quality assurance performance improvement: 12 steps to excellence!

Quality Assurance Performance Improvement:

12 Steps To Excellence!Harmony University

The Provider Unit ofHarmony Healthcare International, Inc.

(HHI)

Presented by:

Beckie Dow, RN, RAC-MTDirector of MDS and Nursing Education & Training

Speaker Bio

Over 20 Years Experience in Long-term CareClinical and Reimbursement Accuracy in AssessmentsQuality Assurance ActivitiesInterrelation between MDS, Care Planning, QA, and Clinical Excellence at the BedsideAANAC Master Teacher

Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 2

Quality Assurance Performance Improvement: 12 Steps to Excellence

Disclosures: The planners and presenter of this educational activity have no relationship with commercial entities or conflicts of interest to disclosePlanners:

Elisa Bovee, MS, OTR/LDiane Buckley, BSN, RN, RAC-CTBeckie Dow, RN, RAC-MT

Presenter:Beckie Dow, RN, RAC-MT


Harmony Healthcare International, Inc.

Criteria for Successful Completion

Complete Sign-in and Sign-Out on Attendance FormAttendance for entire sessionCompletion and submission of speaker evaluation form

Copyright © 2013 All Rights Reserved 4

Program Objectives

Detail the five elements of QAPI and relate the five elements to the twelve action steps of QAPIDiscuss the QAPI demonstration projectArticulate how existing quality improvement programs in SNFs and other settings can benefit from the QAPI materials


Program Objectives

Discuss problem solving models, including Root Cause Analysis, Directed Plan of Correction, Plan Do Study ActList three tools that the facility can use to prepare for the implementation of QAPI


“Don’t judge each day by the harvest you reap, but by the seeds

you plant”-Robert Louis Stevenson


http://www.google.com/imgres?sa=X&hl=en&biw=1518&bih=691&tbm=isch&tbnid=AuTpLDimvO1ugM:&imgrefurl=http://simple-green-frugal-co-op.blogspot.com/2011/02/seed-starting-101.html&docid=hetVrNMOjCSObM&imgurl=http://notdabblinginnormal.files.wordpress.com/2011/01/tomato_seedling1.jpg&w=500&h=333&ei=-6WHUY2pLKW3ywHdqoBg&zoom=1&ved=1t:3588,r:61,s:0,i:278&iact=rc&dur=1227&page=3&tbnh=182&tbnw=275&start=42&ndsp=27&tx=149.111083984375&ty=100.55557250976562

The CMS Nursing Home Action Plan: A Three Part Aim



The CMS Nursing Home Action Plan: Five Approaches

Enhance consumer engagement Strengthen survey processes, standards, and enforcement Promote quality improvementCreate strategic approaches through partnershipsAdvance quality through innovation and demonstration



F520 - Quality Assessment and Assurance (QAA)

The facility has an ongoing QAA committee that includes designated key members and that meets at least quarterly; and The committee identifies quality deficiencies and develops and implements plans of action to correct these quality deficiencies, including monitoring the effect of implemented changes and making needed revisions to the action plans


QAPI Timeline

March 2010—Affordable Care Act passedApril 2011—QAPI announcedSeptember 2011—prototype QAPI program launched to test QAPI tools and resourcesMay 2012—QAPI questionnaireJuly 2012—Panel of experts assembled to discuss the prototype tools and questionnaire results


QAPI Timeline

December 2012—QAPI at a Glance guide introduced in draft formJune 2013—Final version of QAPI at a Glance publishedJune 2013—Announced that wave one NHQI questionnaire results would be available “in the near future”TBD—wave two of the NHQI questionnaire



The QAPI “Elevator Speech”

QAPI is a comprehensive program by which an organization identifies problems or issues early on, develops a plan to address the root causes of problems and prevent adverse events throughout the system, and involves the entire team in using data to understand quality and work to improve performance


What is QAPI?

The merger of two complimentary approaches to quality management:

Quality Assessment – determining where things are going well and where opportunity to improve existsPerformance Improvement – the reaction to the opportunity to improve


What is QAPI?

Quality Assurance Performance Improvement

Motivation Measuring compliance with standards

Continuously improving processes to meet standards

Means Inspection Prevention

Attitude Required , reactive Chosen, proactive

Focus Outliers: “bad apples” Individuals

Processes or Systems

Scope Medical provider Resident care

Responsibility Few All


What is QAPI?

