This is Melody Malone, we will be starting in a moment. I would really like everyone to answer the questions in the chart. You might have to click the little arrow next to the word chat to open up and you will see a little box where you can type in a message. Please answer the two questions, K, did you or your team complete the QAPI self-assessment and B, did you or your team find it difficult to understand the questions of the QAPI self-assessment? Put a yes or a no and that will give us an idea. We have already heard back from sharing, thank you so much sharing. She said yes and yes and then a third yes [ Laughter ]. I love it Sherry, Diane, I think you had a yes, is that two letter A, B or both?
Yes and yes.
Great please do your questions and we will start in just a moment.
Melody has been cut off the line, she will be back in just a moment. For those of you who just joined us, please answer the questions in the chat. The letter a question, did you or your team complete the QAPI self-assessment? And B, did you or your team find it difficult to understand the questions of the QAPI self-assessment? Just put a yes or no. Melody will be back on in a moment.
I am sorry, this is melody. We are back online and I see that several of you said yes and yes and yes and no. So let's get busy with our presentation and see if we can answer some of those questions. I am melody Malone and I will be your speaker for today but I am blessed to have my colleagues on the line. We will get to introducing them in just a second. Our objectives today are very clear. We will describe QAPI quality assurance and you will be able to determine much or next step will be in developing your Q a PI. My colleagues today are Frank Barber, he is one of the quality consultants at TMS and Cayce Brewster. Susan Purcell is our director and I don't believe she is on our line today. We have Minnie Malone our project development and Tiffany Langham. We will all try to answer questions in this week move through the PAI journey we hope to be your guide through this process. Just a little bit about perhaps a refresher for some and maybe new information for others about Q a PI. This is mandated in the affordable care act enacted in 2010 that CMS with established standards and technical assistance to help nursing homes develop best practices and quality assurance and performance improvements.
Since September 2011 CMS has been testing tools resources and technical assistance approaches in a very small demonstration project with 17 nursing homes in four states. What is nice is CMS has seen this as an opportunity to develop tools and resources to help facilities as well as surveyors to understand basic Q a PI principles. As well as test a prototype of a surveyor worksheet to use in nursing homes. As they learn from all of this this will help CMS to be able to craft the regulation and guidance.
Which is really one of the first times that it has really happened this way. I am excited about that in part because CMS is testing tools and resources before they actually write the regulations. So far and the efforts have been pretty good. CMS has pushed out the national quality improvement questionnaire that came out last year. Some of you may have actually completed that. As far as I know at this point, we do not have the results from that yet published. We have also -- CMS has developed resources and we will talk about those later on. They also have a QAPI website. All those will be available already through our QAPI resources on our nursing home network webpage.
On this QAPI demonstration project with the 17 nursing homes, they are piloting and testing tools which is exactly what quality improvement is all about. In the national rollout plan, we have already seen in June of this year release of the materials. We have seen the QAPI at a glance which had the QAPI self-assessment embedded in it. They are continuing to identify resources and case examples which I think we will see when they bring out the rest of the tools and resources as well as possibly in the regulations.
There is a group of national and state wide stakeholders that meets regularly to see how we can push this and permission out to the nursing home community even in a broader way and also be part of the collaborative. You are all participating with us as your CMS QIO, we are an organization working with the collaborative so you have access to all of this material to our website. of course CMS is still developing the regulation and I wish I knew when that would come up. I really don't have a clue. Perhaps someone on the line may have new information regarding that Rex.
Either way it goes, there will be this ongoing development of training material for surveyors which is important in all of those training materials will be available to us as well. We have already seen that in the development of the antipsychotic medication training tool that CMS has pushed out. I think we are seeing a change in CMS and that they are helping push out educational training materials as well. Which is great. That is where things have been in what is going on. This is still in evolutionary process. Let's dig into the meat of this. When we are talking about QAPI, what do we mean by this?
Well, quality assurance has always had a catch the bad apple mentality are almost -- it is usually only done by one or two people. Usually what I see is a lot of accounting. We count our goals, we count whatever. Then we just sort of report that on a monthly or quarterly meeting. We have never really done a lot of action on this. Or quality improvement is looking at how we can improve our overall processes. Our systematic approach to improvement.
