid and the fainthearted, and people that expect quick results, are
    doomed to disappointment.”

    Dr. W. Edwards Deming, Out of the Crisis, 1982


In developing this quality management system (QMS) framework for the support divisions of the
University of Limerick (UL), consideration has been given to the journey taken by each support area to
date and the requirements of the Universities Act (1997). This framework document builds on that work
and clarifies the path to achieving what UL, as an organisation of excellence, has agreed to be an
appropriate QMS framework. All support divisions are currently on a journey to achieving an excellent,
fully functional QMS that can continue to develop far into the future. Some have only just begun the
journey and others are well established with juvenile and maturing systems. A system of routine internal
reviews by the divisions themselves and external reviews organised by the Quality Support Unit (QSU)
will monitor progress and provide encouragement and support as systems are implemented.

The principles of the QMS framework are adopted from recognised best in class management system
frameworks such as Baldrige, EFQM and ISO systems and will strengthen the future development of the
University as a world renowned educational institute.

The principal goals of the QMS must be met by:
          Maintaining customer focus
          Demonstrating good leadership
          Involving all staff (teamwork and inclusion)
          Emphasising continual quality improvement
          Using a defined process approach to services provided
          Using a systematic approach to management within the department
          Using facts and analysing data in all decision-making
          Developing mutually beneficial supplier, partner and community relationships

Underlying the QMS will be each division’s ability to engage in a cycle of ongoing long-term development
based on planning for and delivering improvement.

                                          The Deming1 Improvement Action Cycle is the main model used
                                          for this process. The cycle consists of four steps: Plan,
                                          Implement, Observe and Learn. In the Plan step, divisions will
                                          determine future needs and methods to satisfy those needs. In
                                          the Implement step, the division will act on its plans. Once the
                                          actions are taken, the division will observe and measure the
                                          result of the actions taken until finally the division can learn from
                                          the actions and plan the next cycle of appropriate action.

                                          This cycle has no particular starting point and could easily be
                                          initiated by observing and learning before planning and
                                          implementing actions. Once initiated, the cycle should continue
                                          to progress continually.




1
    Also known as Shewhart cycle



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    University of Limerick Quality Management System – Standard Framework for Support Departments




6          Establishing a Quality Management System
Section 7 of this framework document sets out eight guidelines for the establishment of a quality
management system (QMS). The guidelines are based on the eight QMS principle goals previously
outlined in section 5.


6.1         Steps to Establishing a QMS
The recommended series of steps2 to follow when establishing a QMS is:

      1.    Study the guidelines in section 7 and make a brief assessment of the division’s position in
            relation to the goals described. This is known as a Gap Analysis and is elaborated upon
            below. A report on the position should describe honestly what needs to be done by the
            division and should be presented to CEQMS for discussion. Training and support will be
            provided as required. Target – February 2007.

      2.    On the basis of these guidelines, the gap analysis and the needs of the division, a document
            that describes the division’s QMS must be prepared. This may already exist or could be lifted
            directly from section 7 or from ISO9000, or a hybrid system could be developed using
            divisional expertise assisted by appropriate consultants and quality experts. In any case, the
            system developed and documented by each division should not diverge too significantly from
            the framework described in this document and will be subject to review by CEQMS prior to
            implementation. Target – May 2007.

      3.    Once the division’s QMS has been approved, it will be published on the UL website and the
            task of implementing the system will start. The system documentation must set out an
            appropriate timescale for reaching specific goals, and the first priority should be establishing a
            good customer focus. The goals and schedule should be clearly visible on each divisional
            website and regularly updated to show progress. Target – June 2007.

      4.    Each division should have already established a divisional quality team to conduct the gap
            analysis and develop the division’s QMS, and this team should now meet frequently to develop
            appropriate systems and documentation as the QMS is put in place. The team should draw on
            external expertise and may request customer care training, assistance with customer
            satisfaction surveys and so on. Late in 2007, each team will be invited to review its progress
            and submit to CEQMS detailed plans for the coming year on the basis of achievements to
            date. Target – November 2007.

