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If you work in a Long Term Post-Acute Care (LTPAC) setting, you know that in our field the only constant is change. There is, however, one process that has been with us, in one form or another, for quite a long time. Until recently, Quality Assurance and Performance Improvement were two separate processes. These have since been streamlined into what we now know as the QAPI (Quality Assurance/Performance Improvement) process. Let’s start off with the CMS definition of QAPI:
“QA is a process of meeting quality standards and assuring that care reaches an acceptable level. Nursing homes typically set QA thresholds to comply with regulations. They may also create standards that go beyond regulations. QA is a reactive, retrospective effort to examine why a facility failed to meet certain standards. QA activities do improve quality, but efforts frequently end once the standard is met.
“PI (also called Quality Improvement - QI) is a pro-active and continuous study of processes with the intent to prevent or decrease the likelihood of problems by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems. PI in nursing homes aims to improve processes involved in health care delivery and resident quality of life. PI can make good quality even better.”
Click here to discover how a SNF overcame decline of ADL and customer satisfaction using QAPI.
QAPI is then further divided into five elements as defined by CMS below. Each of these five elements must be an integral part of your QAPI process in order to build a successful program.
Element 1: Design and ScopeA QAPI program must be ongoing and comprehensive, dealing with the full range of services offered by the facility, including the full range of departments. When fully implemented, the QAPI program should address all systems of care and management practices, and should always include clinical care, quality of life, and resident choice. It aims for safety and high quality with all clinical interventions while emphasizing autonomy and choice in daily life for residents (or resident’s agents). It utilizes the best available evidence to define and measure goals.
Element 2: Governance and LeadershipThe governing body and/or administration of the nursing home develop a culture that involves leadership seeking input from facility staff, residents, and their families and/or representatives. The governing body assures adequate resources exist to conduct QAPI efforts. This includes designating one or more persons to be accountable for QAPI, developing leadership and facility-wide training on QAPI, and ensuring staff time, equipment and technical training as needed. The Governing Body should foster a culture where QAPI is a priority by ensuring that policies are developed to sustain QAPI despite changes in personnel and turnover.
Element 3: Feedback, Data Systems, and MonitoringThe facility puts systems in place to monitor care and services, drawing data from multiple sources. Feedback systems actively incorporate input from staff, residents, families, and others as appropriate. This element includes using Performance Indicators to monitor a wide range of care processes and outcomes and reviewing findings against benchmarks and/or targets the facility has established for performance. It also includes tracking, investigating, and monitoring Adverse Events that must be investigated every time they occur and action plans implemented to prevent recurrences.
Element 4: Performance Improvement ProjectsA Performance Improvement Project (PIP) is a concentrated effort on a particular problem in one area of the facility or facility-wide; it involves gathering information systematically to clarify issues or problems and intervening for improvements. The facility conducts PIPs to examine and improve care or services in areas that the facility identifies as needing attention. Areas that need attention will vary depending on the type of facility and the unique scope of services they provide.
Element 5: Systematic Analysis and Systematic ActionThe facility uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, its causes, and implications of a change. The facility uses a thorough and highly organized/ structured approach to determine whether and how identified problems may be caused or exacerbated by the way care and services are organized or delivered. Additionally, facilities will be expected to develop policies and procedures and demonstrate proficiency in the use of Root Cause Analysis. This element includes a focus on continual learning and continuous improvement.
In order for any QAPI process to be effective, it is recommended that you use the twelve steps as developed by the Centers for Medicare and Medicaid Services (CMS). To begin the QAPI process in your building, you should begin with step one of the twelve step process from CMS, and work your way through to step twelve. It may take anywhere from six to twelve months to get your program up and running. Remember, this is a process that requires a team approach to work through. Below is the basic framework you will need to build a successful QAPI process in your facility process.
Setting your QAPI Goals
CMS has developed a SMART formula to assist in the creation of comprehensive goals. When writing your goal based on the SMART formula, the goal needs to be comprehensive, whilst still being succinct. You want to be able to easily articulate the goal you have written to your staff. Sharing the goal with the staff will promote a feeling of ownership and pride as you work through the QAPI process.
Are you interested in learning about how Richter Healthcare Consultants can guide you through your QAPI journey? Download our free e-book or contact us.
Jennifer Leatherbarrow RN, BSN, RAC-CT-QCP, CIC is the Senior Clinical Consultant at Richter Healthcare Consultants. She is a passionate writer and a speaker at both state and national levels. Jennifer has been working in post-acute care for over 20 years. She is an avid proponent of education and providing those on the front lines of healthcare the tools they need to succeed.
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