“QAPI is about critical thinking. It involves figuring out what is

causing certain problems, and implementing interventions and solutions that address the root causes of the problems, rather

than just the symptoms”

Karen SchoenemanPast Technical Director, CMS Division of Nursing

HomesCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 16

The Challenge…

“Not all change is improvement, but all

improvement is change”

Donald Berwick, MDFormer CMS Administrator


The Goal of QAPI and/or Other Quality Improvement Models

The Goal: Meet or exceed the expectations of our customersMeeting customer expectations = meeting the mission!Who are the customers?

External customers: The reason the organization existsInternal customers: Anyone within the organization



Nursing homes are in the best position to assess, evaluate, and improve their care and services, because each home has first-hand knowledge of their own organizational systems, culture, and historyEffective QAPI leverages this knowledge to maximize the return on investments made in care improvement



QAPI will take many nursing homes into a new realm in quality:

SystematicComprehensiveData-drivenProactive

Performance Management and Improvement



When nursing home leaders promote the QAPI philosophy the results may:

Prevent adverse eventsPromote safety and qualityReduce risk for residentsReduce risk for caregivers



The goal of QAPI is not to merely meet

minimum standards—it is about continually

aiming HIGHER!


A Culture of Caring

“I take care of my staff, and they take care of the patients,” said one DON. “If I treat them badly, they will treat the patients badly.”

Source: Beyond Unloving Care by Susan Eaton, June 2000


Are You Already Doing QAPI?

QAPI principles are not new to healthcareQAPI builds on our existing QAA regulationsYour facility may already be participating in QAPI activities, and can use existing activities as a foundation for QAPI



Does your facility…Create systems to provide care and achieve compliance with nursing home regulation?Investigate problems and try to prevent their recurrence?Track and report adverse events?Compare the quality of your home to that of other homes in your state or company?



Does your facility…Receive and investigate complaints?Seek feedback from residents and front-line caregivers?Set targets for quality?Strive to achieve improvement in specific goals related to pressure ulcers, falls, restraints, or permanent caregiver assignment, or other areas (Advancing Excellence campaign)



Does your facility…Have a commitment to balancing a safe environment with resident choice?Strive for deficiency-free surveys?

All of these activities are part of QAPI


Are You Already Doing QAPI…But Could “Take it to the Next Level?”

Some QAPI components are new for many nursing homesQAPI emphasizes quality care for residents and an improved work environment for caregiversQAPI uses a systems approach to actively pursue quality, not just respond to external requirements



Use data to identify quality problems, opportunities for improvement, and setting priorities for actionBuilding on residents’ own goals for health, quality of life, and daily activitiesBuilding meaningful resident and family voices into setting goals and evaluating progressCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 29


Incorporating caregivers broadly in a shared QAPI missionDeveloping Performance Improvement Project (PIP) teams with specific “charters”Performing a Root Cause Analysis (RCA) to get to the heart of the reason for a problem



Undertaking systemic change to eliminate problems at the sourceDeveloping feedback and monitoring systems to sustain continuous improvement


QAPI: The Five Elements

Your QAPI program should contain all five elements, which are closely relatedYour QAPI plan will be based on your own center’s needs, current programs, and unique residents


QAPI: The Five Elements

1. Design and Scope2. Governance and Leadership3. Feedback, Data Systems and

Monitoring4. Performance Improvement

Projects (PIPs)5. Systematic Analysis and

Systemic Action


The 12 Action Steps to QAPI

The 12 steps do not need to be achieved sequentially, but each step builds on other QAPI principlesThe most important aspect of QAPI is effective implementation


Step 1: Leadership Responsibility and Accountability

Support “from the top” is essential, and that support should foster the active participation of every caregiverExecutive leadership sets the tone and provides resourcesExecutive leaders help other leadership flourish in the nursing homeBe available for residents & caregivers, tour and meet where they work


Step 1: Leadership Responsibility and Accountability

Develop a steering committee to provide QAPI leadershipProvide resources for QAPI—equipment, training, and staff timeClimate of open communication and respect (“just culture”)Understand the culture of your homeExpect and build effective teamworkCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 36

Step 2: Develop a Deliberate Approach to Teamwork

Teamwork is a central concept to an effective QAPI programAn effective team has a clear purpose, defined roles for each member to play, and each member is committed to active engagement in the team’s activities


Step 2: Develop a Deliberate Approach to Teamwork

Characteristics of an effective team include the following:

Having a clear purposeHaving defined roles for each team member to playHaving commitment to active engagement from each memberThe roles of team workers may grow out of their original discipline or their defined job responsibilities


