National Quality Award Program Lays the Groundwork for QAPI<p><img src="/Issues/2023/Spring/PublishingImages/Quality.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​​The AHCA/NCAL National Quality Award program is a rigorous three-­level process that evaluates a long term care organization’s capabilities against the Baldrige Excellence Framework, a systems, data-driven approach to performance excellence.&#160;<br></p><p>Each progressive award level—Bronze, Silver, and Gold—requires a more detailed demonstration of superior performance. As teams work toward achieving each level, providers learn and develop over time successful habits that make it easier to comply with federal Quality Assurance and Performance Improvement (QAPI) requirements.</p><p>The program lays the groundwork for the successful implementation of QAPI in five key ways.​<br></p><h3>1. A focus on​​ resident excellence.&#160;</h3><p>The Quality Award program’s Baldrige framework emphasizes the importance of going beyond customer satisfaction to engage residents and exceed their expectations. This emphasis on the resident allows for the provision of person-centered care.&#160;</p><h3>2. A focus on​​ valuing people.&#160;</h3><p>The program’s framework recognizes that an organization’s success relies on an engaged workforce, and that engagement is dependent on meaningful work, clear organizational direction, and the ability to learn and grow. This enables providers to connect staff engagement, competencies, and training directly to the work of the organization to provide person-centered care.&#160;​<br></p><h3>3. A focus on visio​​nary leadership.</h3><p>The Baldrige framework requires senior leaders of any organization to lead by example, set high expectations for their workforce, and create a customer-focused organization.&#160;​<br></p><h3>4. A focus​ on fact-based management.</h3><p>The Baldrige framework requires organizations to make fact-based decisions through systematic analysis of performance measures to support and inform the operations of the organization.&#160;​<br></p><h3>5. A focus on continuous quality improvement.</h3><p>Fundamental to the Baldrige criteria is the concept of continuous quality improvement of an organization’s approaches to work, which leads to improvements and innovations that move organizations toward providing the highest level of care to their residents/patients.&#160;​<br></p><h3>Gold Ex​amples</h3><p>The linkages between QAPI and the Baldrige-based National Quality Award are best explained by two award-winning providers&#58;&#160;</p><ul><li>South Davis Specialty Care in Bountiful, Utah, recipients of the 2009 and 2019 Bronze awards, 2012 and 2020 Silver awards, and 2014 and 2022 Gold awards</li><li>Burgess Square Healthcare and Rehab Centre, in Westmont, Ill., recipients of the 2017 Bronze, 2018 Silver, and 2020 Gold awards​<br></li></ul><p>In “Business Success Through Continuous Quality Improvement,” Lisa Pearson, MSN, RN, CIC, director of infection prevention and quality improvement at South Davis Specialty Care, and Kristin Thrun, administrator and director of operations at Burgess Square Healthcare and Rehab Centre, share their centers’ experiences, examples, tips, and best practices on leveraging Baldrige to successfully operationalize QAPI. You can find the session at <a href="https&#58;//educate.ahcancal.org/products/business-success-through-continuous-quality-improvement#tab-product_tab_meet_the_speakers" target="_blank">https&#58;//educate.ahcancal.org/products/business-success-through-continuous-quality-improvement#tab-product_tab_meet_the_speakers</a>.</p><p>To learn more about the Baldrige-based National Quality Award program, visit ahcancal.org/QualityAward.&#160;</p><p>Register for the AHCA/NCAL Quality Summit, May 22-24, 2023, in Grapevine, Texas, for sessions focused on the Quality Awards, the Baldrige criteria, QAPI, and more! Go to <a href="https&#58;//www.ahcancal.org/Education-Events/Quality-Summit/Pages/default.aspx" target="_blank">https&#58;//www.ahcancal.org/Education-Events/Quality-Summit/Pages/default.aspx</a>&#160;to register.&#160;​<br></p><h3>›&#160; &#7;​About QAPI​<br></h3><p>The QAPI program was introduced by Centers for Medicare &amp; Medicaid Services for nursing homes to adopt a systems, data-driven approach to improvement. The program merges two complementary approaches to quality management&#58; Quality Assurance (QA) and Performance Improvement (PI). Together, QA and PI combine to form QAPI, a comprehensive approach to ensuring high-quality care. Learn more at <a href="https&#58;//www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/QAPIAtaGlance.pdf" target="_blank">https&#58;//www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/<br>QAPIAtaGlance.pdf</a>.​​​<br></p>2023-03-01T05:00:00Z<img alt="" src="/Issues/2023/Spring/PublishingImages/Quality.jpg" style="BORDER&#58;0px solid;" />Quality AwardsFive ways the AHCA/NCAL Award Program aligns with the Baldrige Excellence Framework and leads to QAPI success.