      5.    Three divisions have already undergone quality reviews by stakeholder and quality expert
            groups; the outcomes of these reviews have been published. In order to meet the
            requirements of the Universities Act (1997), the remaining departments will be subject to a
            review during 2007. This review has been designed in the form of a “progress review” so as to
            maximise the benefits. Thus, some divisions will find the review very useful as it gives an
            external perspective on their progress to date and will offer insights that the team can use in
            further development of their systems and services. Divisions who are in the early stages of
            developing their fledgling QMS may find the exercise useful in that the reviewers will be
            commenting on their newly established systems and, significantly, on their goals for the coming
            years. Target – all divisions reviewed by December 2007.




2
 Some divisions have already progressed beyond step 1 but may still benefit from the
exercise.



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    University of Limerick Quality Management System – Standard Framework for Support Departments




6.2         Gap Analysis
The self-assessment gap analysis should be undertaken in conjunction with the QMS guidelines
described in section 7. Each guideline is developed by means of (i) a boxed set of “Requirements”
describing the targets that each divisional QMS should aim to achieve; (ii) explanatory notes; (iii) a set of
questions designed to help individuals to evaluate where their division stands with respect to the
expectations of the University. These questions are available as worksheets on www.quality.ul.ie.

The recommended approach is as follows:

    Define the group to whom each guideline applies and appoint a QMS team to oversee the gap
     analysis.

    Request a selection of people relevant to each guideline, from different areas of the division, to study
     the guideline requirements and explanatory notes, and then answer the questions associated with
     that guideline. Carry out this process for all guidelines.

    The QMS team should analyse the answers and report them to the division at a general meeting.
     This report should clearly reflect the existing status of the division with respect to each QMS
     guideline.

    The QMS team should determine in which areas, and to what extent, the division does not comply
     with each guideline.

    The team should then recommend a set of actions that would result in the division meeting all the
     requirements of each guideline. The Action Plan should pay particular attention to prioritising
     actions.

    The team should then monitor the actions to completion. This should result in the division meeting
     the guideline requirements and having a robust QMS that is customer-focused.

In parallel with these actions, it is necessary to consider whether the QMS described in the framework is
appropriate to the needs of the division and propose revisions as necessary.

Support for this activity is available through the Quality Support Unit on request.



6.3         Review of Progress
CEQMS will oversee the development of support department QMSs by means of annual internal reviews
and periodic reviews by an external quality review team.

Annual Review
All divisions will be expected to undertake internal progress reviews at least annually and to formally
report both progress and plans for the coming year to CEQMS by means of an annual quality status
report. Additionally, a representative of the division may be invited to make a short presentation to
CEQMS based on the report.

The annual quality status report should initially focus on key activity in the areas of customer focus,
continual improvement and involvement of staff (teamwork). The division should clearly state their key
objectives for the coming year, ongoing process targets, and progress in relation to the achievement of
the previous year’s objectives and targets. Regular stakeholder feedback should be sought, reported
honestly, and published. Use of independent survey specialists should be routine. The committee may
request additional information and may suggest alternative or more demanding targets for the division.
The outcomes of the review will be published internally.

A template for the annual quality status report will be provided by CEQMS with a view to keeping the
report concise and focused.




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    University of Limerick Quality Management System – Standard Framework for Support Departments



Periodic Review
It is proposed that external quality reviews, similar to those already undertaken in SAA, LIS and CECD,
will take place in all support divisions on a cyclical basis not exceeding six years. The quality reviews,
which will be organised by the QSU and overseen by CEQMS, are modelled on the system used in
academic departments. In keeping with the Universities Act (1997), the first round of these reviews will
be completed by the end of 2007.

The quality review will involve a self-evaluation and a visit by a quality review group (QRG)
representative of stakeholders, cognate departments and quality experts. The self-evaluation and QRG
report will focus on the eight guidelines set out in section 7. In keeping with an agreement between all
Irish universities and the expectations of the HEA, the outcomes of the review will be presented to
Deans’ Council, the Executive and Governing Authority and then published on the UL website alongside
the reviews of academic departments.

Details of the procedures for both the annual and periodic reviews are available on the Quality website
(subject to approval) www.quality.ul.ie.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




7        QMS Guidelines
The EFQM Business Excellence Models recognise that

  “Excellence is achieving results that delight all the organisation’s stakeholders.”