Step 3: Take your QAPI “pulse” with a Self-Assessment

Self-assessment tool is provided in the QAPI at a Glance guideCan be used at the beginning of the QAPI journey, and then for semi- or annual evaluation thereafterThe results will direct you to areas you need to work on to effectively establish QAPI in your organizationCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 39

Step 3: Take your QAPI “pulse” with a Self-Assessment

See Handouts for the Self-assessment ToolThis should be an honest assessment and reflection of your organizations progressHelps you to determine how you know whether QAPI is taking hold


Step 4: Identify your Organization’s Guiding Principles

Establishing a purpose and guiding principle will unify the organizationMany caregivers do not know the guiding principles of the organization!Taking time to articulate your organizations purpose will assist your organization to develop a written QAPI planSee Handouts for the guide



1. Locate or develop your organization’s vision statement

2. Locate or develop your organization’s mission statement

3. Develop a purpose statement for QAPI



4. Establish guiding principles5. Define the scope of QAPI in your

organization6. Assemble the Document


Step 5: Develop your QAPI Plan

Your plan will assist you in achieving what you have identified as your organizations purpose, guiding principles, and scopeTailor-made program that is a living, breathing documentAmend or change your plan as your organization changes and growsSee HandoutsCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 44

Step 6: Conduct a QAPI Awareness Campaign

Let everyone know about your QAPI plan - often and in multiple waysOngoing and varied caregiver trainingEnsure that consultants and outside agencies that work within your organization are aware of your QAPI programDiscuss the hard questionsCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 45


This is your opportunity to convey the positive message of QAPI and let caregivers from all disciplines know that their participation is key to successIf systems don’t exist, they may need to be developedIf systems impede quality, they must be changed



All residents and families should be made aware that their views are sought, valued, and considered in facility decision-making and process improvementsMake announcements in resident and family council or other communication venues


Step 7: Develop a Strategy for Collecting and Using QAPI Data

QAPI includes the routine monitoring of data from multiple sourcesSet targets for performance in the areas you are monitoringIdentify benchmarks for performanceDevelop a plan for the data you collect to ensure it is used, not just collectedYou are already collecting valuable data



Data sources you may already have:

Clinical care areas (falls, ulcers, infections)Medications (antipsychotics, narcotics)Complaints from residents and familiesHospitalizations and other service useResident satisfactionCaregiver satisfaction



Data sources you may already have:

Resident and caregiver experiences living and working in the settingState survey results and deficienciesResults from MDS assessmentsBusiness and administrative processes (finances, caregiver turnover, staffing patterns, sick calls, staff injuries)Admissions and dischargesCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 50


Use your data to set benchmarksEvery facility is unique, so individual benchmarks based on your own performance are keyThis data will require systematic organization and interpretation in order to achieve meaningful reporting and action


Step 8: Identify your Gaps and Opportunities

Review your sources of information to determine if gaps or patterns existThese gaps may result in quality problems (“quality themes”)Look for areas where there is opportunity for improvementTake notice of things you are doing wellSet priorities for Performance Improvement Projects (PIPs)


Step 9: Prioritize Quality Opportunities and Charter PIPs

Prioritizing opportunities for improvement is a key step in the process of translating data to actionConsider areas that are high risk, high frequency, and/or problem prone, or may affect the psychological well-being and comfort of residentsCharter a PIP teamCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 53


The term “charter” is used in conjunction with the PIP to indicate that it is more than just a casual effortThe PIP will entail a specific written mission to look into a problem areaThe PIP will include people in a position to explore the problem (caregivers, discipline specific)Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 54


Performance Improvement Projects (PIPs)

What do we target?Any area – even if things are going well, there may be the opportunity to improve

Identify opportunities to optimize:EffectivenessEfficiencySafety



Essential steps/elements of a PIP:Define the nature of the problemDevelop change ideasDetermine your actionsTest the actionsDetermine if change has occurred and if it is an improvement



Team activitiesMeet regularlyDevelop the pilot studyOnce the successful change is determined, roll it out organization-wideContinue to monitor and ensure sustained improvement



What should the PIP team expect?3-6 month commitmentManagement and staff supportBe prepared to participate in the organization-wide implementation of the change



Caregivers on a PIP should be empowered to view their participation as a valuable assignment that the team takes seriouslyCaregivers should have the PIP meetings built into their assignment for the dayMake sure floor duties are covered