This is done on a continuous basis. It should be done by teams in those involved on the teams should be those closest to the problem. When you are thinking about quality improvement or performance improvement, you want to think about on our teams, how can we get those people closest to the problem involved in the quality improvement? So, I can sit in an office somewhere and come up with a great process. But whether it can actually be done at a bedside is a whole another ballgame.
We want to make sure as we may quality improvement processes that the people closest to the problem can actually do that. Can actually make it work. So it is continuous but it is also sustainable. So as we put in new quality improvement process in place, we want to monitor that improvement so it sustains over time. QAPI is a data-driven approach. So we collect a lot of dead days -- data already, and how do we utilize that information so we can move it into a systematic improvement. QAPI is also going to be very different for you because what will happen is when the regulation comes out, every nursing home in the country will have to right there QAPI plan.
This is going to be a forward looking plan for how are you going to identify your quality issues and anticipated your quality problems and put into place systematic approaches that will stick. That will have sustainability, so that means we really do have to involve all members at all levels of the organization in this proactive approach. So you're QAPI plan that you will need to be writing, and I will encourage you to get busy writing it now.
Even though we don't have the regulation yet, CMS has already given us much information and we are going to go through that what that plan should look like. So, the QAPI program isn't really a program like they are going to put a falling star program in place. This is really a culture change of how do we identify our problems, how do we involve everyone in the process and how do we actually implement an improvement process and that it has sustainability?
Now, think about what we have always done. We have surveyed, we write a plan of correction. In QAPI we will be looking for opportunities to improve before they may even become big knockout strikeout problems. We want to identify where people are starting to fear from our process of how we get something done. If they are bearing from what we should be doing, then we should be able to see them move off of that path and go a different direction so that we can say, wait a minute, why are we having this cap and the system or in this process?
We need to stop, identified by people are doing a workaround, that is a real common terminology in quality improvement. So they will develop a workaround. Let me give you an idea. Let's say we have a CNA on the weekend who is always -- every Friday a friend of those works with them on Friday, the stock women in a place that no one knows about. That is hearing from our normal process. Alternately, that opens up a whole bunch of problems with making sure that we have the right amount of linen available. They are hearing from the usual process, we have limit available and we use it. If we have the weekend reporting, I am sure on the weekends for linen, I feel I need to stockpile it on Friday, then we can identify what is bogging down. IV what happened is we are working a 10 day, a board day, ten-hour shift in Friday's are our short day. That is actually causing us to have a system failure for the weekend to have enough linens in place.
Quality improvement process for our employee who feels welcome to report a problem, they start seeing a G2 or from normal process. That gives us an opportunity to identify improvement before it is a crisis. I will stop at this.and say I want to take some questions as we go along. In order to get into Q for questions, just press one on your phone. I will stop for a second, do a quick call for questions and see if what I have done so far has made sense pick so, where is CMS in the process? What is the comparison of Q a to quality improvement and what is -- what does QAPI mean? Is everyone good? We have any questions in queue?
There are no questions in the chat.
Okay. Great.
There is no one on queue on the phones yet.
Don't forget, if you have a question just hit one and Alicia will help you. All right. We will move on, what does this plan have to include? There are five basic elements that the plan has to include. When you did your QAPI self-assessment it look like everyone that their QAPI self-assessment. Those questions that you were asked on your QAPI self-assessment will really guide you in developing your plan. the five elements are design and scope, governance and leadership, feedback, data systems and monitoring. Performance improvement projects, which is you are pretty familiar with that with the work you are already doing with your quality improvement consultant and CMS, I think.
But also systematic analysis and systemic action. In each one of these elements as you read your plan, you will want to make sure that you have included all of that information that is listed in the five elements. the five elements are in the standalone document on their website on the QAPI portal. There is also a follow-up document I want to refer you to. It is the five elements of QAPI brainstorming from THC a summer meeting. We broke every one broke everyone up into groups. We brainstormed the statements under each one of the five elements and we have barriers to implementation and steps to success for each one of those statements.