  “In the fast changing environment that is today’s world, excellent organisations are agile, flexible and
  responsive as stakeholder needs and expectations change, often frequently and quickly. Excellent
  organisations measure and anticipate the needs and expectations of their stakeholders, monitor their
  experiences and perceptions, and monitor and review the performance of other organisations.
  Information is gathered from both current and future stakeholders. This information is used in order
  to set, implement and review their policies, strategies, objectives, targets, measures and plans, for
  the short, medium and longer term. The information gathered also helps the organisation to develop
  and achieve a balanced set of stakeholder results.”

The University of Limerick has adopted this philosophy and is putting it in place through this QMS
framework and individualised systems in each division.

Sections 7.1 to 7.8 below list and develop the recommended guidelines to follow when establishing a
QMS. The explanatory notes are not intended to indicate the only way to meet the requirements of each
guideline but should help each division with the initial development of its QMS.

In addition to following the guidelines, it is strongly suggested that the reference documents (section 8),
which provide additional detail, are studied by each divisional quality team.

Any further clarifications and questions should be directed to the Quality Support Unit (QSU).




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.1        Maintain Customer Focus



      The department must clearly identify the customers it serves and must demonstrate
      that:

          It knows and understands its customers
          It is responsive to customers’ current needs and expectations
          It effectively anticipates what customers’ future needs and expectations will be
           and acts promptly in order to meet and strives to exceed them
          It benchmarks peer activity and understands where competitive advantage can
           be leveraged
          It monitors and reviews the experiences and perceptions of its customers and
           where problems or opportunities for improvement are identified, it responds
           quickly and effectively
          It builds and maintains excellent relationships with all its customers

      The department will document processes that are used to achieve the above
      requirements. The process must include a system of regular reporting on customer
      feedback to the department management team. The process must be understood by
      all department employees.

      A customer focus statement should be published.

      Records associated with customer interactions must be maintained and analysis of
      trends published.

      These must be complete by March 2007 and maintained thereafter.




Explanatory Notes
These requirements can be met by gaining an understanding of the division’s customers. This is
achieved by talking with the customers, reviewing independently complied reports or completing
customer surveys. This must be done regularly, and changes in feedback trends should be examined.

Visiting other universities in Ireland or abroad and examining their activities can help to show where the
division can develop systems for the future.

Communication is best performed in a two-way system. To build good relationships, the division must
pass information to customers and clarify roles, performance expectations and commitments. This could
be done online or through regular circulation of information, presentations and informal feedback.

The customer focus statement must clearly establish the attitude of the division towards its customers.

Customers may be identified in groups, particularly where the division is providing support to another
division that may more directly communicate with end customers. Note: An “end customer” is seen as
the person or group of people who ultimately receive the value of the service provided, e.g. students.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Maintain Customer Focus

Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    Who are your customers? Who are your END customers?

    Can you list your customers in groups?

    What kind of informal discussions on service do you have with your customers? How do
     you record what you find out?

    Describe your customers’ perception of your service?

    How many complaints have you received in the last month, quarter and year? Summarise
     them.

    Have you ever run a “Customer Survey” and, if so, were the results useful?

    What is your plan for developing better relationships with your customers?

    How do you record what your customers say?

    What kind of compliments do you get from your customers? (Positive Feedback)

    How often do you write to your customers?

    Do you write to customers if they complain? (Negative Feedback)

    When do you discuss customer feedback with your colleagues?

    Do you look for trends of similar feedback from what your customers say to you?

    Do you have a procedure for how you interact with your customers?

    Do you have a published customer policy?


Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.2        Demonstrate Leadership



      The division must have a strong leadership structure that is visible at all levels of the
      organisation. The leadership must act on the urgency of today while keeping a view to
      the future strategic requirements. This will require clear communication of
      departmental policies, procedures and objectives. To achieve this, the division must
      implement a system of communication that is clearly two-way throughout the division.
      The division must document its communications system, including:

          Statements on divisional values, ethics, culture, quality, environment and
           customer focus
          Demonstrated constancy of purpose through clear business objectives and
           measures of achievement towards objectives

      Motivational leadership must be demonstrated by management at all levels.

      At least once per year the division should complete a review of objectives and targets
      achieved in the previous time period.

      Records associated with leadership must be maintained and published.




Explanatory Notes
These requirements can be met by implementing a series of communications on a frequency that suits
the environment in which the division works. Having clear organisation structures with roles and
responsibilities will help. Items such as job descriptions and organisation charts should be considered.
Mechanisms that allow divisional goals and targets to be communicated to all staff in a timely fashion will
be required.