Step 10: Plan, Conduct, and Document PIPs

Focus your PIP by defining the scope, so the team does not get overwhelmedIdentify the information the PIP team needs and a timeline for completionIdentify and request any materials or supplies neededResidents’ perspective is keyUse a problem-solving model, like PDSA



The PDSA Model for Improvement



Plan: The team learns more about the problem, plans for how improvement would be measured, and plans for any changes that might be implementedDo: The plan is carried out, including the measures that are selected



Study: The team summarizes what was learnedAct: The team and leadership determine what should be done next, which could include adapting (and re-studying), adopting (perhaps expanded to other areas), or abandoning


Step 11: Getting to the “Root” of the Problem

No problem can be effectively addressed without thoroughly exploring the problemThe problem may involve multiple factors and may affect several departmentsRoot Cause Analysis (RCA) is a systemic process for identifying contributing causal factors that underlie variations in performance


Step 11: Getting to the “Root” of the Problem

There is danger in starting with a solution without thoroughly exploring the problemMultiple factors may have contributed, and/or the problem ma be a symptom of a larger issueWhat seems like a simple issue may involve a number of departments


Root Cause Analysis

RCA requires a systematic, intensive, and in-depth review to learn the most basic reasons for the adverse eventFormal logic and defined methodologyGoal is to understand the problem in sufficient depth to effectively eliminate the risk of future injurySee HandoutsCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 66

Root Cause Analysis

Where Traditional Methods will:

Root Cause Analysis will:

Expected staff to perform flawlessly 24/7 and blamed individuals when they didn’t

Encourages the development of systems that are designed to compensate for human limitations and looks to system fixes when an error occurs

Expected staff to adapt their practice to available equipment and regular procedures

Stresses the development of equipment and procedures that are designed for safety

Relied on a chain of command in a facility to investigate errors and impose corrections

Relies on teamwork among all staff to analyze problems and to propose and implement solutions

Punished errors Stresses learning from errors

Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc.

Source: Oregon Patient Safety Commission

67

Root Cause Analysis

RCA also recognizes that adverse events usually result from a number of factors that are all part of the normal process of providing care and serviceAdverse events are rarely a single error made by one personRCA process examines the various contributing factors that led to the adverse event happeningCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 68

Root Cause Analysis

RCA helps you look at the safeguards in your systems or process of care to determine how and why and adverse event happened, and helps you plan to improve those systems to decrease the chances of a similar event happening againIdentifies how systems have failed to keep the resident safe


Root Cause Analysis

The purpose of RCA event investigation is to indentify which imperfections in your safety systems had a role in the adverse event, and then strengthen the protections so that future providers and resident will not be caught in the same set of circumstances


Prepare for Success with RCA

Make sure that you clearly understand the facts surrounding the issue, complaint, or concern/allegation at handSuspend any judgment about how or why it may have happened until you have gathered the factsStart with a “clean slate” attitude



Inquire with those that might have informationMake a sample list of what you hope to learn from each of these sourcesGather documentation that may be relevant and note any personal observations of equipment, general conditions, etc that will contribute to your understandingCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 72


Set aside a time and a place to talk to people privatelyBe clear about what you want to say and how you want to approach themAddress fears that the person may have, such as how the information will be used and what may happen as a result of the information they provideCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 73


Take time to gather all resources you will need in order to have successful interviewsAcknowledge that the RCA process builds on your current investigation approach, but with several key differences


Root Cause Analysis

Step 1 – Gather initial informationStep 2 – Fill in the gapsStep 3 – AnalysisStep 4 – Action plan developmentStep 5 – Evaluation of results




Root Cause AnalysisStep 1 – Gather Initial Information

Immediate data gathering; get the facts first Focus on what happened, not “who did it” Keep an open-minded attitude




Root Cause AnalysisStep 1 – Gather Initial Information

What to watch out for:Emotions of grief and fear altering perceptions during interviewsRote responses assigning blame or denying responsibilityMaking assumptions about the cause




Root Cause AnalysisStep 2 – Fill in the Gaps

Discuss the incidence as a teamIdentify gaps and reconcile differences of viewsGather more informationInvestigate the scene of the incident and any involved equipment

Source: Oregon Patient Safety CommissionCopyright © 2013 All Rights Reserved 78



What to watch out for:Leaving gaps in informationRote responses assigning blame or denying responsibilityMaking assumptions about the cause





Create a “safe table” for interviewTell the interviewee you will take notes. These notes can be copied and given to the interviewee if he/she would like a copy.Do not use information obtained during the interview for disciplinary action. This should be a separate process if the RCA identifies it as an actual or contributing cause.




