This is Part 3 in a periodic series of articles linking the Centers for Medicare & Medicaid Services (CMS) impending Quality Assurance and Performance Improvement (QAPI) procedures with the requirements of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) National Quality Award Program.
The QAPI feature that will be today’s focus is building on residents’ own goals for health, quality of life, and daily activity. Ways to accomplish this goal include using feedback systems to actively incorporate input from staff, residents, families, and others as appropriate. These may include satisfaction surveys, interviews, listening to family council and resident council members, and getting input from care planning team members.

Relationship To Bronze Criteria

The AHCA/NCAL National Quality Award Program criteria, which are based on the Malcolm Baldrige Health Care Criteria for Performance Excellence, ask that applicants for the Bronze award define their key market segments, patient and other customer groups, and stakeholder groups, as appropriate. This includes indentifying their key requirements and expectations for health care services and operations, as well as highlighting key differences in these requirements and expectations.

Customers include the direct and potential users of health care services (residents/patients), as well as referring health care providers and those who pay for services, such as patients’ families, insurers, and other third-party payers. The requirements of those customers will differ based on expectations, behaviors, preferences, or profiles.

The criteria require organizations to first identify their customer groups, and then build on that to identify the unique and specific needs of each group.

Relationship To Silver Criteria

At the Silver award level, applicants are asked to describe how their senior leaders communicate with customers and create an environment for customer engagement, consistent with the customer requirements described at the Bronze level.

Applicants are also asked to explain how they listen to their customers and gain information on their satisfaction, dissatisfaction, and engagement. Then, with this information in mind, applicants should describe how they determine health service offerings and communication mechanisms to support their customers and build relationships with them.

Silver-level recipients must have effective processes in place to design, manage, and improve their key health care services and work processes to achieve value for patients and other customers and achieve organizational success and sustainability. In this area, the Baldrige criteria also ask organizations to describe their process for developing a new or improved service to meet customer and community needs better.

These criteria continue the focus not only on the customer, but on his or her unique needs and providing services that meet those needs.

Key work processes are always accomplished by the recipient’s workforce, not external suppliers. They represent the most important internal value-creation processes. They might include health care service design and delivery, patient and other customer support, and business support processes. Key work processes typically involve the majority of the workforce.

Relationship To Gold Criteria

Gold recipients must demonstrate all the principles and requirements laid out for Silver recipients and more. In Gold recipient organizations, senior leaders create a workforce culture that delivers a consistently positive experience for patients and other customers and fosters customer engagement. This culture goes well beyond customer satisfaction and reflects customers that feel they are a part of the organization and advocate for it—this is a key tenant for a center truly focused on each resident’s individual needs, preferences, and desires.

When setting expectations for organizational performance, senior leaders are expected to include a focus on creating and balancing value for different customers and other stakeholders (consistent with those described at the Bronze level).

When listening to customers, Gold recipients demonstrate effective listening methods that vary for different patient groups, other customer groups, or market segments. They use social media and Web-based technologies to listen to patients and other customers. These organizations also seek immediate and actionable feedback from customers on the quality of health care services, support, and transactions.
This information, together with data about customer satisfaction and engagement, is used to help deliver services and build relationships that exceed the expectations of customers and secure their engagement for the long term.

They are expected to describe how they design their health care services and work processes to meet all key requirements – including health care service excellence. They are expected to address and consider each patient’s expectations and preferences in the day-to-day operation of work processes. This includes explaining health care service delivery processes and likely outcomes to set realistic patient expectations.
In addition, Gold recipients have effective methods in place throughout the organization to factor patient decision making and patient preferences into the delivery of health care.

Following Criteria Gets Results

Marnie Talamona, administrator of 2014 Gold recipient, Glen Hill Center, Genesis HealthCare Corp., talks about the value the Baldrige criteria had in their organization. “Focusing on the Gold application has afforded us the opportunity to apply the Baldrige criteria into our everyday practices,” she says.
“In doing so, we were able to identify what we do best, what we need to improve upon, and the best way to achieve and maintain excellence.”

The Baldrige criteria used in the AHCA/NCAL Quality Award Program helped Glen Hill build on its residents’ own goals for health, quality of life, and daily activities, she adds. Her team has learned that a systematic process is needed to gather information from their residents and families so they can improve their care and services.

Glen Hill has implemented multiple methods to listen and learn from its residents and family members, which has allowed the center to identify expectations and customize the care and service delivery for each resident. “Our senior leaders use this information to make decisions, prioritize their work process improvements, and improve the overall organization,” Talamona says.

“Through the Baldrige criteria we are able to maintain our improvements and understand that by building on residents’ own goals for health we will improve their quality of life and daily activities.”
Barbara Baylis, RN MSN, vice president of clinical services at Sava Senior Care Consulting, is a nurse executive accomplished in clinical and quality improvement systems. She serves as an AHCA/NCAL Quality Award Examiner as well as a member of the Quality Award Board of Overseers. Mark Blazey, PhD, is a leading expert in the application of the Baldrige criteria for performance excellence. Blazey is currently serving as a member of the AHCA/NCAL Quality Award Panel of Judges and is a member of the Quality Award Board of Overseers.