1. QAPI: Basic Building Blocks Governance & Leadership Beth Hercher, CPHQ June/July 2013

2. 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 NH Quality Care Collaborative Mission Statement:

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

4. 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 Today’s Objectives

5. 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 QAA Historical Perspective

6. 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 QAA Historical Perspective (cont.)

7. 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 QAA Historical Perspective (cont.)

8. “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. 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 QAPI: Background

10. 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 Transformational Change

11. 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 QAPI: Framework

12. 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 5 Elements of QAPI

13. 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 5 Elements of QAPI (cont.)

14. 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 5 Elements of QAPI (cont.)

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

19. 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 Breakthrough Collaboration: Action Periods (AP)

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

21. 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 Action Period 1 (July thru September)

22. 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 12 Step Guide, QAPI and Podcasts…oh my!

23. 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 Podcast Topics:

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

25. The presentation and related material was prepared by Qsource, the Medicare Quality Improvement Organization (QIO) for Tennessee, under a contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the Department of Health and Human Services (HHS). Contents do not necessarily reflect CMS policy. 13.IPC-HAC.06.024 Beth Hercher, CPHQ Quality Improvement Specialist bhercher@Qsource.org 901-273-2640

26. The presentation and related material was prepared by Qsource, the Medicare Quality Improvement Organization (QIO) for Tennessee, under a contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the Department of Health and Human Services (HHS). Contents do not necessarily reflect CMS policy. 13.IPC-HAC.06.024 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