Long-Term Care

Quality assurance: Why your facility should focus on quality

Contemporary Long-Term Care Weekly, February 19, 2009

Quality assurance (QA) is linked to quality improvement (QI), and in long-term care, it’s important to maintain a quality improvement program.

Nursing homes tend to rely on QI programs, but QA is different.

“In our homes, we’re moving to ensure we have a continuous quality improvement program, and we’ve tailored it to our long-term care facilities,” says Jeffrey Backer, director of QA and risk management at the State Veterans’ Homes Pennsylvania Department of Military and Veterans Affairs in Fort Indiantown Gap, Annville.

Focusing on quality is something that should be an ongoing process.

“It doesn’t have to be broken to improve it, and it doesn’t have to be sick for it to get better,” Backer says. “Every system or process and every person can be improved. You have to measure everything you’re doing and find ways to do it better.”

In order to know whether you’re getting better, you have to know how you’re doing.

Therefore, you need to have a system that captures, tracks, measures, and assesses data.

These steps are important in creating an ongoing focus on quality in your facility.

After you have implemented a QA program, the next step is to assess which parts of the program were effective. To do so, you should consider the following:

Adjust the procedure if it didn’t work and try something different

Understand what you did if it worked and know how to make that a systematic change

There are a lot of tools, such as Plan, Do, Study, Act, through the Institute of Healthcare Information, to put the information into a framework that suits your facility, explains Backer.

Facility involvement

“The quality assurance program has to be embedded in the whole culture of the facility, that way every single department is doing this routinely,” says Backer.

All facilities are required to have a QA committee, and involving all staff members is essential. The regulations explain what needs to be done, but that’s just the start of it, Backer explains.

When implementing new programs, it’s important to gain input from your staff members.

“We have six facilities with numerous kinds of professionals, who are responsible for implementing these quality assurance programs. Without input from the staff who work daily with and run the operations, the programs are not going to be properly implemented,” says Backer.

“By including [all staff members], they all make small steps, and the whole facility gets better, and these can be incorporated and identified as best practices,” he explains.

Focusing on quality

The best judges of the nursing home are the residents and their family members, Backer says. “You have to step back and ask, ‘Why are we here?’ And we’re here to serve the residents. You have to justify it by putting the residents’ needs first.”

As far as quality goes, the minimum regulatory requirements must be met. “They have a lot of quality built into them,” says Backer.

However, it is important to go above and beyond the minimum requirement.

“We have to make sure we’re one step ahead of the various regulatory agencies to make sure we’re meeting all of their changing requirements in order to stay up on the requirements.”

Effects of ignoring quality

Many facilities have been through a bad survey and have been subjected to various citations from the state and federal governments that regulate them.

“If there’s an issue with quality in your nursing home, the level of scope and severity will be assigned,” says Backer.

The penalties can include:

  • A plan of correction
  • Civil monetary penalties
  • Denial of admissions
  • Closing of nursing homes

“The real impact of poor quality is on the people that you serve. If you’re not keeping up and continually finding ways to improve your nursing homes, you’re not getting better, you’re getting worse,” says Backer.

If you look at it from a business perspective, you’re in danger of:

  • Not attracting new residents
  • Not satisfying current residents
  • Staff turnover

“It’s a snowball effect—it’s a matter of being successful or unsuccessful in the business,” Backer says.

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