The Ripple Effect of Benefits, Opportunities That Come from Quality Awards<p>​​​The pursuit of quality is a constant in long term care, and little is more representative of that than the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) National Quality Awards Program. As of 2021, nearly 2,000 providers have received the Bronze award, nearly 700 have received the Silver, and 49 have received the Gold. Award recipients consistently perform better than the national average in several areas, including hospital readmissions and off-label use of antipsychotics. They also have higher ratings regarding surveys, staffing, and quality metrics.&#160;</p><p>But the awards are about more than numbers. Pursuing the awards opens doors to new and innovative opportunities, and it equips organizations and teams to more adeptly manage crises and change, thrive, and be resilient.</p><p><img src="/Issues/2023/Spring/PublishingImages/TammyKelly.jpg" alt="Tammy Kelly" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;180px;height&#58;225px;" />“The awards program represents a journey. It’s a framework for a better resident experience and quality of life. It enables staff to work better, smarter. You can set deployment goals and introduce team-building activities such as contests between departments,” said Tammy Kelly, PT, LNHA, RAC-CT, director of resident assessment instrument and clinical reimbursement at Commonwealth Care of Roanoke. “And you gain employee enthusiasm and engagement.” She noted that it also can be used as a metric in the value-based payment system for incentive payments. “There are so many things you can weave into this.”</p><p>Mike Hensley, managing partner and owner at Burgess Square Healthcare and Rehab Centre in Westmont, Ill., observed, “We were always striving for quality before the awards journey, but this is a systematic way for facilities to achieve quality goals that give AHCA a foothold in Washington, so they can show policymakers and others that their members are committed to excellence in patient care and achieving quality outcomes.”</p><h3>​​The Ripple Effect … or a Wave?<br></h3><p>As teams sharpen their skills, taking a hard look at the systems and processes and making changes and&#160;improvements in pursuit of the Quality Awards, their accomplishments flow into other areas. For instance, Hensley said, “We were named the number one skilled nursing facility provider in Illinois by Newsweek, and we were in the top 60 in Illinois as identified by U.S. News &amp; World Report. Our quality improvement efforts as we pursued the awards set us up for these accomplishments.”&#160;</p><p>On a local level, Hensley said, “we received positive media recognition, and this was invaluable.” Of course, such acknowledgement takes some effort, he noted, saying, “When we received the Gold award, it was a major accomplishment and a heavy lift, and we did it during the pandemic. We promoted the prestigious value of this achievement. Then we were named number one by Newsweek, and that really caught fire with physicians, hospitals, and potential residents.”</p><h3>​​From Stick to Carrot<br></h3><p>Particularly during the pandemic, long term care providers came under scrutiny and were often unfairly portrayed in the media. The focus was often negative and critical. Genuine opportunities to celebrate are empowering and essential.&#160;</p><img src="/Issues/2023/Spring/PublishingImages/MikeHensley.jpg" alt="Mike Hensley" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;180px;height&#58;225px;" /><p>Hensley said, “When you look at the operations of nursing centers and organizations, we are measured in an infinite number of ways on everything from staff retention and turnover to outcomes. But almost 100 percent of these measurements involve a negative outcome associated with the grade or rating. For instance, if you are cited too many times, your star ratings go down. We have so many sticks coming at us but few carrots.”&#160;</p><p>The Quality Award process is something providers can strive for, he said, that has a positive outcome “beyond what we do every day.” He noted, “When we went through the awards, it was the pursuit that was the important part. We are always improving our quality, and we had concrete results to celebrate and many carrots in a world where there are so many sticks.”&#160;</p><h3>​​​From Assessment to Action and Teamwork<br></h3><p>Going through the process helps connect the dots. Kelly said, “As I was writing for the Bronze award, I started connecting things. Then we wrote for the Silver, and it opened a whole world to us—with new and better processes and systems. It created a ripple effect.”