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QAPI: Basic Building Blocks
Governance & LeadershipBeth Hercher, CPHQJune/July 2013
The National NHQCC and its partners seek to ensure that every nursing home resident receives the highest quality of care. Specifically, the collaborative strives to:
Instill quality and performance improvement practices
Eliminate healthcare acquired conditions
Dramatically improve resident satisfaction by July 31, 2014
NH Quality Care Collaborative Mission Statement:
Select group of Tennessee nursing homes, committed to this national initiative, working together for 18 months to test systems of change
NHQCC: Local Initiative
TN
Understand the first 2 elements of QAPI: Design and Scope and Governance and Leadership
Understand the difference between a vision statement and a mission statement
How to align your vision and mission statement with a Performance Improvement Project (PIP)
Apply QAPI elements 1 and 2 to your organizational initiatives and culture
Today’s Objectives
OBRA 1987, established first quality of care legislation and defined Quality Assessment and Assurance (QAA F-520) as a:
Management process that is “ongoing, multi-level and facility-wide”
Framework for evaluating systems
Enforcement system for noncompliance
QAA Historical Perspective
2007 Kaiser Family Foundation Report recounts that the Administration on Aging National Ombudsman System received:
Over 230,000 complaints in 2005 concerning nursing facility residents’ quality of care, quality of life or residents’ rights
Citations for one or more deficiencies in 2006 for over 90% of all certified facilities
One-fifth were cited for deficiencies that caused harm or immediate jeopardy to its residents
QAA Historical Perspective (cont.)
American Health Care Association (AHCA), released 2011 Annual Report:
New strides in quality of care reporting improvements in 9 out of 10 quality measures
Steady decline in health facility survey citations and facilities cited for substandard quality of care
QAA Historical Perspective (cont.)
QAA Historical Perspective (cont.)
“While things are moving in the right direction and people on average are making improvements, not everyone is making improvements.”
— David Gifford, MD, MPH, Senior VP of Quality and Regulatory
AffairsAHCA
Requirement of the Affordable Care Act enacted in March 2010
Legislation requires CMS to establish QAPI program standards and provide technical assistance to nursing homes
Opportunity for CMS to develop and test QAPI technical assistance tools and resources before the rule promulgation
QAPI: Background
CMS is challenging providers to create an environment that promotes transformational change
This occurs through collaboration, partnership and commitment to shift paradigms to a person-directed care approach to quality improvement
Transformational Change
QAPI does not refer to a program; rather, it is the way we do our work
The ability to think, make decisions and take action at the system level is a prerequisite for QAPI success
QAPI: Framework
Design and ScopeClinical care, quality of life, resident choice and care transitions
Governance and Leadership Leadership working with staff, residents and families on QAPI
Feedback, Data Systems and Monitoring Design, implementation, and monitoring of care and services
Performance Improvement Projects (PIPs)
Specialized projects of focus centered around a particular opportunity for improvement or conducted facility-wide
Systematic Analysis and Systemic Action A systematic approach to reviewing process and outcomes measures
5 Elements of QAPI
Design and Scope
Should address clinical care, quality of life, resident choice and care transitions
Utilize the best available evidence to define and measure goals
Written QAPI plan adhering to these principles
5 Elements of QAPI (cont.)
Governance and Leadership
Administration of the NH develops and leads a QAPI program
Administration supports working with and obtaining input from facility staff, as well as from residents and families
Leadership should be responsible for sustaining QAPI, setting expectations around resident’s safety, rights choice and respect
Staff are held accountable, but do not feel they will be punished for errors so as to not fear reporting quality concerns
5 Elements of QAPI (cont.)
Building Blocks for QAPI - Facilitators
Beverly Patnaik Charla Long P. Elaine Griffin
Next Steps….
Breakthrough Collaboration: Blueprints
The TN NHQCC collaborative series will follow this plan
All teach, all learn event
Highly interactive, engaging
Opportunity to learn from a set of strategies and change concepts
Existing and fun educational experience
Breakthrough Collaboration: Learning Sessions (LS)
The time between Learning Sessions
▪ Conduct tests of change
– PDSAs▪ Implement and spread improvements
– Inside and outside of facility▪ Measure and report results
– Sharing calls– Tracking tools– Storyboard
Breakthrough Collaboration: Action Periods (AP)
Celebrate
Share lessons learned
Share sustainability concepts
Share spread concepts
Breakthrough Collaboration: Outcomes Congress (OC)
July through September you and your QAPI team will be…
Participating on monthly coaching calls hosted by the Qsource NH Team
Meeting with your QAPI team to review brief podcasts that will assist you in achieving your goals and QAPI structure
Providing Qsource with a monthly progress report via Survey Monkey
Developing a storyboard (see handout for details)
Preparing for LS 2 scheduled for Fall 2013
Action Period 1 (July thru September)
Say what…
The 12 Step Guide will be a companion to the CMS QAPI At A Glance Toolkit
Podcasts will walk your team through the steps, supporting tools and resources that will assist with the next step
Will not replace QAPI toolkit; it will enhance it and align with the CMS resources already developed
The 12 Step Guide and podcasts will be posted on the NHQCC webpage beginning in late July
12 Step Guide, QAPI and Podcasts…oh my!
How to conduct PDSA cycles
How to utilize the CMS Change Package for small tests of change (PDSAs)
How to conduct an effective Root Cause Analysis
How to develop a “living” Storyboard
How to have a productive and effective QAPI team
How to use and track data for your Performance Improvement Project
Podcast Topics:
Antipsychotic Reduction
Dementia Care/Person Centered Care
Consistent Assignment & Staff Stability
Mobility: Falls
TN NHQCC webpage
http://www.qsource.org/nhqcc/
Qsource NHQCC Webpage Hot Topic Tools & Resources:
The presentation and related material was prepared by Qsource, the Medicare Quality Improvement Organization (QIO) for Tennessee, under a contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the Department of Health and Human Services (HHS). Contents do not necessarily reflect CMS policy.
13.IPC-HAC.06.024
Beth Hercher, CPHQQuality Improvement [email protected]
901-273-2640
The presentation and related material was prepared by Qsource, the Medicare Quality Improvement Organization (QIO) for Tennessee, under a contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the Department of Health and Human Services (HHS). Contents do not necessarily reflect CMS policy.
13.IPC-HAC.06.024
Nursing Home Team:
Beth Hercher, [email protected]
John Wright, SR, RN, BSN, WCC, [email protected]
Julie Clark, [email protected]
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