Steps to QAPI

Working to improve the quality of care delivery to nursing home residents.

STEP 1: Leadership Responsibility and Accountability

Ways in which leadership can take action:

  • Develop a steering committee, a team that will provide QAPI leadership
  • Provide resources for QAPI – including equipment and training
  • Establish a climate of open communication
  • Understand the organizations current culture and how it will promote performance improvement

STEP 2: Develop a Deliberate Approach to Teamwork

Generally, each team should be composed of inter-disciplinary members.

STEP 3: Take your QAPI “Pulse” with a Self-Assessment

In order to establish QAPI in your organization, it is helpful to conduct a self-assessment in your organization. Use the self-assessment tool to take your QAPI “pulse.” It will assist you in evaluating the extent to which components of QAPI are in place within your organization and identifying areas requiring further development.

STEP 4: Identify Your Organization’s Guiding Principles

Taking time to articulate the organizations purpose, develop guiding principles, and define the scope will help you to understand how QAPI will be used and integrated into your organization. This information will also help your organization to develop a written QAPI plan.

STEP 5: Develop Your QAPI Plan

A written QAPI plan guides the nursing home’s quality efforts and serves as the main document to support implementation of QAPI. The plan describes guiding principles that will be used in QAPI as well as the scope QAPI will have based on the unique characteristics and services of the nursing home. The QAPI plan should be something that is actually used and not viewed as a task that must be completed. You should continually review and refine your QAPI plan.

STEP 6: Conduct a QAPI Awareness Campaign

Let everyone know about your QAPI plan – often and in multiple ways.

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

Your team will decide what data to monitor routinely. This data will require systematic organization and interpretation in order to achieve meaningful reporting and action. Otherwise, it would only be a collection of unrelated, diverse data and may not be useful. You’ll want to develop a plan for the data you collect. Determine who reviews certain data, and how often. Collecting information is not helpful unless it is actually used. Be purposeful about who should review certain data, and how often – and about the next steps in interpreting the information.

STEP 8: Identify Your Gaps and Opportunities

This step involves reviewing your sources of information to determine if gaps or patterns exist in your systems of care that could result in quality problems. Or, are there opportunities to make improvements.

STEP 9: Prioritize Quality Opportunities and Charter PIPs

Prioritizing opportunities for improvement is a key step in the process of translating data into action. As you continue to implement QAPI, you and your team will:

  • Prioritize opportunities for more intensive improvement work. Problems versus opportunities are a matter of perspective and often a discussion is in order.
  • Choose problems or issues that you consider important (consider if the issue is high risk, high frequency, and/or problem prone).
  • Consider which problems will become the focus for a Performance Improvement Project (PIP).

STEP 10: Plan, Conduct and Document Performance Improvement Project (PIPs)

Careful development of performance improvement plans includes identifying areas to work on through your comprehensive data review which are meaningful and important to your residents. Try out some changes and then see whether or not they made a difference in the area you were trying to improve (PDSA).

STEP 11: Getting to the "Root" of the Problem

The systematic process for identifying contributing causal factors that underlie variations in performance. A structured method of analysis designed to get to the underlying cause of a problem – which then leads to identification of effective interventions that can be implemented in order to make improvements.

STEP 12: Take Systemic Action

Identifying root causes is only the first step in improving performance. Next you will want to implement changes or corrective actions that will result in improvement or reduce the chance of the event recurring. The goal is to make changes that will result in lasting improvement. Avoiding quick fixes and weak actions is vital to achieving that goal. To be effective, interventions or corrective actions should target the elimination of root causes, offer long term solutions to the problem, and have a greater positive than negative impact on other processes. In addition, interventions must be achievable, objective, and measurable.

As you can see from Scenario 2, many of the Key QAPI Action Steps are built-into the plan:

  • The facility had a structured Steering Committee for directing the QAPI activities (Responsibility and Accountability)
  • The facility established performance measures and was conducting routine monitoring (Awareness)
  • The facility used data to identify gaps or opportunities for improvement (Identify Gaps and Opportunities)
  • The QAPI Steering Committee used prioritization to decide when to conduct PIPs (Prioritize Quality Opportunities)
  • The QAPI Steering Committee created an interdisciplinary team, and as seen in this example, each discipline in the team brought a unique perspective that contributed to a balanced and comprehensive analysis (Teamwork)
  • The QAPI Steering Committee gave each team member real responsibility to study the issue, analyze the data, and recommend corrective actions (Teamwork)
  • The PIP team explored the issue, and designed interventions using a Plan-Do-Study-Act (PDSA) model (Plan, Conduct, and Document)
  • The PIP team’s investigation revealed several underlying systemic issues and made recommendations that addressed those systems, rather than focusing on individual behavior (Take Systematic Action)

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Pauline Kinney, RN, MA, LNHA, RAC-CT
Senior Director, Health Care Quality Improvement
Tel: (516) 209-5402
Fax: (516) 326-0434
pauline.kinney@area-I.hcqis.org

Maureen Valvo, RN, BSN, RAC-CT
Senior Quality Improvement Specialist
Tel: (516) 209-5308
Maureen.valvo@area-I.hcqis.org

David L. Johnson, NHA, RAC-CT
Senior Quality Improvement Specialist
Tel: (518) 320-3516
David.johnson@area-I.hcqis.org

Dan Yuricic, MA
Senior Quality Improvement Specialist
Tel: (516) 209-5458
Danny.yuricic@area-I.hcqis.org

IPRO Nursing Home Team
ipronursinghometeam@ipro.org