To give you an example, under design and scope, a QAPI program has to be ongoing and comprehensive, dealing with the full range of services offered by the facility including the full range of departments. That is a pretty huge designing scope. We had people brainstormed that statement, identify barriers to implementation and steps to success. Within each one of these five elements there are multiple statements that will help you and guiding your plan. I encourage you as a team, as a facility team to print that I've elements page, review it regularly, discuss those statements routinely.
Identified within your facility. Where do we do that? How do we do that? How are we sure that includes the full departments, contract or otherwise and how do we make sure that is done all of the time? That is what we need to do with our QAPI plan. You would do that for each one of these elements. As I mentioned, these are just in the QAPI self-assessment tool. One of the things that we did for you to help you utilize this tool more effectively other than just saving your rating scale, have you not even started, or two where you are doing great. We have a document on the website on the QAPI self-assessment, and work.
Not like word man, but like word like in the computer program word. It is set up like a word document so you can type on it. On the left-hand side you can see the actual statement the QAPI self-assessment tool. Then there is a center section which is, a place to put notes where you feel where you are, what you feel you need to do or kind of from and action standpoint. What does your team working on right now.
the third column on the right is all of our tools and resources that are available to you already on the TMS website. I don't want you to feel like you are going at this alone. You have got lots of tools available to you to begin writing this forward looking QAPI.
the website address we just put in our chat, thank you Carla. You have to create your account, be a member of the nursing home network so that means you have joined the network and I heard [ Indiscernible ] you can push out to us how often you want e-mail information from us. So we can help you in your efforts. the QAPI self-assessment and word will help you and how do we look forward from here. So on our website as I mentioned, you will need to create your account joined the vision home network, manage and notification, which you can see right here, then these blue boxes of resources are items that you can click on and when you click on them they will open up a new page so that you can see all of the resources available to you.
In order to move forward in writing care plan, one I encourage you to get busy now writing it. If you wait until the regulations, you will find it is much part of call. Because keep in mind what will happen when that regulation hits, number one, there will be open for comment. Number two, it will be most likely that the clock will start clicking on a one year that every nursing home in the country will have to right there program. So don't view this as a linear process. the process really is going to be more of [ Indiscernible ] implement a part of a copyrighted part of it, implement a part of it. Because when you get to the end of that year and the regulation that goes live, it will mean you have to have your plan written but also it will get turned on for surveyors so surveyors can survey you based on your QAPI plan.
So you can't write for a year and that "-left-double-quote it. You will have the right, implement, right, implement. As you move from completing the QAPI assessment you have tools available to you. You have the QAPI self-assessment and word so that you can see all of the tools that are available. You have got the QAPI five element brainstorming tool that is also available to you that can list every one of those statements in the five elements and see what are barriers to implementation of better out -- yet what are the steps to success? There is also a wonderful document called the QAPI at a glance. The QAPI at a glance document is what CMS has provided for us already.
It is rich in information. Has the five elements, it has the QAPI self-assessment tool. Also has a guide for developing your purpose guiding principles and scope or QAPI. It also has a guide for developing your QAPI plan. and a role setting worksheet. But in addition to that, it has a good explanation of what is QAPI, the comparison of Q a and how it builds on that but it also has 12 actions to QAPI.
You will all be on a 12 step program working on QAPI. But it will be wonderful for you to take a QAPI at a glance, read it, handle it, discuss it with your staff. I had a call today with a facility and we were discussing how do we move forward with this? One of the suggestions that I had with them was print the QAPI at a glance document and treated with your leadership team like a book report. Everyone reads the first section, introduction.
Then come to the table tomorrow and discuss that part. Because I think it is really going to be in the reading and discussing that we really begin to embed these principles of QAPI and who we are. So that we can involve into -- a ball into an industry that can really speak the language but also walk the talk. We can't just talk the talk, we have to be able to see QAPI in action, on the floor, in the facility, every day.
So the QAPI at a glance is an invaluable document for you to use to help you begin deciding how do we move forward? In addition to the QAPI at a glance, CMS is also producing a document called the change package. the change package has seven strategies for making change happen in nursing homes.