Create a “safe table” for interviewBe unbiased and nonjudgmentalDo not interview more than one person at a timeDo not discuss who else will be interviewed or what other interviewees have said




Root Cause AnalysisStep 3 - Analysis

Ask why until you can’t ask it anymore!Review contributing factorsDocumentConduct the “Common Sense Test” on the conclusions or the investigation

Described using specific/objective words?If you eliminate this cause will it go away?Is human error really the cause?If procedure was violated, why?




Focus on finding the most fundamental reasons (the root cause!) for the eventCreate conclusion or findings statements that link the causes to the effect or resultUse statements that lead to strong action plans




What to watch out for:Easy answers that don’t address the fundamental causesStopping at the first or second answer to the question “why”Omitting findings because “we can’t do anything about that”—create an action plan




Root Cause AnalysisStep 4 – Action Plan Development

Develop an immediate plan as well as (if needed) a long or short term planUse the S.M.A.R.T.S. system for action plansDocument the planImplement the planConsider the application of the plan to others




Focus on the most fundamental reasons (the root causes!) for the eventDevelop physical and natural protections/safety systems as much as possibleDevelop preventative actions that keep a different person from the same or similar adverse event




What to watch out for:Setting policies that rely on individuals “trying harder” or “paying more attention”Trying to change people




Root Cause AnalysisStep 5 – Evaluation of Results

Track the implementation How are other residents affected?Measure how each plan is doing and how you will track and trendCelebrate success Did you identify & solve an organizational/system problem?




Root Cause AnalysisStep 5 – Evaluation of Results

What to watch out for:Slippage over time as people return to their old routine Not providing feedback to staff on progressTiring of the measurement



Step 12: Take Systemic Action

Implement changes that will result in improvement or reduce the chance of an event recurringChoose actions that are tightly linked to the root cause and lead to a system or process changeCorrective action should target the elimination of the root cause



Pilot test the change in one area of your facility before launching facility-widePilot testing gives the team the opportunity to correct unintended consequences of the changeChoose strong methods of corrective action for facility policy to increase success



Weak corrective actions rely on staff to remember their training or what is written in policy

Double-checksWarnings/labelsNew policies/procedures/memorandaTraining/educationAdditional study



Intermediate corrective actions are somewhat dependent on staff remembering to do the right thing, but they provide tools to help staff to remember or to promote clear communication

Decreased workloadSoftware enhancements/modifications



Intermediate corrective actions (Cont.)

Eliminate/reduce distractionChecklists/cognitive aids/triggers/promptsEliminate look alike and sound alikeRead backEnhanced documentation/communicationBuild in redundancy



Strong corrective actions do not depend on staff to remember to do the right thing

Change or re-design the processDetect and warn so there is an opportunity to correct before the error reaches the patientHard stops which will not allow the process to continue unless something is corrected



Strong corrective actions (Cont.)Physical changes in environmentForcing functions or constraints (different connection ports so only the correct line will connect)Electronic Medical Records (cannot proceed until all fields filled in)Simplifying (unit dose packaging)


Group Activity

See Handouts for the Group Activity ScenarioUse the Goal Setting Worksheet in your Handouts to make a plan for quality improvementWork in small groupsBe creative! There are no wrong answers!


QAPI Principles Summarized

QAPI may not be new for you—build on what you haveQAPI leadership starts at the top with executive management, Board of Directors, Owners or Trustees and includes top management in each homeSystems, Systems, Systems



Involve the people directly working in a process in order to improve that processOrganization-wide inclusion to truly understand what is going onContinuous communication about QAPI throughout the organization, and built-in to an educational effort that involves caregivers, residents, and familiesCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 100


Residents’ perspective is key in setting QAPI priorities for PIPsTwo key activities are setting priorities and chartering PIPs, and everyone should have the opportunity to participate in bothCreate a log of your QAPI activitiesCelebrate and reward success!


