Nursing Home Quality Improvement


To improve and sustain systems of person-centered care that result in positive resident outcomes and a rewarding job experience for staff, nursing homes need a resident focus,  empowered and well-trained staff, strong leadership, data informed practice, and effective interdisciplinary teamwork within a just culture. These key concepts are embodied in the following organizational areas which include tools and resources to help you improve and strengthen your systems of care.

The ACE Best Practices, a summary of recommendations and lessons learned from nursing homes participating in the last ACE series, provides excellent information on leadership presence, staff stability, consistent assignment, huddles, antipsychotic medications, hospital readmissions, and falls/mobility/alarms.

The Nursing Home Quality Care Collaborative Change Package is intended for nursing homes participating in the National Nursing Home Quality Care Collaborative (NNHQCC) to improve care for the millions of nursing home residents across the country. This change package focuses on the successful practices of high-performing nursing homes including two South Carolina facilities, NHC Healthcare – Anderson and NHC Healthcare – Parklane.

Consistent Assignment

Consistent or dedicated assignment means that the same nursing assistants and nurses care for the same residents every day that they work. On-going consistent assignments are the foundation for high quality individualized care and effective teamwork. When frontline staff know the resident and their baseline, they can anticipate needs and detect early acute changes. When frontline staff work on the same teams with the same residents each day, they can problem solve in real time to implement interventions more easily and quickly. Research shows that the consistent assignment of nurses and nursing assistants improves clinical outcomes of residents as well as workforce outcomes such as staff attendance and satisfaction. Dedicated assignments transform caregiving tasks into relationship-based care.

Tools and Resources

Determination of Resident Acuity Level and Process for Fair Assignment

This tip sheet outlines a process to determine resident acuity level and tips for ensuring fair assignment.

Advancing Excellence Consistent Assignment Goal

The Advancing Excellence (AE) in America’s Nursing Homes website includes consistent assignment as one of nine goals. Experts have developed a tracking tool for tracking consistent assignment and resources including a video on the impact of consistent staff assignment in nursing homes. Click here to access this information.


Strong leadership skills are the foundation for providing quality care in nursing homes. Kuzes and Pozner in their book, The Leadership Challenge, describe the five practices found in dynamic leadership.

  1. Model the way
  2. Inspire a shared vision
  3. Challenge the process
  4. Enable others to act
  5. Encourage the heart

High performing nursing homes have strong leaders that use these practices. In the tools and resources that follow, you will find simple methods to use in your facility that embody these practices.

Tools and Resources

All Hands on Deck

This model for leadership to check in and help the frontline during busiest times is from Meeting the Leadership Challenge in Long-Term Care: What You Do Matters by David Farrell, Cathie Brady, and Barbara Frank. It is an excellent way to reduce staff stress through active support and involvement. Facilities that implement All Hands on Deck report great success and enhanced teamwork across all staff levels.

Everyone Stands Up Together

Everyone Stands Up Together takes the management team’s morning stand-up meeting out to where staff closest to the resident work so that CNAs, nurses, and managers meet at the same time to share information needed by everyone.

Stabilizing Staff

Staff stability is key to providing quality care in nursing homes. Where there is high turnover, resident outcomes suffer and staff are disadvantaged in multiple ways. Good hiring practices, attendance policies, scheduling methods, and assignment practices are effective methods to stabilize staff.

Tools and Resources

Hiring Well: Key Questions David Farrell Asks in Initial Interviews

David Farrell shares his interview questions that gather critical information for making informed hiring decisions.

Providing On the Job Support for Newly Hired Nursing Assistants
A large percentage of nursing assistants quit during the first three to six months on the job citing lack of support as the primary reason. Strong orientation of sufficient length and continued support within a stable team are key to reducing turnover of new hires.

Attendance, Scheduling, and Assignments

This is a comprehensive summary of the content found in the Staff Stability Toolkit prepared by B&F Consulting for HealthCentric Advisors. It includes effective attendance policies and practices, scheduling methods, assignment practices, and a positive chain of leadership.

Advancing Excellence Staff Stability Goal

The Advancing Excellence (AE) in America’s Nursing Home website includes staff stability as one of nine goals. Experts have developed a tracking tool for tracking monthly turnover rates for nursing assistants, registered nurses, and licensed practical nurses as well as processes related to staff stability. Resources include job satisfaction scales and measurements. This website includes multiple other tools and resources to assist with orientation programs and creating a culture of retention. Click here to access this information.

Teamwork and Real Time Problem-Solving

Teamwork is critical to positive outcomes for both residents and staff. When staff work together to problem solve in real time, resident needs can be anticipated and challenges responded to quickly. Staff feel supported and better care is achievable when staff members know that “pitching-in” and working together are part of their culture.

Tools and Resources

Team Huddles

Pioneer Network Shift Huddles Tip Sheet

Huddles are an excellent way to communicate information quickly while ensuring that the right staff are present who can respond to challenges.


Cardiovascular Health
Cardiovascular Health (DC)
Cardiovascular Health (NY)
Cardiovascular Health (SC)
Care Coordination
Care Coordination DC
Care Coordination NY
Beneficiaries and Families
Healthcare Professionals
Other Website Resources
Tools and Resources
Past Success
Upcoming Events
Past Events
Contact Us
Care Coordination SC
Community Based Sepsis
Educational Webinar Programs
Sepsis in the News
Tools and Resources
Diabetes Self-Management
EDC Foot Care Campaign
Diabetes Self-Management Education (DC)
Diabetes Self-Management Education (NY)
Drug Safety
Anticoagulation Safety
Hypoglycemia Avoidance
Opioid Safety
Opioid Safety (DC)
Opioid Safety in Community Pharmacy
Drug Safety (DC)
Drug Safety (NY)
Drug Safety (SC)
Immunization (DC)
Immunization (NY)
Immunization (SC)
SC Immunization Coalition Materials
Nursing Home Quality
Nursing Home Quality (NY)
QAPI Self-Assessment
Eliminating Inappropriate Antipsychotic Medication Use
Clinical Quality Measures (QM)
Composite Measure Score
NHQCC Collaborative I Kick-Off
NHQCC Collaborative I Outcomes Congress
Using a System's Approach to Quality & Performance Improvement
Nursing Home Quality Care Collaborative (NHQCC) Learning
Engaging Staff in Individualized Care
QAPI Self-Assessment and Related Resources
QAPI In Action
Quality Improvement (QI) Resources
Quality Improvement Strategies
Steps to QAPI
Elements for Framing QAPI in Nursing Homes
Clinical Topics
Medication Use Tools & Resources
Pressure Ulcer Clinical Tools & Resources
Restraint Clinical Tools & Resources
Falls with Major Injuries
Health Care Acquired Conditions
Eliminating Long Term Care Re-Admissions Tools & Resources
Nursing Home Quality (DC)
Nursing Home Quality (SC)
ACE e-Newsletter
Clinical Topics
Organizational Change
Presentations and Handouts
Upcoming Events
Outpatient Antibiotic Stewardship
Core Element One: Commitment
Core Element Two: Action for Policy and Practice
Core Element Three: Tracking and Reporting
Core Element Four: Education and Expertise
Quality Payment Program
QPP Support for Large Practices
QPP Support for Small Practices
CMS Webinars & Programs
Request Free Technical Assistance
QPP Education
QPP General Information
Quality Measures
Improvement Activities (IA)
Promoting Interoperability (PI)
Transforming End of Life

Contact Us

Nancy (Libby) Lawson, M.Ed., RN
Quality Specialist
Tel: 803-212-7500 ext. 5619