QAPI Can Engage Staff and Improve Your LTC Facility

Nell Griffin, EdM, CHC, CPHQ is a Healthcare Quality Improvement Facilitator

At long last, the final rule is final. All of the Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities are to be actively implemented by November 28, 2019.

A key component of active implementation of the final rule is for all staff to be trained and participating in Quality Assurance Performance Improvement (QAPI) activities. All staff participating in quality improvement is a paradigm shift for some nursing homes.

Involved Staff Stick Around

Staff being involved in the changes that impact their duties and working with leadership to modify work hours so time is allotted for training and process improvement activities is a proven strategy to support staff retention.

Research confirms that when staff feel more engaged, valued and involved where they are employed, they are less likely to seek other employment.

An intended outcome of the reformed requirements is to instill high-quality practices in nursing homes certified by the Centers for Medicare and Medicaid Services (CMS). Facilities certified by CMS are partners in the mission to deliver value and results to Medicare and Medicaid beneficiaries and to meet established quality standards.

This also brings opportunities. Nursing homes are assessing their current practices to identify the changes needed to implement the reforms, which include all staff being trained on quality improvement methodologies and becoming active quality improvement participants.

The staff performing the process are the subject matter experts. Without their input, the strong processes necessary to sustain the reformed regulations will be absent.

QAPI Approach and Benefits

QAPI is both an ongoing process improvement method and one of the regulations. The successful implementation of QAPI is a foundation for the successful implementation of all of the reformed requirements.

The QAPI implementation guidebook, QAPI at a Glance, defines QAPI as a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes.

QAPI requires members at all levels of the organization to:

• identify opportunities for improvement
• address gaps in systems or processes
• develop and implement an improvement or corrective plan
• continuously monitor effectiveness of interventions

The guidebook also says, “Once QAPI is launched and sustained, many people report that it is a rewarding and even an enjoyable way of working.” The rewards of QAPI include:

• Competencies that equip staff to solve problems and prevent their recurrence
• Competencies that allow staff to seize opportunities and achieve new goals
• Fulfillment for caregivers as they become active partners in performance improvement
• Better care and better quality of life for residents.

Training Is Vital

The final rule acknowledges that training is an essential element of meeting the regulations and includes specific trainings in the requirements. Included in the regulations is 483.95, Training Requirements.

Although it is not all-inclusive, this regulation lists training topics that nursing homes must provide to staff. After completing these trainings, nursing home staff will be more comfortable in their overall jobs and job expectations. Required training topics are:

• Communication
• Residents’ rights and facility responsibilities
• Abuse, neglect, and exploitation
• Quality assurance and performance improvement
• Infection control
• Compliance and ethics
• Required in-service training for nurse aides
• Required training of feeding assistants
• Behavioral health

To meet this requirement, every nursing home staff member’s job now includes participating in quality improvement. Updating job descriptions to include attending the required trainings and participating in quality improvement activities is an important step.

CMS has provided Examples of Performance Objectives for Job Descriptions and Performance Reviews to help nursing home leaderships accomplish this. Including as many of the training requirements as possible in the new hire orientation program can be a strong improvement.

Knowledge Gaps Can Be Harmful for New Hires

Including the required training topics in new hire orientation can be effective if no knowledge gap is present between the new hire and the current staff with whom he or she will be working.

If new hires complete training and are expected to use skills that current staff have not been trained on or implemented on that unit, an unsustainable social and professional situation is likely to emerge.

Without influence or strong relationships with the current staff to effect change, the new hire will either abandon the training and conform to the current staff’s way of task completion or leave the position.

While meeting the training requirements, it’s a good practice for leadership to use system thinking to help them be mindful of unintentionally creating knowledge gaps that could lead to turnover.

The Quality Improvement Organization (QIO) is a free resource that can help. Each QIO is contracted with CMS to assist CMS certified healthcare provides with their quality improvement efforts and care system updates. QIOs are a component of the healthcare quality improvement system available in each state.

Nell Griffin

Nell Griffin, EdM, CHC, CPHQ is a Healthcare Quality Improvement Facilitator. An experienced LPN and TeamSTEPPS Master Trainer, she has a master’s degree in Educational Policy Studies. She is a Certified Health Coach and a Certified Professional in Healthcare Quality specializing in long term care quality improvement. Her passion is working with LTC facilities to help improve quality activities and sustain effective practices. She can be contacted via her website, I Illuminate, Inc., www.iilluminate.net, which offers training and consulting services.