Engaging Front-line Staff inQuality Assurance &

Performance ImprovementPrepared for: The Members of LeadingAge

Missouri

Presented by: Jeff Wellman, MSHRDChief Operating Officer

National Association of Health Care Assistance (NAHCA)

Presentation Description:CNAs have the potential to play an important role in your organization’s Quality Assurance and Performance Improvement processes. This session will incorporate fundamental elements of QAPI and identify a variety of ways in which your caregivers can and should participate in the pursuit of quality. The audience will be encouraged to share their perspectives and best practices. Participants will come away with specific ideas about how to engage the front-line of care as well as anticipated outcomes.

Presentation Objectives:• Explain the genesis of QAPI.• Differentiate quality assurance (QA) and performance improvement (PI) within LTC.• Identify resources that support QAPI.• Evaluate the advantages and potential barriers related to CNA engagement.• List potential roles for caregivers to play in the QAPI process.• Describe examples of where CNAs are being effectively engaged in the quality journey.• Challenge participants to commit to engaging the front-line of care in root-cause analysis (RCA) and performance improvement projects (PIPs).

LTC Journey Toward Quality

History of Quality Initiatives:

• 1960s – Quality = Structure, Process and Outcomes

• OBRA 87 – Quality = Life & Care (Holistic View of Care)

• ACA 2010 – Quality = Quality Assessment and

Assurance & Performance Improvement (Addresses

both reactive and proactive approaches to quality)

Performance Improvement ResourcesFlorence Nightingale: nineteenth century apostle of quality

Dr. W. Edward Deming: Father of Quality Evolution“Put everybody in the company to work to accomplish the transformation. The transformation is everybody’s job”

QAPI at a Glance: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/QAPIAtaGlance.pdf

CNA Engagement

Advantages:• Operationally engaged• Largest employee group• Intimately committed to

quality• Institutional knowledge• Unique perspective which

spans all three shifts• Cognitively processes on a

practical level• Engagement breeds

ownership• Engaged staff are

statistically more satisfied

Disadvantages:• Potential disruption to

care• Organizations culture• Requires an initial

investment• Not accustom to strategic

processing• Change paradigm • Silo perspective • Peer attitudes

Potential Roles for CNAs in QAPI

• QAPI Champion – Chiefly responsible for chairing the QAPI Steering Committee

• QAPI Steering Committee member• Performance Improvement Project (PIP) – Leader• Root Cause Analysis (RCA) - Leader• PIP Member• PIP Reporter• QAPI/PIP educator (Peer Teacher)

Examples of CNA Engagement in QAPI

• Brent – Courtyard• Skin Care – Arkansas• NLT – Greenbrier• Julie – Hawkeye Care Center• http://www.ltlmagazine.com/article/12-steps-qapi-

step-2-teamwork

Root Cause Analysis (RCA)

• Five Whys – Simplest of RCA strategies• Herringbone – Slightly more complicated and useful in

categorization• CNA Participation Strategies• Facilitator of the process• Recorder of the process• Participant in the analysis process