1. Purpose of procedures
These procedures specify requirements and processes associated with external reviews of organisational units as required under the Organisational Unit Reviews – Operational Policy and should be read in association with that policy.
Please refer to the University’s Glossary of Terms for policies and procedures. Terms and definitions identified below are specific to these procedures and are critical to the effectiveness of it:
Organisational unit means operational support areas of the University approved by the Vice-Chancellor and President for review.
Portfolio Manager means the member of the University Executive to whom the Director of an organisational unit reports.
3.1 Review coordination
The Quality Office has overall responsibility for coordinating organisational unit reviews, including:
- drafting schedules for approval by the Vice-Chancellor and President
- providing timely notice to an organisational unit Director of their forthcoming review
- appointing a review support officer for each review who will liaise with the Portfolio Manager, Director, organisational unit’s review personnel and the appointed review panel in order to progress and coordinate the review
- providing advice and information on the organisation and conduct of reviews
- liaising with each organisational unit in relation to reporting, record-keeping and other data-capture related to a review.
3.2 Scheduling of reviews
3.2.1 Organisational unit reviews will be held at least every five years and the schedule for these reviews, as approved by the Vice-Chancellor and President, will include milestone dates for each major activity.
3.2.2 Any changes to scheduled dates for reviews require the approval of the Vice-Chancellor and President.
3.2.3 The Vice-Chancellor and President may approve the conduct of an organisational unit review at a time other than a scheduled five-yearly review or in addition to a scheduled review.
3.2.4 The schedule of reviews will be updated as required by the Vice-Chancellor and President, and on conclusion of an organisational unit review will be automatically updated to include the next five-yearly review of that organisational unit.
3.2.5 Quality Office will provide the latest approved schedule to the Quality and Standards Committee and also publish it on MyUSC.
3.3 Advance notice and reminders of review
3.3.1 At least 12 months prior to the first milestone date for the review, the Quality Office will provide the Portfolio Manager and Director with:
- written advice of a forthcoming organisational unit review, together with details of the relevant University review personnel and milestone dates
- copies of the Organisational Unit Reviews policy, associated procedures, and other relevant review support materials
- a proposal for convening an initial meeting of the relevant University review personnel to plan for and progress the review.
3.3.2 At least six months prior to the first milestone date for an organisational unit review, the Quality Office will consult the Director to ascertain progress with review preparations and, if necessary, remind all review personnel of the milestone dates for the review and initiate appropriate action to expedite review preparations.
3.4 Review planning meetings
Review planning meetings involving (as appropriate) the Portfolio Manager, Director or nominee and the review support officer should be held well in advance of the first milestone date for the review, and thereafter as needed, in order to:
- develop a common understanding of the review’s purpose, nature, scope, processes and stages
- clarify the roles and responsibilities of review personnel
- identify and discuss possible members and a possible Chairperson of the review panel
- determine the overall structure and contents of the review portfolio
- develop a timeline of key events and activities for the review, including the proposed dates for a review panel site visit
- agree on a broad indicative program for the site visit that, among other things, identifies likely interviewee groups and potential interviewees, including external stakeholders
- identify any specific groups or organisations to be invited to make confidential submissions to the review panel
- clarify that the organisational unit is responsible for funding all review-related expenditure
- reach agreement on the amount of any honoraria to be offered to external panel members and the panel Chairperson.
3.5 Terms of reference for organisational unit reviews
3.5.1 There is no standard set of terms of reference for organisational unit reviews.
3.5.2 The terms of reference will be developed by the Director, in consultation with the Portfolio Manager, and will provide clear guidance to the review panel on the specific matters that are to be addressed in the review.
3.5.3 The final set of terms of reference will be as approved in writing by the Portfolio Manager.
3.5.4 Information and templates for development and approval of terms of reference, produced by the Quality Office, will be provided to review personnel at the first review planning meeting, and will also be available on MyUSC.
3.6 Appointment of review panel
3.6.1 After the terms of reference for a review have been finalised and approved, the Director will initiate action for recommending appointment of a panel to undertake the review.
3.6.2 The panel membership should:
- be sufficiently broad to allow for a range of perspectives and expertise amongst the reviewers
- include persons with the understanding, skill, experience or capability needed to undertake the review
- comprise no fewer than three (3) persons, all external to the University, who have no current or past formal association with the organisational unit or the University and who have no close professional or personal association with any member of the organisational unit under review.
