0. Red Alert – QAPI: Tools and Tips to Enhance QAPI Implementation
Jane C. Pederson, MD, MS
Stratis Health

1. Stratis Health

2. Objectives Discuss the relationship between QA and PI
Describe tools to assist in successful QAPI
Gain practical tips to support QAPI efforts
Identify three personal steps to enhance your readiness for QAPI

3. What is QAPI? Quality Assurance + Performance Improvement
Merger of two reinforcing aspects of quality management

4. Quality Assurance (QA)
Has common focus in LTC
Aims at “assuring” a certain level of performance
Tends to be more retrospective
Looks for variation

5. Quality/Performance Improvement (QI or PI)
Can come from QA findings
Aims at “improving” the level of performance
Tends to be more prospective
Leads to Performance Improvement Projects (PIPs)

6. Is QAPI Really Different?
Nursing homes have pieces in place through QA
QAPI builds out the puzzle

7. Shift in Focus Prospective Systems Initiatives based on facility data
Learn from past but plan forward
Systems
Impact on individual behavior
Initiatives based on facility data
Meet unique needs
Modeled by Leadership

8. QAPI is more than a program – it is an integral part of how work is done in an organization.

9. Five Elements of QAPI Design and Scope Leadership & Governance
Feedback, Data Systems & Monitoring
Performance Improvement Projects (PIPs)
Systematic Analysis & Systemic Action

10. Lay a Solid Foundation
Ask - What should QAPI look like in your organization?
Assess current QAPI readiness
Define goals
Articulate the scope
Create a structure for supporting QAPI

11. Assessing the Foundation
“Quality” has moved beyond the QA committee
“Quality” is not one person’s job
Leadership is actively engaged
Addressing not only clinical care but also resident quality of life and choice

12. A QAPI Leader Leads by Example (whether they intend to or not)
Know (really know) your current culture
How do you balance accountability and expectations while creating a fair and non-punitive environment?
Assess your individual skills, practice and attitudes
Do you gather and use data (input) for decision making?
Do you model a proactive approach to improving performance?

13. Signs of Strong Leadership
QAPI is not an “add-on”
Time and resources are provided
Ongoing training for all staff
People ask, “Why did that happen?” instead of “Who did that?”

14. You can have data without information, but you cannot have information without data. Daniel Keys Moran

15. Collect and Analyze Data
Choose data to collect that reflects your unique organization
Just because data is available does not make it useful
Challenge is turning data into useful information

16. Inventory of Potential Measures Tool

17. Data Management Challenge

18. Signs of Data Converting to Information
Combining data from variety of sources
Creating new measures
Asking, “What is this telling us?” instead of just tracking
Finding opportunities for improvement
Knowing your performance

19. Performance Improvement Projects - PIPs
Creating new systems or processes
Learning from an error or unintended outcome
Root Cause Analysis (RCA)
Proactively improving an existing process
Failure Mode and Effects Analysis (FMEA)

20. The key is not to prioritize what's on your schedule, but to schedule your priorities. Stephen Covey

21. Prioritization Worksheet for PIPs

22. Why Prioritize? Avoids working on “Flavor of the Day”
Forces the team to assess opportunities objectively
Provides rationale for choosing PIPs
Avoids choosing only low-hanging fruit

23. Well Begun is Half Done Keys to a Successful PIP Charter Goal
Resources
People who care

24. PIP Charter Worksheet

25. Tools Can Help Know the common QI tools and how to use them
Process Mapping/Flowcharting
PDSA: Small tests of change
RCA: Cause and Effect Diagrams
FMEA

26. Look for Best Practice Literature Advancing Excellence INTERACT
Institute for Healthcare Improvement
National Nursing Home Quality of Care Collaborative - NNHQCC

27. Don’t Assume Measure the impact of any changes Ongoing monitoring
Process Measures
Outcome Measure
Structural Measures
Ongoing monitoring
Feedback

28. Expect Challenges Skill Building Systems thinking/Critical thinking
Basic QI tools
Data analysis and display
Project management
Teamwork
Documentation

29. Expect Challenges Changing the culture
Receiving resident and family input
Experiencing staff turnover
Feeling regulatory pressures
Breaking old habits

30. What Can You Do? Define the problem before determining a solution
Identify data that is meaningful
Know how to use basic QI tools
Set goals
Don’t get distracted by putting out fires

31. Questions? Jane Pederson 952-853-8575 or 877-787-2847

32. Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities. 
INCLUDE FUNDER CREDIT OR CMS DISCLAIMER:
Prepared by Stratis Health, the Medicare Quality Improvement Organization for Minnesota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 9SOW-MN