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QAPI- What We See and Where It Starts

Why do we perform Quality Assurance Performance Improvement exercises in home care? QAPI started out being a standard only for nursing homes! After seeing that it worked, it became required that Home Health Agencies conduct performance improvement exercises, at least one every year.

QAPI is more than just a task you have to check off your list. It’s a way to creatively problem solve while literally improving the performance of your agency and standards of care. As you read, start thinking about innovative ways to achieve measurable goals and outcomes for your own agency all while enhancing (or beginning) your QAPI processes. Here are some thoughts to get you started!

1. An ounce of prevention is worth a pound of cure!

Let’s break down what’s being measured with QAPI. First, QA is reactive and retrospective, while PI is pro-active and continuous. You’re measuring incidents, infections, client satisfaction, complaints, and other service specific goals like the efficacy of any special programs you provide. The goal is to catch small issues as they happen before anything becomes a major problem.

2. Who’s looking and when?

Once you determine what you need to measure, now consider who should be looking out for those things and how often. This would be your QAPI Committee. Committee members include owners and administrators, office personnel, marketing team members, Human Resources, field staff, clients, family members, and 3rd party organizations. Find out what they’re noticing and get their feedback. All those different perspectives bring insights to the table that you otherwise may miss. This is ultra-valuable feedback for your business and the culture of transparency mentioned above.

Now, determining how often QAPI processes are reviewed depends on the size of your agency. If you have less than 50 clients, annually may suffice; over 100, quarterly may be better to make any necessary corrections.

3. What Are We Looking For?

You’ve figured out who’s looking and when, now… for what! What is it that you’re looking for during the QAPI processes and reviews? You (and your team) will be looking for many different factors that impact our success and ultimately our bottom line:

1. Patterns and trends of performance indicators

2. Problems to solve, hopefully before they become a big problem

3. Opportunities to train and educate staff, clients and families

4. Opportunities to weed out those who don’t live up to the organization’s mission

5. Opportunities to create policies that improve your agency’s overall health and reputation

“I often say that when you can measure what you are speaking about, and express it in numbers, you know something about it…” ~ William Thomson

So when your Marketing staff can say “We have a record of helping our clients to reduce falls and hospitalizations by 80%” - or Your Admissions Coordinator tell potential clients “We’ve been able to reduce staff turnover by 50% in the past year.” All because your QAPI committee identified such goals - WOW! That’s a win for everyone!

4. Look for the Root of The Problem…DIG!

Everything noted above are opportunities for you to dig - looking for the root of any problem no matter how big or small. Ideally you want to catch them in small hurdles before they turn into big ones. One efficient way is to ask “why” 5 times. Don’t just look for symptoms, find out the root of the issue. How far down does it go or how high UP? The problem could be a fundamental practice of the owner. Your hiring manager could be burned out and stopped doing thorough orientations. Ask why is that? How come that happened? Where did this come from and why? Keep going and keeping digging. Just because the beautiful canopy of the tree is on top doesn't mean that there isn’t a problem at the roots!

5. Share Your PI Results!

Results and feedback derived from your QAPI processes are priceless gifts that all help with creating a culture of transparency and honesty among your clients and home care workers. When you come across an issue that may be affecting multiple areas/people in your organization, consider sharing your results with staff and clients - and let them know that you’re being proactive!

Click below for this video on QAPI (Quality Assurance and a Performance Improvement) for Non-Medical Home Care. It doesn’t have to be as complex as CMS makes it out to be! .

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