This is more of a cultural type of change that we need to make within ourselves. How do we grow leadership? How do we do different strategies for change? Within the change package there are the seven strategies and I think you can find as you begin searching for information, find yourself going to the change package, looking at what is there. In the very new future we will have to change package broken up into the seven segments or the seven strategies as individual documents as well. So it is a large change package, if it feels overwhelming to you if you will have access to the seven strategies.
Lastly, we have got a video series called the QAPI to Terry L -- tutorial series. How to develop teams? How do we improve application? How do we do the root cause analysis? Taking into account human factors and culture. Then move into the models for improvement and running alterable cycles. So you have got those QAPI tutorials available to you today. So all of those are available and as you need, feel free to let us know and we will be happy to see what we can do to identify or develop a tool of resource for you.
Now I will give you a challenge. You have heard a lot of information. Remember the call in, you just press number one on your phone. What can you do today. I want you to write something down. What document do you want to read? We have mentioned several. QAPI at a glance, the change package, the self-assessment, five elements, or one of the tutorials. What tools you want to view? Maybe want to look at what a team charter is. We have all kinds of things on our website. Have you looked at your QAPI self-assessment? to determine where the team can begin to explore addressing one of those questions.
What do you want to do by 5:00 p.m. today? Quality improvement is about making things happen quickly. You want to make change happen quickly and ourselves, we have to we have to evolve and become QAPI literate. We have to be good at this, but you can't get good until you get started. Whether you want to read a review or work in your team begin to explore? Because here is what I will challenge you to do. Our quality implement projects begin by searching for the root cause. This is the fundamental reason a problem has occurred. Or when performance does not meet expectations. I want you to think about developing your Q a PI plan along this line model of root cause analysis. In the model for improvement. You will have to figure out how to start this QAPI plan writing process. You will have to figure out where do we need to begin? Do we need to begin by developing a mission, a vision, a Valium -- value statement? Do we need to begin by determining what leadership responsibility is and accountability? Do we need to identify what our writing principles are?
I want you to think about writing your QAPI plan just like you would any other quality improvement project. We follow the model for improvement and it is also discussed in the QAPI at a glance. As a quick review, when you are looking at your opportunity for improvement, what are we trying to accomplish? In our case today it is to write our QAPI plan and to begin implementing along the way. How will we know that a changes in improvement?
We will have to develop a Q a plan timeline in order to know, are we meeting our milestones when we want our plan fully written? Only you can decide what change you can make that will result in an improvement. We can do this individually, but your teammates do this and then you come up with your plan to study, act, plan, do cycle. You determine where you start, then go do it. Then study those results and then act on those results. As you write your plan, you can test, are we actually able to work our plan? by doing it?
Then study those results and determine whether or not you can really adapt that change or can we adopt it or do we need to abandon that, that part of the plan didn't work, we need to review the plan. You can apply the model for improvement to anything. It is not just a clinical model for proven, it is a total model for improvement. As we go on, this is really kind of what it will look like. And every quality improvement we always start very small so you will do one test of change on one thing, one person, one staff member, one resident. Then we will continue to do wider scale testing involving two, three, or four and grow to more.
Then eventually to the point where we have tested multiple times, we know that this implementation or this opportunity for injured -- opportunity is ready for implementation and spread throughout the organization. As you work through the writing of your QAPI plan and you are thinking about it like this in this model for improvement mode, I doubt that you will feels like you can only do one thing at one time. It might look more like this. You might have one team working on developing the mission, vision and value. Another team may be working on staff response to errors, how do we respond to our staff one in error is made?
What behavior changes to it want to make and how we respond to errors? Just keep in mind human [ Indiscernible ] not everyone showed up every day to do a better job. We want to make sure people have that opportunities to report errors, to report potential problems. Remember our linen example, we are starting to do to her up the path. We want to applaud those employees I can bring in a potential detour from saved practice or usual practice so we can begin working on that. In the beginning we may have to see how we respond to errors. We may have a group that is working on team training, how do we train teams to be performance improvement project teams?
