Quality Assurance and Performance Improvement (QAPI) programs are essential to a successful home health agency. In fact, it’s been a required process in nursing facilities since the introduction of the Affordable Care Act in 2010. QAPI programs combine all the elements of quality assurance and performance improvement to ensure that facilities meet best practices and care for residents and staff.
Why QAPI?
Before 2010, quality assurance (QA) and performance improvement (PI) often functioned separately. QA focuses on quality of service related to set company standards. Facilities must closely examine areas they might be underperforming in or risk underperforming in. PI is about identifying improvement areas and bringing up quality before problems arise. Better performance equals better care for residents and a better workplace for staff.
The two management systems merged in March 2010 under provisions in the Affordable Care Act. The provisions aimed to set and maintain high standards in nursing facilities to ensure the best care possible. CMS established a list of QAPI regulations for facilities to follow when setting up their plans. Fortunately, CMS also compiled many QAPI tools to assist in planning and compliance including these twelve steps.
The Twelve Steps to Implement QAPI
Before you start any journey, you take a look at the map, right? Knowing where you’re going and how to get there saves time and money. Learning these twelve steps now, before you get started, will make the overall job easier in the long run.
- Leadership Responsibility and Accountability
To impress upon your staff how important your QAPI program is, the culture should be developed from the top. With leadership on board, participation from every caregiver is more likely. Consider a steering committee to get more people involved in developing the program from the ground up. Invest in the equipment and training necessary so your staff has everything they need. And provide an environment where communication is possible so you always get helpful feedback.
- Develop Your Approach to Teamwork
For best results, everyone must work together. Establish a culture of teamwork, with defined roles for each member of every team. Keep in mind that your teams could include more than just staff members. Family members and even residents could also contribute; they just can’t have access to some data for privacy reasons.
- Conduct a Readiness Assessment
This is a step you will likely repeat often throughout the implementation process. Essentially, you’ll take the assessment at various steps to gauge what you’ve learned and what you still need to master.
- Identify Guiding Principles
By understanding and agreeing on your organization’s guiding principles, your whole team buys into the process and gets a say in setting the priorities so that goals can be met.
- Develop the QAPI
At this point, you’re ready to develop your plan. You’ll need to take into account all units, programs, groups, team members, residents, and care provided to ensure your plan fits your home health organization and addresses all the services your agency provides.
- Grow Awareness
Your QAPI team members have been on board from the beginning, but what about the rest of the staff? This is the step where everyone learns of the program, the plans, the priorities, and the goals. All caregivers should learn to identify quality concerns and report them.
- Collect and Use Data
Data collection is key to tracking performance measures. Health care providers must have a system in place that collects relevant data points related to quality improvement goals and that this data can then be analyzed to determine progress of the QAPI program. Data collection and analysis should be an ongoing process that is reviewed on a regular basis.
- Identify Issues and Opportunities
Establish benchmarks and targets for each measure. This will provide a way of tracking progress towards goals over time. This can also be helpful in identifying areas of improvement and where more attention needs to be directed.
- Prioritize Quality
Search for areas where improvements can be made and begin developing performance improvement plans. Stick to your goals and use those to identify your priorities. Start with easy solves because quick wins build confidence and even excitement with the staff.
- Performance Improvement Plans
Every PIP should be a learning opportunity. Take them all very seriously, with solid planning and execution, and documentation of all steps and outcomes.
- Perform a Root Cause Analysis
Sometimes issues are indicative of deeper problems within the organization. Use your PIPs to identify possible root problems that could be contributing to several different quality issues in the organization. By identifying the main problem, you’ll solve several smaller ones at one time.
- Develop New Systems
As you work to implement your QAPI program, you’ll discover new systems that can be introduced to reduce the chances that issues will reoccur. As more systems are introduced, quality will soar.
There’s a thirteenth step, but it’s not part of the official CMS guidelines. That step is to reach out to Forte Consulting Group so we can help you through every step of this process. We’ve consulted with hundreds of home health and hospice care leaders to implement solid QAPI processes, and we can do the same for you.