</p><p>At a time when it is more essential than ever to have cohesive, committed teams, Kelly observed that writing for the awards “brings disciplines together.” She explained, “Your teams begin to understand and appreciate the whole picture. You establish sustainable processes and systems and concentrate on things beyond the daily minutia. You step back, let it run, and focus on other opportunities for quality improvement. As the teams and processes become more efficient, the energy you previously put into putting out fires you can now direct toward broadening your perspective and moving your organization forward.”&#160;</p><p>Using the <a href="/Issues/2023/Spring/Pages/The-Partnership-of-Baldrige-Criteria-and-Quality-Awards.aspx" target="_blank">Baldrige criteria</a>​ employed in the Quality Awards program for ongoing process improvement, she suggested, enables you to look at opportunities to continue building on your processes and systems and for other resources such as grants and research partnerships. “This process makes us more comfortable opening doors and inviting people in,” Kelly said.</p><p>Opening doors also enables providers to strengthen relationships. Kelly said, “As part of the Baldrige criteria, you take a deep dive into who your stakeholders are, and you identify who you work well with, as well as those who have a strong need for your services but you’re not well-connected with—such as a hospital system.” She said that her organization has been able to make closer connections with area hospital systems so they can move patients more effectively through the continuum, and communicate and share information effectively. “If we can break through the blame game via such efforts and share information more transparently, we become allies instead of just a referral source and receivers.”</p><h3>​​​Weathering Whatever Comes<br></h3><p>While data is still being collected, it seems clear that Silver and Gold Quality Award recipients weathered the pandemic more efficiently and effectively. “A word we use a lot in the program is sustainability, and going through the awards process helps organizations build that,” said Kelly. This means that when a crisis takes focus away from other efforts, facilities can go on autopilot for a time and don’t fall apart. She explained, “Going through the application as a team and setting up interdisciplinary processes build confidence, teamwork, and oneness of thought so when things get difficult, there is more stability and agility. The team is able to pull together when things feel like they’re burning down around us. We have solid ground to stand on.”</p><p>During the pandemic, organizations learned that transparency builds trust. Kelly observed that Quality Award participants already knew this. These organizations have already assessed and addressed how and with whom they share information, and what information various audiences need access to. They realize, she said, that “if people don’t have good information, they make it up; and when&#160;</p><p>this happens, things go sideways.” Going through the awards process and sharing information, she said, builds confidence in your ability to communicate both “when things are great and when they’re not so good.”</p><p><img src="/Issues/2023/Spring/PublishingImages/LisaPearson.jpg" alt="Lisa Pearson" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;180px;height&#58;225px;" />Lisa Pearson, MSN, RN, CIC, director of infection prevention and quality improvement at South Davis Community Hospital in Bountiful, Utah, said, “At the beginning of the pandemic, we recognized that staff wanted information. There was a lot of fear that could be felt everywhere. Having information was essential, so we created a newsletter—The COVID Connection—containing the information staff needed.” At the same time, she said, “we already had key people in place who knew what they needed to do. We formed a task force with key leaders, and we created a systematic process to respond to new guidance and information with daily team meetings.” As a result, she said, they reacted less with fear, and they made decisions that were data-informed instead of based on emotion.</p><p>Hensley noted, “We were much better equipped to handle the pandemic, and we were able to respond to the almost daily changing guidance. We could rely on our processes and provide our staff with great stability in uncertain times.”&#160;</p><p>Pearson agreed, “Going through the awards program teaches you not to have a reactive approach where you’re putting out fires all the time. Instead, you become proactive and are able to mitigate many small problems before they become big ones.” She added, “Since you have streamlined and efficient processes in place, it saves time, and you have happier staff and better outcomes.”