Like so many other advances, the Quality Assurance and Performance Improvement mandate from the Centers for Medicare & Medicaid Services is both a blessing and a curse for nursing homes. The potential upsides for QAPI are hard to overstate. They include:

  • Expertise growth in troubleshooting quality issues and preventing their return
  • Improved caregiver satisfaction as staff take a more personal stake in outcomes
  • Greater ability to set more aggressive goals and achieve them
  • Significantly higher resident quality of life

The curse aspect? It comes down to accountability and penalties for facilities that fail to meet CMS guidelines. Negative consequences can range from daily fines to loss of star rating and the resulting loss of incoming business, both from searching families as well as hospitals.

Fortunately, while QAPI compliance can be lengthy and detail-driven, navigating QAPI isn’t particularly technical or esoteric. In fact, CMS even provides a playbook of sorts for nursing facilities to follow in the form of its five key elements for effective quality management. Administrators would be wise to study CMS’s QAPI mandate in depth, but for those who want a starting point and an understanding of how software tools can assist with making QAPI compliance a snap, consider the following summary of the five elements and how software tools interplay with them.

Element 1: Design and Scope

CMS says: A QAPI program must be ongoing and cover the facility’s full range of services across all departments. Fully-implemented QAPI, fueled by defined and measurable goals, should address all care and management practices, including clinical care, quality of life, and resident choice, while emphasizing residents’ autonomy and agency. It utilizes the best available evidence to define and measure goals.

QAPI compliance software allows a nursing home to comprehensively evaluate every aspect of its day-to-day operations. It begins with the facility assessment and continues, spanning through clinical care systems, environmental observations, personal funds, and even medical record reviews. Software should enable users to consistently and proactively assesses every component of resident care and service delivery. The resident, family, and staff interviews, along with observations and reviews, help the nursing home gather valuable feedback concerning resident choice and quality of life. By using a full-featured QAPI compliance application as part of its routine QAPI process, nursing home companies can track and benchmark results over time for an individual facility as well as multiple facilities by operational region or the entire organization.

Element 2: Governance and Leadership

CMS says that nursing home leadership should develop a culture wherein leadership seeks input from facility staff, residents, and their families and/or representatives. The governing body also assures adequate resources exist to conduct QAPI efforts, including staff leadership, equipment, training, general accountability, and a culture that sustains QAPI efforts over time and turnover. Their responsibilities include setting expectations around safety, quality, balancing safety with resident-centered rights and choice, and creating an atmosphere where staff is comfortable identifying and reporting quality problems as well as opportunities for improvement.

QAPI compliance software should be available to any staff member for gathering feedback and providing input. By investing in such software, nursing homes help foster a culture of resident, family, and staff empowerment and engagement that goes far beyond the haphazard suggestion boxes of years past. 

Through tasks and investigations coordinated by compliance software, any staff member may identify and report quality problems and opportunities for improvement. Leadership no longer need guess at quality concerns. Instead, compliance software can identify where problems exist and then help management to strategically and cost-effectively align resources to fix those deficiencies.

Element 3: Feedback, Data Systems, and Monitoring

CMS says that a facility puts multi-source systems in place to monitor care and services while also incorporating input from staff, residents, families, and others as appropriate. Performance Indicators help to monitor a wide range of care processes and outcomes which can then be compared against the facility’s performance benchmarks and/or targets. Adverse Events must be tracked, investigated, and investigated every time they occur, and action plans must be implemented to prevent recurrences.

As you would expect, better outcomes follow from pulling data from more sources. Of course, more sources can also mean more tracking and management. Without QAPI compliance software guiding this process, it’s too easy for data gathering and analysis to bog down and fall into disuse. Software should assist with facility assessment, interviews, observations, investigations, and recording of reviews. 

Once all of that data is gathered, the planning application should provide reporting features that allow management to compare results in detail or summary format according to facility, operational region, and company. Reporting should also benchmark results and develop trend line graphing for every aspect of nursing home operations. These analyses can then export into Microsoft Excel or Word to form the basis of performance improvement projects (PIPs) that address and prevent recurrences of quality concerns.

Element 4: Performance Improvement Projects (PIPs)

 A Performance Improvement Project spotlights a particular problem in a facility. It involves systematically gathering information to clarify issues and intervening to create improvements.

As with home improvement projects, for example, sometimes it’s hard to know where to start and just how far problem impacts extend. In nursing facilities, planning software can synthesize data from multiple sources and help identify what specific areas require PIPs and the steps needed to address them.

After completing the mandatory tasks, your software should produce an F-tag report. Based on the type and frequency of F-tags, the software will then recommend relevant investigations. Additionally, the application should allow users to comment on observations and gather feedback that helps them drill down to the problem source. With the problem identified, the facility can use tools within their QAPI software for remediation, including a goal-setting worksheet, PIP template, and/or a meeting minutes form that guides users through developing a PIP and working through its critical components.

Element 5: Systematic Analysis and Systemic Action

 The facility uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, its causes, and implications of a change, especially when problems may be caused or exacerbated by the way care and services are organized or delivered, according to CMS. Facilities will develop policies and procedures and demonstrate proficiency in the use of Root Cause Analysis. 

Systemic Actions look comprehensively across all involved systems to prevent future events, focus on continual learning, and promote sustained improvement.

Everyone understands why reinventing the wheel on projects is a bad idea. You want a system for approaching and executing QAPI the same way every time. Planning software excels at enabling this. 

Even if facility or company management turns over, software-based execution systems help ensures that QAPI will be performed consistently. Ideally, that software should organize along three components: preparation, mandatory tasks, and investigations. Preparation gathers all the required documentation users need to know about the facility, staff, and residents. Mandatory tasks gather input through observations, interviews, and reviews. That input is then filtered to identify areas of concern that warrant in-depth investigations using Critical Element Pathways. Well-executed planning software will guide users through comprehensive examination of all systems related to a quality concern to help identify its root cause and make sure that no related factors go overlooked. In this way, planning software helps train staff to become proficient in identifying problems as well as finding problem root causes. In turn, nursing homes save money by targeting their resources to proactively address areas of concern before those concerns become major problems.

Our cloud-based FoQIS application from FoQIS, LLC serves double duty in both helping nursing facilities to prepare for LTC surveys and in providing an end-to-end tool for the creating, maintenance, and refining of an ongoing QAPI program. While there are several capable QAPI planning tools available today, FoQIS remains the most cost-effective solution free from cumbersome ties to major medical suppliers. Moreover, FoQIS was designed with direct input from nursing home administrators, not a panel of marketers, to deliver exactly what real world nursing facilities need in order to excel with their QAPI efforts in the most streamlined, impactful, and effective way possible.

Jay Hamilton is the founder and CEO of FoQIS, LLC.