3.6.3 The panel Chairperson will have recent high level leadership and management experience in or of an organisational unit elsewhere that has a similar focus or orientation.
3.6.4 The Director or nominee will:
- document a short list of persons considered appropriate to be appointed as members or as the Chairperson of the review panel, including full contact details and information on why each person would be an appropriate appointment, and including a statement that none of the persons on the list has a current or past formal association with the organisational unit or the University and has no close professional or personal association with any member of the organisational unit
- seek approval from the Portfolio Manager to contact persons on the short-list to ascertain their interest in becoming members or the Chairperson of the review panel
- following contact with potential panel members, use the standard panel appointment form to recommend to the Portfolio Manager the appointment of the Chairperson and other members of the review panel.
3.6.5 The Portfolio Manager will determine and appoint the review panel members and Chairperson and provide the review support officer with a copy of the signed review panel appointment form.
3.6.6 Members and the Chairperson of the review panel will be:
- required to accept membership of the panel in writing and enter into an agreement to protect University intellectual property and maintain the confidentiality of any corporate or personal information made known to them during the review process
- reimbursed for all out-of-pocket expenses and may receive an honorarium for their contribution to the review.
3.7 Review portfolio
3.7.1 The Director will arrange for the production of a review portfolio for submission to the review panel by the relevant milestone date in the review schedule.
3.7.2 The portfolio is the starting point for the formal review, should be structured to reflect the terms of reference for the review, and will contain sufficient information about the organisational unit, with supporting evidence, to enable the review panel to address each of the terms of reference.
3.7.3 Separate evidence that supplements or substantiates information and statements made in the portfolio may be provided to the review panel as appendix documents.
3.7.4 Any confidential information should be provided as separate appendix documents, marked “Confidential”, and should not be included in the main body of the portfolio.
3.7.5 The Director should ensure that senior personnel of the unit and the Portfolio Manager have been given opportunity to provide input to the structure and contents of the portfolio, and the Director may also seek input from any other appropriate source.
3.7.6 The final draft of the review portfolio must be submitted to the review support officer no later than six weeks prior to the scheduled site visit.
3.7.7 The review support officer will provide feedback as required to facilitate finalisation of the review portfolio.
3.7.8 The final portfolio must be:
- submitted by the Director to the Portfolio Manager for approval no later than five weeks prior to the site visit (where this is required by the Portfolio Manager)
- provided by the organisational unit to each member of the review panel, in the requested format, no later than four weeks prior to the site visit
- forwarded simultaneously to the review support officer – in print form if requested, and in e-copy
- provided in print or e-copy by the organisational unit to the review personnel within the unit and to the Portfolio Manager.
3.7.9 Once the portfolio is submitted to the review panel, the review support officer becomes the primary conduit for communications between the University and the review panel concerning the substance of the review.
3.7.10 The review support officer will:
- provide the organisational unit with guidance to assist in production of a review portfolio
- make the portfolio and appendices available to the University community via MyUSC by no later than two working days after their submission to the review panel
- advise persons invited to participate in interviews with the review panel of the availability of the review portfolio on MyUSC
- provide the review portfolio to any external interviewees.
3.8 Confidential submissions to review panel
3.8.1 As soon as practicable after submission of the review portfolio to the panel, the review support officer arranges for an announcement about the review to be made to the University community and calls for confidential submissions to the panel.
3.8.2 The Director arranges for the review support officer to be provided with names and contact details for any external stakeholders who should be specifically invited to make a confidential submission to the review panel.
3.8.3 All submissions are confidential to the review panel members and the Review Support Officer and are disposed of appropriately by the review support officer upon receipt of the final review report.
3.9 Site visit by review panel
3.9.1 The review support officer, in consultation with the Director or nominee, will develop the site visit schedule, which will be submitted to the Portfolio Manager for consideration and approval no later than six weeks prior to the site visit.
3.9.2 A review of an organisational unit will normally include a two-to-three day site visit by the review panel to the University.