</p><h3>Star Staffing<br></h3><p>While the Quality Awards aren’t a panacea, Hensley noted their value for improving—or at least stabilizing—staffing. He said, “If you are a quality nurse, wouldn’t you rather work for a five-star Gold award facility? It’s easier to retain and recruit good staff when you demonstrate your commitment to quality and make it clear that you engage and value staff in these efforts. It also may be a deterrent to those who just want a job and don’t have any real interest or passion for long term care.”</p><p>Even with a strong staff, it can be challenging to ask people to do the work of writing for Quality Awards. However, Hensley stressed, “pursuing this milestone is worth it. It engages our staff and gives them purpose beyond what they are doing every day. It makes a weak team strong and a great team exceptional.” He suggested that it can be easier to pursue the awards if “you take it in small steps and celebrate milestones.”</p><p>For those organizations that feel like they’re just staying above water, Pearson suggested, “You are the perfect candidate for this. It will teach you to develop processes; identify blind spots; and better support staff, residents, families, and other stakeholders. The awards aren’t just a vanity project. They will help you not only survive but thrive.”&#160;<br></p>2023-03-01T05:00:00Z<img alt="" src="/Issues/2023/Spring/PublishingImages/QualityAwards.jpg" style="BORDER&#58;0px solid;" />Quality AwardsJoanne KaldyPutting quality improvement processes in place can win awards, but also helps build teamwork, motivation, and communication.
2022 AHCA Annual Awards<p>The American Health Care Association (AHCA) pay tribute to the best and brightest in long term and post-acute care. Individuals and groups honored with awards will be recognized during the 73rd AHCA/NCAL Convention &amp; Expo this month in Nashville, Tenn.</p><p><strong class="ms-rteThemeForeColor-5-0"><br></strong></p><p><strong class="ms-rteThemeForeColor-5-0">MyRon Zimmer, Bowdle Healthcare Center, Bowdle, SD</strong><br><span class="ms-rteForeColor-2">AHCA Volunteer of the Year Award</span></p><p><img src="/Issues/2022/SeptOct/PublishingImages/MyRonZimmer.jpg" alt="MyRon Zimmer" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />MyRon Zimmer has been a volunteer at Bowdle Nursing Home in Bowdle, SD, for many years, and has volunteered every day of the last four years. He can be described as the “textbook definition” of a passionate and caring health care volunteer. He interacts with every resident of Bowdle Nursing Home as if they are his own loved ones. His caring smile and outgoing personality bring joy to each and every resident he interacts with. Zimmer partners with Bowdle’s activities department for monthly “Painting with MyRon” sessions which residents enjoy and look forward to. As an extremely talented artist who loves to share that passion, Zimmer leads residents in painting free-hand creations that decorate the dining room and hallways at Bowdle.</p><p>At the height of COVID-19, Zimmer led the charge to continually bring joy to the residents to combat the fear and uncertainty many residents felt. He goes beyond above and beyond to ensure residents experience the highest quality of life, whether it be by planting and tending the luxurious garden that all residents enjoy in the back courtyard, giving haircuts, taking residents outside, or spending one-on-one time with residents who confide in him. Without a doubt, Zimmer is an extraordinary volunteer that the staff at Bowdle Nursing Home are honored to work alongside. </p><p><strong class="ms-rteThemeForeColor-5-0">Meera Riner</strong><br><span class="ms-rteForeColor-2">Mary K. Ousley Champion of Quality Award</span><br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/MeeraRiner.jpg" alt="Meera Riner" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />Meera Riner, chief operating officer of Nexion Health Management, Inc., based in Sykesville Maryland, is the 2022 recipient of the&#160;Mary K. Ousley Champion of Quality Award. Riner is recognized for her outstanding contributions to quality in long term and post-acute care.