Use of the web and email systems, memos to staff and daily, weekly, monthly or quarterly updates will all
support this.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Demonstrate Leadership

Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    How does your division communicate priorities to you?

    Does your division have a published code of ethics?

    Does your division have a published statement on quality and the environment?

    Is there a Division organisation chart and, if so, is it published?

    Is it clear what your responsibilities are and who you report to?

    Do you have a published job description?

    List the top three division objectives in order of priority for this year.

    How often are divisional meetings held?

    Are there useful exchanges of views at these meetings?

    How many meetings have you attended on the strategic development of the division?

    How many meetings have you attended where success measures have been discussed?

    How important is it to complete all the actions you are assigned at a meeting by the
     following week?

    Do you feel under pressure to complete assigned actions? If so, why?




Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.3        Involve All Staff



      The division must identify the resources that are required to operate effectively within
      the campus environment. The process of staff selection and development and the
      involvement of staff in the business of the division must be demonstrated.

      The division should:

          Clearly define the method of staff selection and promotion used
          Implement a system of employee welcome that introduces new employees to
           their role, to division systems and to staff
          Develop a team spirit with clearly defined group objectives
          Regularly develop individual training plans based on the competence of staff and
           the requirements of the role within the division
          Provide training opportunities to all staff to encourage learning, development,
           increased self-awareness and confidence
          Evaluate all training provided to determine its value
          Invest in appropriate work environment and infrastructure to allow all employees
           to carry out their functions to the best of their ability
          Ensure that a system is in place for employees to make suggestions and use
           their initiative

      Records of selection and training should be available to employees. Records should
      be available to demonstrate that the above requirements are regularly achieved.




Explanatory Notes
A divisional handbook and induction programme should be given to all new employees to welcome them
on arrival. Records of training and evaluation should be used, possibly annually, to formally discuss with
individual employees what the requirements for the next year should be. Plans can be put in place and
budgets allocated where required.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Involve All Staff

Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    Is there a clear published process for selecting new employees and promoting existing
     employees?

    Do you have a divisional training programme?

    When you joined the division, were you given introductory training about the division?

    How was this training done?

    How often do you sit with your direct supervisor or line manager and discuss your own
     training needs?

    Does your department encourage you to develop your skills professionally by providing
     time and fees for courses?

    How often do you formally record your training and discuss how effective it has been with
     your line manager?

    Do you have a good work environment?

    Is the work environment clean and pleasant to work in?

    Are you aware of all the opportunities for promotion within your division and the
     qualifications required for such positions?

    How do you offer suggestions for improvements to your division?

    Are you encouraged to make such suggestions and do you know how they are dealt with?



Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.4        Emphasise Continual Improvement



      The process of achieving “Quality” is continual, and the division is expected to
      constantly challenge norms and seek opportunities to make improvement. A system to
      achieve this should be formally defined.

      The system should:

          Focus on customer and employee satisfaction
          Use data analysis to identify developing problem trends
          Be available for any member of staff to use appropriately
          Involve regular specific communication on improvement projects
          Be linked to divisional objectives and targets
          Include a system of self-assessment to be carried out at least once a year
          Clearly demonstrate the use of lessons learned in the improvement cycle

      Records of improvements, projects and results should be published routinely on the
      web.




Explanatory Notes
People should learn continually, both from their own activities and performance and from those of others.
Internal self-assessment should question all activities and not look for compliance alone but challenge
the process being used and seek to recommend areas for improvement.

The division should encourage an openness to develop, evaluate, accept and use ideas from any
member of the campus community.

All major projects and activities undertaken by the division should be regularly reviewed, in a reflective
manner, with a view to identifying potential room for improvement when such activities recur.

The activities in this area may be carried out by individuals or groups.

Good “project management” practices should be employed to ensure that each activity maintains focus
and targets expectations.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Emphasise Continual Improvement

Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    Give two examples of efforts you were recently involved in to make the division a better
     place to work.

    Give two examples of efforts you were involved in to make the division’s customers
     happier.

    Are you aware of the measures your division uses to monitor success? Describe two of
     them and explain their relevance to the division’s success.

    How many continual improvement activities have you recently been involved in?

    Have you had any formal training in continual improvement and, if so, was it effective?

    Have any of your work colleagues ever carried out an audit in your work area to look for
     potential improvements?