Benefits of a QAPI Program

Competencies that equip you to solve quality problems and prevent their recurrenceCompetencies that allow you to seize opportunities to reach new goalsFulfillment for caregivers, as they become active partners in performance improvement (“buy in”)Better care and quality of life


The Demonstration Project States

CaliforniaFloridaMassachusetts Minnesota


Demonstration Activities

Develop and implement QAPI plansParticipate in virtual and in-person meetingsReceive tools and resourcesOffer feedbackGenerate best practice ideas



Expectations of the demonstration participants:

Implement all elements of QAPIProvide an environment that encourages quality improvementDevelop systems to identify problems and address themConduct quality improvement projects



Benefits to participants:A liaison to assist each facilityTechnical assistanceOn-line instructionLearning collaborative Early access to tools


Getting Ready for QAPI

Nursing Homes can use a variety of resources to select their Performance Improvement GoalsMany tools are available online, free of chargeThese tools can be used to develop a facility-specific plan


Advancing Excellence in America’s Nursing Homes Goals

The Advancing Excellence in America’s Nursing Homes campaign is designed to improve the quality of life for both nursing home residents and the staff who serve themTo participate, a nursing home will voluntarily pledge to work on three or more goalsGoals were updated August 2013Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 108



Process Goals:Increasing Use of Consistent AssignmentSafely Reducing HospitalizationsIncreasing Person-Centered Care Planning and Decision MakingImproving Staff Stability



Clinical Outcomes Goals:Preventing and Managing Infections Safely (C. diff)Using Medications AppropriatelyIncreasing Resident MobilityDecreasing Symptoms of Pain Reducing the Prevalence of Pressure Ulcers



The Advancing Excellence campaign uses a model called The Circle of SuccessSee HandoutsAspects of this model correlate well with the QAPI 12 StepsFacilities can begin their QAPI journey by participating in the Advancing Excellence campaign



Advancing Excellence in America’s Nursing Homes - Goals for 2012

Check the Excellence in America’s Nursing Homes Web site for updated tools to assist you in your efforts: www.nhqualitycampaign.org


http://www.nhqualitycampaign.org/

Consider Quality Indicator Survey (QIS) Tools as QAPI Data Sources

Available at www.QTSO.org Use tools consistently and without biasGo beyond Stage I toolsStage II tools help ensure in-depth investigation


http://www.qtso.org/

The DPOC Model:Great for Problem Solving

DPOC = Directed Plan of CorrectionAssessment of causative factorsSteps/interventions undertakenTriggers/parameters to signal an evolving problemHow the facility will measure the success of its efforts


Final Thoughts…

“Excellence is an art won by training and habituation. We do not act rightly because we have

virtue or excellence, but we rather have those because we have acted

rightly. We are what we repeatedly do. Excellence, then, is

not an act but a habit.”

-AristotleCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 115

Final Thoughts…

The goal of providing the best possible quality of care and life for those entrusted to our care does not changeSuccess depends on us evolving and always striving to redefine and achieve excellenceSuccessful QAPI will not be a department, it will be a way of life in the organization Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 116

References

Nursing Home Quality Assurance & Performance Improvement (CMS) website http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/NHQAPI.html CMS Advancing Excellence In America’s Nursing Homes website http://www.nhqualitycampaign.org/


http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/NHQAPI.html



http://www.nhqualitycampaign.org/


References

S&C Letter Quality Assurance and Performance Improvement (QAPI) in Nursing Homes- Activities Related to QAPI Implementation http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-12-38.pdf


http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-12-38.pdf





References

Root Cause Analysis Materials for Long Term Care Facilitieshttp://oregonpatientsafety.org/healthcare-professionals/nursing-homes/root-cause-analysis-materials-for-long-term-care-facilities/283/


http://oregonpatientsafety.org/healthcare-professionals/nursing-homes/root-cause-analysis-materials-for-long-term-care-facilities/283/




References

QAPI at a Glance guide http://newsmanager.commpartners.com/fhca/downloads/SC13-05%2002_%20attach_QAPI%20at%20a%20glance%204.pdfS&C Letter dated 12-14-12 http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-05.html


http://newsmanager.commpartners.com/fhca/downloads/SC13-05%2002_%20attach_QAPI%20at%20a%20glance%204.pdf



http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-05.html





References

Quality Improvement Organization (QIO) http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html?redirect=/qualityimprovementorgs/


http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html?redirect=/qualityimprovementorgs/





Questions/Answers

Beckie Dow, RN, [email protected] Healthcare International1 (800) 530 – 4413www.Harmony-Healthcare.com


Harmony Healthcare InternationalHave you Considered a Customized Complimentary

HARMONY(HHI) MEDICARE PROGRAM EVALUATION

or CASE MIX ANALYSIS

for your Facility?Perhaps your facility has potential for additional

revenue Benchmark your facility against key indicators and

national norms

Email us at for more [email protected]

Analysis is cost & obligation freeHarmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 123

mailto:[email protected]