Another year is about to end and 2017 is right around the corner. What else comes with the New Year...New Year’s Resolutions!  The New Year is the perfect time to begin new Performance Improvement Plans (PIPs). As LTPAC providers we have an obligation to provide our residents the best care possible. We also need to educate our staff on how providing the best care can be accomplished. When we identify educational opportunities in the facility, we should automatically ask the question…is this something I should include in a PIP? That being said, my New Year’s resolution is to bring PIPs to the forefront of your mind and help make the task of writing PIPs a little more manageable.

How do you know when a PIP is indicated?

The short answer is to complete a PIP on any areas that you have determined need improvement. Performance improvement Plans (PIPs) should be directed by the Quality Assurance/Performance Plan (QAPI) Steering Committee.

This committee is responsible for prioritizing opportunities for improvement from their ongoing structured review of facility performance. Furthermore, you should prioritize those items that affect residents or are high-risk items and complete PIPs for those items first. You should then move on to those items that are medium and low-risk.

Medium to Low-Risk Priority Items to Consider in Your PIPs

• Evaluate your health care delivery services, resident outcomes, resident satisfaction, supply chain management and business processes to identify indicators of a problem or an opportunity for improvement.
• Your annual planning should include a variety of processes to monitor and frequency of monitoring such as assessment/care planning, pharmacy services including medication administration, dietary services, safety, infection control, environmental services and CMS initiatives.
• Careful planning of performance improvement includes identifying areas to work on through comprehensive data review which is meaningful and important to your residents. It is important to focus PIPs by defining the scope, so they do not become overwhelming. You and your team may:
• Consider each PIP a learning process/opportunity.
• Determine what information you need for the PIP.
• Determine a timeline and communicate it to the Steering Committee.
• Identify and request any needed supplies or equipment.
• Select or create measurement tools as needed:
• Prepare and present results.
• Use a problem-solving model like PDSA (Plan-Do-Study-Act).
• Report results to the Steering Committee.
• Prioritizing opportunities for improvement is a key step in the process of translating data into action. Your QAPI team will:
• Prioritize opportunities for more intensive improvement work. Problems versus opportunities are a matter of perspective and often require discussion.
• Choose problems or issues that you consider important (consider if the issue is high risk, high frequency, and/or problem prone). Remember that problems affecting psychosocial well-being and the ability of residents to exercise choice should also be considered as they may lead to resident suffering.
• Consider which problems will become the focus for a PIP:
• All identified problems need attention and usually from more than one person, but they do not all require PIPs.
• Begin some PIPs with problems you think you can solve relatively easily. A quick win is worthwhile.
• Some opportunities are not global enough to create a Performance Improvement Project (PIP). Corporations or facilities may have the desire to document smaller scoped projects of a shorter term. Check with your Steering Committee for guidance on selection of Performance Improvement Projects (PIP) versus Improvement Activities (IA).

If you need assistance with Performance Improvement Plans or developing a QAPI program for your facility contact the experts at Richter Healthcare Consultants today!

Below are links to some helpful tools and resources available from The Centers for Medicare and Medicaid (CMS):

PIP Checklist

PDSA Cycle Template

Performance Improvement Project (PIP) Inventory

Sustainability Decision Guide

Brainstorming, Affinity Grouping, and Multi-Voting Tool