<br></p><p>Over the last several years, Riner has worked to bridge the gap between regulators and long term care facilities. She was instrumental in the development of the Texas Coalition for Long-Term Care and the criteria for the Texas Quality Incentive Payment Program (QIPP), a performance-based program that incentivizes nursing facilities to improve the quality and innovation of their services. As a result, since 2019, the QIPP program has positively impacted quality in Texas nursing facilities by improving resident outcomes, with antipsychotic usage down in long-stay residents by 33 percent and improvement in long-stay residents’ ability to move independently up by 10 percent. <br></p><p>She is a Baldrige Program Fellow, the first person in long term care to achieve the honor. In 2020, Riner was awarded the McKnight’s Woman of Distinction Hall of Honor, and in 2020 she was recognized by McKnight’s Senior Living with an Innovation in Technology Award for her work during the COVID-19 pandemic. <br></p><p>Riner has served on the Texas Healthcare Association’s Board of Directors, and as an AHCA/NCAL National Quality Award Program Examiner, and on AHCA committees that address quality and workforce. <br>Each year, AHCA/NCAL presents the Mary K. Ousley Champion of Quality Award to an individual that has made significant national contributions to advancing quality performance in long term and post-acute care. Recipients display leadership in the development, promotion, and implementation of quality improvement initiatives that have resulted in measurable outcomes.<br></p><p>In 2011, the Friend of Quality Award was renamed the Mary K. Ousley Champion of Quality Award to honor the ongoing legacy and commitment to quality care demonstrated by its namesake, Mary Ousley, a licensed nursing center administrator and nurse who has dedicated her life to quality improvement programs in long term care.</p><p><strong class="ms-rteThemeForeColor-5-0">Mario Whitt, Harris Hill Nursing Facility, Williamsville, NY</strong><br><span class="ms-rteForeColor-2">AHCA Noble Caregiver</span><br></p><p>Mario Whitt has been part of The McGuire Group’s Harris Hill Nursing Facility for <span></span>over 20 years and currently <span><span><span><img src="/Issues/2022/SeptOct/PublishingImages/MarioWhitt.jpg" alt="Mario Whitt" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;150px;height&#58;188px;" /></span></span></span>chairs the Advisory Board Council. Whitt has been a beacon of inspiration throughout the COVID-19 pandemic and as the sector moves <span><span></span></span>forward. He continually contributes to the positive well-being of Harris Hill and displays leadership of the highest standards. Over the last year, Whitt has been instrumental in implementing of the State of New York vaccine mandate. He coordinated messaging to staff across McGuire Group’s facilities to help achieve some of the highest vaccination rates in the region. He served as a spokesman throughout the vaccine campaign and provided an in-depth overview of the vaccine, defining efficacy, best clinical practices, and debunking myths along the way. <br></p><p>Whitt also encourages employment for youth in health care. He introduced the concept of youth employment to reinvigorate workforce development, creating a pipeline of school-aged employees. In 2022, Harris Hill launched the program, which works primarily with inner-city high school students to develop health career tracks and valuable life skills for future employment. The first program of its kind within the Western New York Region, it is designed to be a paid internship for youth interested in health care and help them realize their dreams. <br></p><p>Additionally, Whitt is a true conduit bridging the gap between Harris Hill and the local community. In May 2022, following a mass shooting that took the lives of 10 individuals at a local grocery store, he coordinated efforts between local churches, community parishes, and The McGuire Group to hold numerous food drives and fundraisers. All of the food went to families of the victims, and proceeds funded the burial and funeral arrangements for the victims. <br></p><p>Whitt is closely tied with his community and continues to work toward a brighter future for the families, staff, and residents within the long term care community.<br><strong class="ms-rteThemeForeColor-5-0"><br></strong></p><p><strong class="ms-rteThemeForeColor-5-0">Larry Slatky, Shaker Place Rehab Nursing Center, Albany, NY</strong><br><span class="ms-rteForeColor-2">AHCA Administrator of the Year Award</span><br></p><p><img src="/Issues/2022/SeptOct/PublishingImages/LarrySlatky.jpg" alt="Larry Slatky" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />Larry Slatky has been the Administrator at Shaker Place Rehab Nursing Center in Albany, NY, since 2014. Prior to his arrival, Shaker Place was a one-star facility based on CMS’ Five-Star Quality Rating system. Under his leadership, the nursing home is now a four-star CMS Quality facility, an AHCA Silver Award recipient, and recently named the Best Senior Living Facility in the Capital Region by the Times Union, Albany’s local newspaper.