Alice Bonner:
Across the country, nursing home residents and families are saying that they
want high quality care for themselves or their loved ones. They want an
environment that improves and promotes their quality of life. They also want
nursing home caregivers that are engaged and committed to providing the highest
quality of care to those they serve. And the caregivers who work in Nursing
Homes want to work in a facility where they are valued and have a voice in
improving the care and services they deliver.
I'm Alice Bonner, Director of the CMS Division of Nursing Homes. Quality
Assurance and Performance Improvement, or QAPI, can make these goals a reality.
QAPI represents an important transformation in the way we deliver health care in
nursing homes. It's a shift in emphasis to creating quality proactively, rather
than reacting to adverse events or responding to regulators. It's an approach
where problems can be detected before they become serious, where underlying
causes of persistent problems are identified, and where changes are made to
systems in order to sustain improvement. It is an environment where residents
and caregivers are engaged in bringing forward opportunities for improvement.
Thomas Hamilton, the Director of the Survey and Certification Group here at CMS,
will give us some background on QAPI.
Thomas Hamilton:
The Affordable Care Act, passed in March of 2010, requires CMS to develop a
Quality Assurance and Performance Improvement regulation and establish a
national program for providing technical assistance to the nation's nursing
homes.
We are excited about this transformative initiative. This is one of the first
times that a statute has required technical assistance to provide and test the
regulation before it is promulgated.
Since passage of the Affordable Care Act, we have been testing tools and
approaches to technical assistance that we believe will help nursing homes
develop best practices in QAPI. CMS expects to make these tools and technical
assistance available over the next two years. Together, we can improve the
quality of care for all those living in America's Nursing Homes. Thank you.
Narrator:
To help providers understand and implement QAPI, we established a framework that
we refer to as the 5 elements.
Element 1 is Design and Scope -this addresses the design and scope of your QAPI
plan, and means that your plan should be comprehensive and include all the care
and services your facility provides, while balancing safety and quality of care
with resident choice and autonomy.
QAPI is not just about nursing or about food or the kitchen - it involves every
single aspect of the care and services provided by the nursing home.
Element 2, Governance and Leadership, addresses the expectation that the
executive leadership of your facility must be actively engaged and involved in
QAPI; this is more than just stating the commitment - it must be real, visible
involvement at all levels.
Element 3, Feedback, Data Systems and Monitoring - this element emphasizes the
establishment of systems for proactively identifying and using data to measure
performance and identify opportunities for improvement;
Element 4 is Performance Improvement Projects, this element builds on the other
elements to ensure that opportunities for improvement found in all departments
throughout the facility, are prioritized and incorporated into performance
improvement projects;
Element 5, Systematic Analysis and Systemic Action addresses two basic themes.
Using a systematic, formal process for analysis, such as Root Cause Analysis;
and then, ensuring that actions are taken to address changes or improvements to
the system.
For a full definition of each element, go to our webpage.
Alice Bonner:
So, why should nursing homes get involved? Why is QAPI of value? We've asked
ourselves these same questions.
What's in it for those nursing homes who embrace QAPI..., is it simply
regulatory compliance? We've also asked experts in Nursing Home Quality and the
nation's leaders this same question.
Let's hear what's in it for nursing homes who embrace QAPI from a few of our
partners.
Carol Benner:
The benefits of this improvement really pay off for the nursing home. Care is
better, quality of life is better. The census goes up. The nursing home saves
money and most importantly, the nursing home becomes a better place for
residents to live for staff to work and for consumers and families to visit.
It's a "win win" for everybody.
Cheryl Phillips:
QAPI will help guide nursing homes to frame what is most important for quality
improvement in their own community, but there's also some other important areas
that QAPI translates into a business plan. It improves staff satisfaction. When
things are working well, when staff know the goals and expectations and are
together engaged in process improvement they are more aligned and more invested.
And most importantly QAPI improves care and quality and experience of the
residents, thus the resident turnover is less, costly expensive care related to
negative outcomes is less. So when you look at each of these elements it
differentiates quality for the nursing home, it enhances staff engagement, it
improves quality and reduces unnecessary costs for residents. All of those
things pull together to the equation of a strong business argument for QAPI in
the nursing home.
David Ferrell:
QAPI's a great value because it provides our profession with a scientific
process of how to make effective change in complex organizations like skilled
nursing facilities. I'm an administrator. I'm charged with making effective
change. QAPI insures that by following that process the changes that we make are
more likely to stick and to be effective.
David Gifford:
Some facilities are aware of QAPI, others are not aware of QAPI. I think the
confusion I hear is that, "is this an additional program
that I have to add to everything I do everyday?". This is not an additional
program. It is changing the way we do and provide our care in the facility so we
have better outcomes. That is going to be a benefit to everyone.
Alice Bonner:
Now that you've seen the possibilities created by applying QAPI principles in
your nursing home, how can you establish an environment where QAPI will thrive?
Well, it starts with leadership.
Carol Benner:
To make the transition from quality assurance to performance improvement, the
nursing home leadership will need to totally buy in to the process. The
leadership is going to have to embrace QAPI and involve all of the staff in all
operations of the nursing home.
David Ferrell:
People are excited to be a part of a process of improvement in my organization.
They're thrilled to be asked questions. Good leaders ask a lot of good
questions. QAPI reminds me that my role in the organization is to lead with
questions not with answers.
The feedback I've received from my staff is excitement about being included in
the process. The feedback that I've received from my staff is excitement about
knowing the score and understanding the metrics of which we're measured. My
staff is thrilled to be serving on committees to improve quality of care and
quality of life. My managers and I see now that the answers are with our staff,
our families and our residents themselves.
Thomas Hamilton:
Thank you for your interest in the key elements of QAPI. And most importantly,
thank you for your dedicated work, every day, to ensure that each nursing home
resident attains the highest practicable physical, mental, and psychosocial well
being. Those are the very words of the Social Security Act, and we hope this
QAPI initiative will help nursing home staff, owners, residents, and families
fulfill that mission. Stay tuned for additional communications from CMS and our
partners, as we all work to help nursing homes provide the best quality of care
possible.
Alice Bonner:
For more information about QAPI please explore the rest of our website. You'll
find tools, resources, and other information to help put QAPI in action in your
nursing home. By applying QAPI principles, we truly believe that it will
transform the lives of nursing home residents through continuous attention to
quality of care and quality of life.