    Have you ever carried out an audit with one of your colleagues to look for potential
     systematic process improvements?

    Are records of the continual improvement and audit activities published promptly?




Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.5        Use a Defined Process Approach to Services Provided



      In the case of each service, the division must list the processes it uses to provide
      services or indirectly support services. The support processes used to enable the
      service processes to be carried out must also be defined.

      The detail used to describe the processes should be determined by considering the
      customer and the competence of the people providing the service. Consideration
      should also be given to how the process would be impacted by change in personnel
      and temporary or long-term staff absence.

      Processes should be written in terms of procedures and should be defined in clear
      steps.

      Processes that are shared between and/or across divisions or under the control of
      other divisions must be appropriately linked to the division’s processes.

      The following support processes must be defined:

          Control of documentation and web content
          Purchasing and supplier management
          Customer interaction
          Training and development
          Self-assessment
          Communications
          Continual improvement

      Key processes must be clearly defined; this will identify steps that lend themselves to
      rationalisation and improvement.




Explanatory Notes
Processes are used to clearly outline the steps that are required to deliver a particular service by the
division or operate a particular system within the division. By documenting processes, the division can
demonstrate an understanding of the processes it is employing, develop process improvements and
ensure personnel have the necessary tools and information to carry out their roles within the division.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Use a Defined Process Approach to Services Provided

Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    What services does your division provide?

    Does your division plan how it will provide its services?

    Does your division set quality objectives whenever it provides a service?

    Does your division define requirements for each service?

    Do you identify the processes that are needed whenever you provide a service?

    Do you identify the documents that you will need to use whenever you plan to provide a
     service?

    Do you identify the records that you will need to use and keep whenever you provide a
     service?

    Do you identify the records that you will need to use to prove that your services meet
     requirements?

    Have you asked your customers if the processes you use to implement a service are
     user-friendly for them?

    How do you verify that what you “think” is happening actually is happening?

    How does your division identify customers' service-oriented requirements and
     obligations?

    How do you identify your customers' service requirements?

    How do you identify your customers' delivery and post-service requirements?

    Have you published your support processes?

    How does your division review service requirements before it agrees to supply services to
     customers?



Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.6          Use a Systematic Approach to Management


         Pictorial example of process interactions


                                             Communications
                                             and Management
            Documentation/Web                 Review Process        Continual Improvement
            Content Control Process                                        Process



      Customer                                                                     Customer
     Interaction                           Service Processes                      Interaction
      Process                                                                      Process
       (Input)                                                                     (Output)




          Training and                  Purchasing and Supplier      Self-Assessment
          Development Process           Management Processes              Process




     The relationship between the processes should be shown in picture format.

     It is important that all activities within the division are structured and effectively linked to
     allow optimum performance. The main service processes are supported by the ancillary
     processes, and together these form the whole system.

     Having this picture will enable the division to systematically approach reviews for
     improvement of the individual processes and overall system.

     Internal and external communications must be identified in the system. Two-way
     communication must be demonstrated.




Explanatory Notes
These requirements can be met by publishing the processes and interaction of those processes in a
picture format in conjunction with documented procedures for each process.

By having a published communications process, the division can show how communication to all
stakeholders is managed. This will demonstrate that the division is aware of its main stakeholders’
requirements. Use of the web and email systems, memos to staff and daily, weekly, monthly or quarterly
updates will all support this.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Use a Systematic Approach to Management

Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    Can you show a picture/diagram of how all your processes within the division interact with
     each other to be effective?

    How many support processes do you have?

    How does management plan for each process?

    Are resources sufficient for supporting the services provided?

    Is cover available for staff on holiday or absent through illness?

    How often is the processes diagram reviewed?




Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.7        Use Facts and Analyse Data in All Decision-Making



     Decisions taken within the division must be based on factually reliable information
     relating to current and projected performance, process and systems capability,
     customer, staff and University needs.

     Business risks must be identified based on sound performance measures. These
     must then be managed effectively. Appropriate prevention measures should be
     identified and implemented, inspiring and maintaining high levels of confidence with
     the campus community.

     To achieve this, all processes should be transparent to all staff and customers. Clear
     decision-making criteria should be stated in areas of service provision. These should
     be published.

     In addition, the division must define and conduct a management review process that
     shows what information is used to make decisions.

