NH Quality Care Collaborative Mission Statement:

2. NH Quality Care Collaborative Mission Statement: The National NHQCC and its partners seek to ensure that every nursing home resident receives the highest quality of care. Specifically, the collaborative strives to: • Instill quality and performance improvement practices • Eliminate healthcare acquired conditions • Dramatically improve resident satisfaction by July 31, 2014

3. NHQCC: Local Initiative • Select group of Tennessee nursing homes, committed to this national initiative, working together for 18 months to test systems of change TN

4. Today’s Objectives • Understand the first 2 elements of QAPI: Design and Scope and Governance and Leadership • Understand the difference between a vision statement and a mission statement • How to align your vision and mission statement with a Performance Improvement Project (PIP) • Apply QAPI elements 1 and 2 to your organizational initiatives and culture

5. QAA Historical Perspective • OBRA 1987, established first quality of care legislation and defined Quality Assessment and Assurance (QAA F-520) as a: • Management process that is “ongoing, multi-level and facility-wide” • Framework for evaluating systems • Enforcement system for noncompliance

6. QAA Historical Perspective (cont.) • 2007 Kaiser Family Foundation Report recounts that the Administration on Aging National Ombudsman System received: • Over 230,000 complaints in 2005 concerning nursing facility residents’ quality of care, quality of life or residents’ rights • Citations for one or more deficiencies in 2006 for over 90% of all certified facilities • One-fifth were cited for deficiencies that caused harm or immediate jeopardy to its residents

7. QAA Historical Perspective (cont.) American Health Care Association (AHCA), released 2011 Annual Report: • New strides in quality of care reporting improvements in 9 out of 10 quality measures • Steady decline in health facility survey citations and facilities cited for substandard quality of care

8. QAA Historical Perspective (cont.) • “While things are moving in the right direction and people on average are making improvements, not everyone is making improvements.” • — David Gifford, MD, MPH, Senior VP of Quality and Regulatory Affairs • AHCA

9. QAPI: Background • Requirement of the Affordable Care Act enacted in March 2010 • Legislation requires CMS to establish QAPI program standards and provide technical assistance to nursing homes • Opportunity for CMS to develop and test QAPI technical assistance tools and resources before the rule promulgation

10. Transformational Change • CMS is challenging providers to create an environment that promotes transformational change • This occurs through collaboration, partnership and commitment to shift paradigms to a person-directed care approach to quality improvement

11. QAPI: Framework • QAPI does not refer to a program; rather, it is the way we do our work • The ability to think, make decisions and take action at the system level is a prerequisite for QAPI success

12. 5 Elements of QAPI Design and Scope Clinical care, quality of life, resident choice and care transitions Governance and Leadership Leadership working with staff, residents and families on QAPI Feedback, Data Systems and Monitoring Design, implementation, and monitoring of care and services Performance Improvement Projects (PIPs) Specialized projects of focus centered around a particular opportunity for improvement or conducted facility-wide Systematic Analysis and Systemic Action A systematic approach to reviewing process and outcomes measures

13. 5 Elements of QAPI (cont.) Design and Scope Should address clinical care, quality of life, resident choice and care transitions Utilize the best available evidence to define and measure goals Written QAPI plan adhering to these principles

14. 5 Elements of QAPI (cont.) Governance and Leadership Administration of the NH develops and leads a QAPI program Administration supports working with and obtaining input from facility staff, as well as from residents and families Leadership should be responsible for sustaining QAPI, setting expectations around resident’s safety, rights choice and respect Staff are held accountable, but do not feel they will be punished for errors so as to not fear reporting quality concerns

15. Building Blocks for QAPI - Facilitators Beverly Patnaik Charla Long P. Elaine Griffin

16. Next Steps….

17. Breakthrough Collaboration: Blueprints The TN NHQCC collaborative series will follow this plan

18. Breakthrough Collaboration: Learning Sessions (LS) • All teach, all learn event • Highly interactive, engaging • Opportunity to learn from a set of strategies and change concepts • Existing and fun educational experience

19. Breakthrough Collaboration: Action Periods (AP) • The time between Learning Sessions • Conduct tests of change • PDSAs • Implement and spread improvements • Inside and outside of facility • Measure and report results • Sharing calls • Tracking tools • Storyboard

20. Breakthrough Collaboration: Outcomes Congress (OC) • Celebrate • Share lessons learned • Share sustainability concepts • Share spread concepts

21. Action Period 1 (July thru September) • July through September you and your QAPI team will be… • Participating on monthly coaching calls hosted by the Qsource NH Team • Meeting with your QAPI team to review brief podcasts that will assist you in achieving your goals and QAPI structure • Providing Qsource with a monthly progress report via Survey Monkey • Developing a storyboard (see handout for details) • Preparing for LS 2 scheduled for Fall 2013

22. 12 Step Guide, QAPI and Podcasts…oh my! • Say what… • The 12 Step Guide will be a companion to the CMS QAPI At A Glance Toolkit • Podcasts will walk your team through the steps, supporting tools and resources that will assist with the next step • Will not replace QAPI toolkit; it will enhance it and align with the CMS resources already developed • The 12 Step Guide and podcasts will be posted on the NHQCC webpage beginning in late July

23. Podcast Topics: • How to conduct PDSA cycles • How to utilize the CMS Change Package for small tests of change (PDSAs) • How to conduct an effective Root Cause Analysis • How to develop a “living” Storyboard • How to have a productive and effective QAPI team • How to use and track data for your Performance Improvement Project

24. Qsource NHQCC Webpage Hot Topic Tools & Resources: • Antipsychotic Reduction • Dementia Care/Person Centered Care • Consistent Assignment & Staff Stability • Mobility: Falls TN NHQCC webpage http://www.qsource.org/nhqcc/

25. Beth Hercher, CPHQ • Quality Improvement Specialistbhercher@Qsource.org • 901-273-2640

26. Nursing Home Team: • Beth Hercher, CPHQ • bhercher@qsource.org • John Wright, SR, RN, BSN, WCC, BC • jwright@qsource.org • Julie Clark, LPTA • jclark@qsource.org