We have to figure out how to involve the residence Inn QAPI. They are crucial to the stuff part of QAPI is figure out how we involve the rest of or, how we engage more, how do we listen better and take their feedback so that we can work on opportunities for improvement that they present to us. That we may even develop root cause analysis, RCA, root cause analysis. That is actually one of the things in the five elements. An element, element number five is often time facilities are expected to develop policies and procedures and demonstrate proficiencies and root cause analysis. We have never done a root cause analysis, how do we do that. How do we do that screening so that we can get people confident.
As you are developing your QAPI implementation plan, you may find that you have also pulled different teams, different aspects of your QAPI implementation outline. That may actually work more like this. You have got all of these teams working to your improve goals, improve outcomes from having a full functional working embedded QAPI plan. So I think I will stop right there and do a call for questions. Remember, press one on your phone to submit a question, or you can also put your question in the chat.
One thing that we found helpful is the worksheet for testing change. When you look at this it looks busy and kind of grainy looking, this is nothing more than the model of improvement pushed out on a piece of paper. the worksheet for testing change is a great tool for us to hold performance improvement teams accountable for the work that we are asking them to do. So we are asking a team to work on a mission, vision and value, we can ask who will they work on this tested change with? How will they testing? Who is responsible? What did they predict is really going to happen when they do the testing of change? What measure will they used to predict success?
Then they had to go out and do this. What they might do, do some focus groups with some of the facility staff, to identify what they think the mission, vision and value for the organization are. and they may come back to the group, the stirring ready for the QAPI and say, here is what our employees are saying. Then you may draft out more information go back out, tested again, see what people have to say about it and then come back and decided, yes, we think we have a well-crafted vision. Them that team can move on and take on a new quality improvement project.
With each of one of those things, they go out and test, that is a tested change. Recently we put the worksheet for testing change in Spanish in our QAPI resources. So we hope some Spanish speaking employees will be able to access this and use that for their best advantage. So I will pull you back to the website once again and I will say everything you need right now is here. All you have to do is create your account, join the nursing home network and manager notification and when you do that you will have the resources available in the QAPI resources to help you move forward in your QAPI plan writing which we strongly encourage you to get busy doing. Remember, you have lots available to you. You have the QAPI self-assessment in word which has all of the tools and resources that go with every statement that are already available in your resources for QAPI. You have the five elements, brainstorming documents. You have the QAPI at a glance which walks you through how to develop your QAPI plan as well as it has good educational materials that you can use with your staff.
You have the change package available to you as well as the QAPI tutorial which is available through recorded events and they are an item resources for QAPI. Now I will come back and ask you the challenge again. What can you do by 5:00 p.m. today? 5:00 p.m. today? I would like for you to put this in the chat what can you do by 5:00 p.m. today Rex what document will you read? What tool or resource do you want to view? What question on the QAPI self-assessment can the team begin to explore? Or what is going to be your QAPI of limitation timeline?
How about we get some chatter going on. Let me do a call for questions. Press one to ask any question that you may have and let me see those answers in the chat. I do not see anyone putting anything in chat.
There is currently no question Inc. you on the phone.
Thank you, Alicia. Remember to push one. We will go back to the website and review the intent and timeline, John will log into the website and make sure it is available, especially the worksheet for testing change. Join the website. I think you will find it to be helpful. Remember, in addition to the QAPI self-assessment you have the other one. Many homes I work with say that corporations have developed their program for them. Sure, thank you Debbie for the question.
While a corporation may decide to write the over arching QAPI plan for their participating homes or their organizations, the hard part about that for each of you is to actually take that plan and customize it to your individual nursing home. So for example copper someone who might be in Weatherford, there issues are going to be different from someone who might be in Avalon or down in central Texas, or might be out in Lubbock or maybe in Longview.
Every nursing homes QAPI plan is going to have to do some real internal work about what does QAPI mean for us? Make sure that we are adjusting things that our nursing home that are critical and important for our individual nursing home. Because I know for folks in West Texas, they are struggling with staffing because of the oil boom. It may be folks in the Dallas Fort Worth area have it different issue in a different reason why they are struggling with staffing.