3.9.3 During the site visit, the review panel:
- will interview a range of persons with a stake in the organisational unit under review
- may inspect physical and other facilities and resources that support the work of the unit
- will identify key findings and indicative recommendations to make in relation to the terms of reference for the review.
3.9.4 The review support officer, in consultation with the Director or nominee, is responsible for organising the arrangements for the participation of persons identified for interview by the review panel.
3.10 Review report
3.10.1 The review panel Chairperson will submit a draft report (through the review support officer) to the Portfolio Manager on the panel’s findings in relation to the terms of reference, including any recommendations, by no later than six weeks after conclusion of the site visit.
3.10.2 If the draft report identifies, or the review panel has separately identified, matters that potentially pose significant risk to the University, the Portfolio Manager should bring those matters to the attention of the Vice-Chancellor and President.
3.10.3 As soon as practicable after receipt of a draft review report, the Portfolio Manager (through the review support officer) will advise the panel in writing of any matters in the report that appear to be in need of correction or reconsideration.
3.10.4 Where a draft report is regarded as containing matters significantly beyond the terms of reference for the review or to pose serious risk to the University if made public, the Portfolio Manager may request the panel in writing (through the review support officer) to remove reference to those matters from the review report and advise that, if the panel wishes, it may present a separate issues paper to the Vice-Chancellor and President in relation to those matters.
3.10.5 The review panel Chairperson will submit a final report (through the review support officer) to the Portfolio Manager as soon as practicable after submission of the draft report.
3.10.6 The Portfolio Manager, after considering the final report, will provide the Vice-Chancellor and President with a copy of the report and, if appropriate, discuss the findings with the Vice-Chancellor and President.
3.10.7 The Portfolio Manager will then provide members of the University Executive and the Director of the relevant organisational unit with a copy of the final report and discuss the findings with the Director.
3.10.8 The Director will provide their senior staff with a copy of the final report.
3.10.9 When advised by the Portfolio Manager that the final report may be released to the wider university community, the review support officer will arrange for the final report to be made available via MyUSC and for advice to be given to the University community of its availability.
3.10.10 The Director may provide a copy of the final report to external stakeholders if appropriate.
3.11 Response to review report and action plan
3.11.1 Guides and templates for development and documentation of the response and action plan will be produced by the Quality Office, provided to Directors and made available on MyUSC.
3.11.2 The Director will:
- initiate discussion of the review report by relevant staff, any relevant committees/reference groups, and senior members of other areas of the University impacted by recommendations or findings contained in the report
- develop a draft review response and action plan addressing the recommendations and other matters of significance in the review report
- within eight weeks of receipt of the review report, submit the draft review response and action plan to the Portfolio Manager for consideration.
3.11.3 To obtain appropriate feedback, the Portfolio Manager will present the draft response and action plan to the USC Executive.
3.11.4 On the basis of discussions by the USC Executive, the Director will finalise the review response and action plan for approval by the Portfolio Manager.
3.11.5 The Portfolio Manager will subsequently provide the approved review response and action plan for noting to the Quality and Standards Committee and any other committee as considered appropriate.
3.11.6 The review support officer will arrange for the approved response and action plan to be made available via MyUSC.
3.12 Reporting and monitoring progress with action plan
3.12.1 The Director will present six-monthly written reports to the Portfolio Manager for the monitoring of progress in implementing the action plan, until such time as the Portfolio Manager is satisfied that all matters in the plan have been addressed appropriately.
3.12.2 After each progress report has been approved by the Portfolio Manager, the progress report will be submitted to the Quality and Standards Committee and any other relevant committee, for information.
3.12.3 When the Director is satisfied that all recommendations have been satisfactorily addressed, the Director will present to the Portfolio Manager a final progress report for approval.
3.12.4 The review support officer will arrange for a copy of each progress report to be registered in the relevant file in the University’s corporate records system and made available on MyUSC.
3.13 Review support materials
The Quality Office will develop and make available review support materials such as handbooks, guidelines, forms, templates, indicative role statements, checklists and flowcharts to assist personnel involved with organisational unit reviews.
3.14 Official review records
3.14.1 The Quality Office will arrange for the creation of a discrete University file in the corporate records system for each organisational unit review in accordance with University’s Information Management Framework – Governing Policy.
3.14.2 Records of key review documents will be registered in the appropriate review file by the Quality Office.