<br></p><p>Slatky creates a team approach to manage Shaker Place, keeps lines of communication open, provides staff with the tools necessary for every department to reach its goals of operation, and always maintains an open-door policy. Understanding the importance of community, Slatky has established partnerships with educational institutions including BOCES, Siena College, St. Mary’s College, University of Albany, and the College of St. Rose that use Shaker Place for their various nursing, therapy, and dietician programs. Slatky also permits low-income families to send their young adults and other relatives to receive training in the trades, such as food services, maintenance, environmental services, and security.<br></p><p>Slatky leads from the heart with a passion to serve others, and with the highest degree of integrity and ethical behavior.</p><p><strong class="ms-rteThemeForeColor-5-0">Longevity Fun Run, Forest Hills of DC, Washington, DC</strong><br><span class="ms-rteForeColor-2">AHCA Program of the Year Award<br></span></p><p><img src="/Issues/2022/SeptOct/PublishingImages/Awards_run.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />After an annual city-wide AARP luncheon to honor centenarians was canceled due to COVID in May 2021, Forest Hills of DC established its Longevity Fun Run. Born out of the need to celebrate health care heroes and honor their residents during COVID, this event brings together residents, families, staff, volunteers, and community representatives, including DC Department of Health (DOH) Council members. The event takes place every May during Older Americans Month and National Skilled Care Week in a fun, inclusive, community-bonding running event connecting assisted living and nursing homes across the District of Columbia. <br></p><p>At this year’s Longevity Fun Run on May 12, 2022, DC Council passed a proclamation that May 2022 be decreed as “Old People Are Cool” month to honor seniors and residents, take a stance against ageism, celebrate the wisdom seniors have to offer, and to lift up those health care workers who care for the residents. The event builds a sense of greater community with and around Forest Hills’ residents, involves government council representatives, the DOH, skilled nursing facilities, assisted living facilities, board members, staff department heads, and CNAs all on a level playing field. <br></p><p>The energetic exchange between teams running and support from friends and family waiting to greet them when they arrived are reminders that the purposeful work of long term care connects everyone involved.&#160; <br></p>2022-09-01T04:00:00Z<img alt="" src="/Issues/2022/SeptOct/PublishingImages/Awards.jpg" style="BORDER&#58;0px solid;" />Quality AwardsAndrea Todd and Natalie VisnickAHCA pays tribute to the best and brightest in long term and post-acute care.
2022 AHCA/NCAL National Quality Awards Recipients<p>The American Health Care Association/National Center for Assisted Living is pleased to present the companies that have earned AHCA/NCAL National Quality Awards in the Gold—Excellence in Quality, Silver—Achievement in Quality, and Bronze—Commitment to Quality categories.</p><p><strong style="color&#58;#cc9900;"><span style="color&#58;#cc9900;">GOLD</span></strong><br>Gold recipients demonstrate through their approach, deployment, and consistency of results that they are achieving high levels of performance in health care, customer satisfaction, market, workforce, process, and leadership outcomes. At the Gold level, applicants must address the Health Care Criteria of the Baldrige Performance Excellence Program in its entirety.​</p><p><span class="ms-rteThemeForeColor-1-4"><strong>SILVER</strong></span><br>Applicants that receive the Silver award provide an extensive assessment of their systematic approaches, performance measures, and sustainable organizational and process results that are linked to the key customer requirements, success factors, and challenges the applicants previously identified in earning the Bronze award. </p><p><strong style="color&#58;#cc6600;"><span style="color&#58;#cc6600;">BRONZE</span></strong><br>Applicants that receive the Bronze award are able to describe their vision and mission, outline plans to improve processes within their communities, identify key challenges, and recognize the relationship of these factors with their ability to achieve performance improvement.</p><p><a href="/Issues/2022/SeptOct/Documents/QualityAward%20Prv091022.pdf" target="_blank">2022 AHCA/NCAL National Quality Award Recipients</a><br></p>2022-09-01T04:00:00Z<img alt="" src="/Issues/2022/SeptOct/PublishingImages/QA_Maunalani.jpg" style="BORDER&#58;0px solid;" />Quality AwardsAHCA/NCAL is pleased to present the companies that have earned National Quality Awards in the Gold, Silver, and Bronze categories.