So our QAPI plan may be very different for every facility. the other thing about this, we are all out here doing the work today. So, if you are not handling these documents, if you are not working with these tools, if you are not reading this material and really kind of going through the struggle of letting this play out in my concern is that it might be really hard. You to internalize all of this, observant, embedded into who you are and help. Nursing home really emerge into a -- into a QAPI model. That can be done. If you have a corporate model you will follow and then you embellish it and customize it to make it your individual facility, you will have to go through all of that to make that happen.
But it will be a lot easier for those of us coming behind it because it is during that struggle that you will really learn. They are in school now, they are going to be learning about QAPI. It is a little different. I hope that answers your question. I see that there are some other things going on. People said they will read the QAPI at a glance, they will make copies of the edit glance and distributed. They are going to schedule some internal training with their team before the end of the month. Good for you, Christy. You should see already that the pulling is up we want to make sure that everyone answers our polling questions. Let me just see if there aren't any more questions in the queue, press one if you have a question for us or feel free to put it in the chat.
We do have a question from Christy at Santa Fe health rehab.
Hello Christy.
I'm sorry, I am always the one with 1000 questions. I just wanted to clarify, CMS is timeline as they are rolling things out from start to finish, exactly how is that going to be? We are working on this now to be prepared, but what is the dropdead date?
Kristy, we don't know that yet because they have not provided the final, they haven't even final lies the draft regulation. Here is my feeling on this, I have colleagues on the line as well. Probably everyone has a different opinion. My feeling is because CMS pushed the QAPI at a glance, we have somebody tools and resources in such as information. It is fairly directive on what needs to be included in the plan. I feel like one we see the regulations, we are going to see it kind of as a regurgitation of the QAPI at a glance.
I could be wrong, I don't have a crystal ball, but the timeline ultimately will be up to them, whenever they published regulations. Then the one here clock. Is my understanding, that the clock will start taking them. But there will be, it should be, when it is posted it should be posted with questions or comments as well. But I believe that the timeline will start when the regulation hits. Then the nursing also have one year from that date to read their plan. Of the ones that date ends, let's say a comes out on December 31st of this year. By December 31st of Baxter you will have to have your plan completed, but then say survey Watson January 1st, they expect to see that your plan is being implemented. So they should be able to see it in practice at the bedside so to speak. >
What is the root cause analysis can't have you participated in the team, they are going to want to see that your employees know what is going on.
Thank you, Libby.
Anything else in the chat or any questions online?
There is no questions on the phone.
There is a question in the chat, she says she will review QAPI at a glance and put a plan in place to motivate the team. How many more times have we heard it is just more work.
Oh my gosh, a billion maybe.
Pattie, I commiserate that it does feel like extra work but keep in mind what will change is QAPI becomes that replacement for Q a and AA. If we can solve the problem like the linen issue for example. We can solve that that problem goes away and we no longer have that problem because we have a nice sustainable system in place. Are employees are reported to us, issues and concerns before they become big not down drag out problems, now we deal with issues and concerns and are being proactive. For -- before it becomes a big problem. In the QAPI at a glance there is a great analogy between Q a NPI. Under QAPI they are forward-looking and the problem, identify the issues, got a team working, work other problems,, systems in place so that they would be sustainable.
So it is just a different way of looking at things. But I think you are right. I think people will feel it is extra work until they start seeing it in action. I think that is why it is important to get busy now. Not wait on the regulation. We have been waiting for this regulation forever. But there is nothing that says you cannot move now. The regulation comes up and it is different, then you can tweak your plan to include whatever might be slightly different. But if you are working on a forward-looking quality improvement program now, how is that going to her? It is not.
I think it will get you there faster and then you will become the leader. We all want to be the leaders, right? Frank just said, staff awareness is critical. He is absolutely right. Part of the regulation I think is going to be that how does our team, does our facility team look at rings with a QAPI perspective? We will always be wearing those QAPI glasses and look at things from that perspective.
Alicia, any more calls?
There are no questions on the phone at this time.
Okay. Thank you. Anyone else has anything else you are welcome to contact us. Individually to your quality improvement consultant or on our network or through the phone. I hope all of you will join the website and involve all of your employees to use the website, share any tools that you develop or anything you need. If you have any questions or concerns, we look for to receiving them. Thank you so much for spending part of your day with us. Have a blessed day.