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Concordance Healthcare Solutions Resources

QAPI: 5 Performance Improvement Project Tips


As the healthcare industry continues to navigate change, leaders throughout the entire continuum of care are focusing on ways to improve the health of the population in a cost-effective manner. In order to do this, it’s important to ensure processes are as efficient as possible so quality care can be provided. 

While delivering high quality care has always been a primary focus for nursing homes, the Centers for Medicare & Medicaid Services (CMS) has set forth provisions that expand the requirements for Quality Assurance and Performance Improvement (QAPI). This provides opportunities for nursing home leaders to put a systematic, sustainable method together that creates a proactive approach to problem solving and solution implementation.

Nursing homes across the country continue to navigate the guidelines and define their QAPI programs. There are many tools and resources available. Here are some quick points to consider as you prepare for Element 4 Performance Improvement Projects (PIPs):

    1. Project scope
    2. Facilitation
    3. Stakeholders
    4. Education
    5. Follow up 

Project Scope

The scope of a project helps define boundaries. It's important that the scope is clearly defined so that it's meaningful and meets the needs of the staff, residents and family members. If a scope is not the right size, it may need to be adjusted midway through the project.

In order to ensure you have an appropriate scope, consider the goals you want to accomplish. If the scope is too small, the impact may not be big enough to justify the time and effort spent. If the scope is too large, the team may not be able to manage the project effectively and move it forward.

Performance improvement measures are often multifaceted, so understanding the scope can also help redirect the project so that it doesn't become too large and unmanageable. Often, the review of current processes leads to other areas that need improved. As this occurs, other conversations start and idea sharing begins. With a clearly defined scope, it's possible to bring the team’s focus back to the project at hand.


When your staff is engaged in the process every day, they become the experts. They know the process better than anyone else. But, do they know how to improve it? Having a facilitator that fully understands the components of improving a process is a key to success. Below are some top reasons to have a facilitator:

    • Dedicates focus to the project – Your staff is busy taking care of residents. Appointing a project facilitator will provide assurance that you have someone to dedicate time to overseeing the entire project and keep it moving forward.
    • Utilizes a step-by-step approach – The facilitator will guide the team through every step to ensure all aspects are considered and reviewed. This also makes the process “visible.”
    • Views project as a whole – As multiple stakeholders work together on a project, many opinions may surface regarding the importance of parts of the process. This can create some difficulty in seeing how each part effects the others. Facilitators are not emotionally attached to any one part so they can see the process as a whole.


Choosing the right stakeholders can directly affect the success of the project. If the right stakeholders aren't involved, project delays are likely to occur as other staff members will need to be consulted as to how the current process works.

With so many knowledgeable staff members, how do you decide who will make up a project team? The answer is easier than one may think. Stakeholders own the process. They are the ones that do the work every day and can explain it in detail. They are fully invested in the improvements because it will have direct effects on their work flow.

As you choose stakeholders, it's important that project expectations and timelines are set. This enables each project team member to dedicate the appropriate amount of time and resources. This dedication of time and focus will help ensure the project progresses.


Performance improvement is time consuming and can be a big undertaking, especially for staff members that have time constraints due to other responsibilities. Even though it seems nearly impossible to dedicate resources to these projects, the benefits of understanding the root cause of issues and creating improvements can drive results that equal more time and better outcomes.

In order for a team to embrace a project fully, they need to understand why they have been selected to do it. Educating the entire team at the beginning of the project helps clear up questions and gain support. When educating the team, consider:

    • Leadership engagement – A key step to educating the team is completing the project charter. Once you have this complete, you need to provide the information to the leadership team and ensure you have understanding and buy-in so that they are supportive of the project. When the project team knows that the leadership is in support of their efforts, they are more likely to stay engaged in the process.
    • Stakeholder engagement – The project stakeholders will be your ticket to success. In order for the project to bring the most value to the stakeholders, they need to know why they have been selected. Be sure to communicate that they were selected because they know the process best and you need them to represent it.
    • Departmental education – Often, education of performance improvement projects is completed at the stakeholder and leadership levels. This is a great start. In order to ensure success, though, it is necessary to expand this education to the entire department that completes the process. As stakeholders step away from daily routines to work on projects, those remaining in the department may need to cover for them. Help them understand why they are doing this, including how the improvements will make positive long-term outcomes on the department.
    • Use terminology they understand – There are many terms associated with performance improvement. Make sure that you understand your audience, including their familiarity with performance improvement, and tailor your message to them.

Follow Up

Having a clearly defined project scope, selecting the right facilitator and stakeholders, and educating the team are all key factors to successful implementation of PIPs. Even with all of these factors in place for the initial performance improvement, it's not uncommon to see a process breakdown over time. This is often because systems have not been implemented to monitor ongoing success and review for further improvements. To increase the success of your performance improvement, consider the following steps:

    • Define metrics – Be sure to capture baseline data and analyze improvements.
    • Make sure the process is repeatable – Document the process and develop standard work and best practices.
    • Communicate and educate – Create plans to ensure the information is being shared throughout the nursing home (this goes beyond those involved in the project).
    • Provide updates – Develop a schedule to make sure the stakeholders, departmental, and leadership teams are provided with the same information to ensure continuity.
    • Listen – Create a forum that listens to each member of the team and fosters idea sharing.
    • Relate the value to the stakeholders – Continually relating the value of the improvements will increase accountability and acceptance of the process.
    • Review for future projects – Areas will be uncovered during the project that may warrant further performance improvement. Be sure to fully review these and advance those that will support staff, resident and family member goals.

As the healthcare industry continues to rapidly advance, the need for nursing homes to focus on continual performance improvement becomes even more essential. Concordance Healthcare Solutions understands this and is dedicated to working with our customers to ensure the supply chain is as efficient as possible. Contact us today to learn more.

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