     This must include:

        Meeting structures that appropriately account for daily operations and strategic
         development
        Determining and reviewing of key measures for running the divisional services in
         all key processes
        Target-setting and review in all business areas
        Systems to collect, analyse and identify trends in all key business areas

     Records associated with management reviews must be maintained and published.




Explanatory Notes
The division must demonstrate through its records that it has systems to prioritise activities in a clear
way. This may involve listing selection criteria for employment, stating clearly the queuing system used
to provide services to customers or publication of the tender process for sub-contractors.

This will mean that each division has a system to collect and analyse data in a way that allows it to make
these decisions.

A clear agenda for the management review and other management meetings should be available.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Use Facts and Analyse Data in All Decision-Making
Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    Have clear division business risks been established?

    Are there records for each service provided?

    Are the records analysed to allow factual decisions to be made regarding performance?

    Do you think or feel that the division is doing well?

    Do you know that the division is doing well?

    Are there regular planning meetings in the division?

    Are you allowed to get on with your work as you see fit?

    If you encounter a problem, how do you solve it?

    Are there records of problems kept by the division?

    How does the division make sure that the same problem does not happen more than
     once?

    Are your customers aware of how you decide on priorities for them?




Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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  University of Limerick Quality Management System – Standard Framework for Support Departments




7.8        Develop Mutually Beneficial Supplier, Partner and
           Community Relationships


      The division should develop partnerships with suppliers that enable it to deliver
      enhanced value to its customers. To do this, the division must identify its core
      competencies and determine where it needs support.

      It should be possible to demonstrate that all partnerships have been developed on the
      basis of clearly identified mutual benefit to the parties involved. This should be
      demonstrated by records such as contracts and supplier reviews.

      The division must also communicate with the campus community and, where
      appropriate, with the local community. The local community inputs should be
      considered within the framework of the University requirements.

      Records must be maintained and published to demonstrate this.




Explanatory Notes
This section is covered by the division identifying where it impacts local community life, both social and
environmental, and stating how it plans to develop or maintain these areas.

Recognising that suppliers and the community are stakeholders in the division is very important.

Defining a clear supplier selection and monitoring system will allow the division to make informed
decisions regarding suppliers and to have structured reviews with all key suppliers. Suppliers need to
perform well to remain as preferred suppliers. To do this, suppliers need to have a clear understanding
of what is expected of them. A process that includes two-way communication should be put in place to
ensure that this is the case.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




Develop Mutually Beneficial Supplier, Partner and Community
Relationships
Questions to help identify your status with respect to a QMS:

These questions are available in worksheet format on www.quality.ul.ie.


    Do you contract out any of your services?

    If the contractor causes a problem, who has to solve it?

    How do you select contractors or suppliers?

    How often do you meet and discuss performance with your suppliers and contractors?

    How do you evaluate the performance of suppliers and contractors?

    Do you have records of the performance of suppliers and of meetings held with them?

    What benefits are you giving to your suppliers’ and contractors’ businesses?

    How do you think your suppliers and contractors view you?

    Do you think that your division is seen by others as good to work with?

    What plans do you already have to improve your performance as a partner?




Note to respondent: Single-word answers such as YES/NO are not valuable on their own. In
answering these questions you should give an explanation of your answer and, in all cases,
give examples to illustrate your response.




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    University of Limerick Quality Management System – Standard Framework for Support Departments




8        References
Primary References
Universities Act 1997 - “…procedures for quality assurance aimed at improving the quality of
education and related services provided by the university”

A Framework for Quality in Irish Universities
(Meeting the challenge of change), Conference of Heads of Irish Universities 2003

Baldrige National Quality Program
Education Criteria for Performance Excellence, 2006

ISO/IWA2/WD1 N5, International Workshop Agreement 2 – Quality Management Systems –
Guidelines for the application of ISO9001:2000 on education

The European Foundation for Quality Management Excellence Model, EFQM

A Guide to the Quality Review System for Support Departments at the University of Limerick,
Quality Support Unit approved by Deans’ Council 2005


Additional References and Support Material
Standards and Guidelines for Quality Assurance in the European Higher Education Area,
European Association for Quality Assurance in Higher Education (ENQA), ISBN 952-5539-
05-9 (pdf)

Quality Assurance: A reference system for indicators and evaluation procedures. Francois
Tavenas. EUA.




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