Eli's Hospice Insider

Make the most of this Medicare-mandated program by fostering staff involvement.

Gathering data is only the first step in building your Quality Assessment and Performance Improvement (QAPI) program. Using that data to uncover simple improvement steps can help you quickly and efficiently improve outcomes.

Know these QAPI Requirements

The basics of a hospice QAPI program are simple, says Charlene Ross, MBA, MSN, RN with R&C Healthcare Solutions in Phoenix, AZ.

Your hospice must:

• Be able to show that it can improve quality, patient safety and outcomes,

• Decide how it wants to measure improvement (related to patient care and hospice operations)

• Track adverse events (reduce the amount of adverse events when possible)

All patient services and all activities that impact patient/family care must be examined as part of the QAPI program, Ross says.

Your hospice must use the data collected to:

• Monitor the effectiveness and safety of services and quality of care

• Identify opportunities and priorities for improvement

How do you move beyond simply gathering and examining data? How do you get staff involved and make QAPI a part of their job?

Take an organizational approach to QAPI, Ross says. With this method, everyone at every level is involved: senior leaders, managers, clinical staff, and administrative staff. And every problem becomes an opportunity to learn and improve

Key: Staff must know that what they do makes a difference.

Change your mindset: One winning technique of the organizational approach is to follow a rapid cycle improvement process. In such a process, you use the data to identify a problem, get a group together to determine what needs to change, make those changes, observe the results, and act on what you learn.

For example: Suppose the data you gather shows that there are problems with hospice aides following the plan of care, Ross says. The best people to figure out a fix would be a couple of nurses who create the POCs and a couple of aides who should follow that POC. Gather these staff members together to brainstorm.

Start with Small Changes

Don't look at too big a problem, Ross says. For example "Staff can't case manage" is too far-reaching an issue. Break this problem down into a smaller issue that can be readily addressed, such as what is showing up in the on call log. You might discover that the bulk of the calls you receive stem from caregivers wanting to know when staff will visit next. You can act on solving this problem easily by providing patients with a staff schedule.

Tip: Have a quality bulletin board that shows your data -- good and bad. Also show your quality improvement efforts -- celebrate the good and bad.

Make Time for Quality

Giving staff time to help with quality shows that you value their input and helps create an organizational effort. If you want to hold a brainstorming session, make sure the participants' patients are covered so that staff doesn't don't have to go back to see patients after the session.

And make sure that when staff makes suggestions, the suggestions get heard. It's frustrating to work to develop a solution to a problem only to see it go unused and unacknowledged.