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Quality assurance/performance improvement (QAPI) programs ensure all internal policies and processes mirror appropriate standards and regulations.
ASCs that are accredited or that accept Medicare patients need consistent quality assurance/performance improvement (QAPI) programs to ensure all policies and processes align with existing standards and regulations.
The question is: How do centers pull this off while convincing staff to buy in? One answer is to engage every employee in QA by providing financial and social incentives.
While many facilities use QA committees and managers who work on QAPI projects, it is even more effective to involve all employees in these initiatives, according to Tina J. DiMarino, MSN, RN, CNOR, CASC, a board member with the Maryland Ambulatory Surgery Association. “What we’ve done over the years is have every staff member look at their area and think about what they could do to improve the area,” says DiMarino, administrator at Mid-Atlantic Surgery Pavilion in Aberdeen, MD.
The result has been original and innovative projects that empower staff. The projects also have impressed accreditation surveyors, DiMarino notes. “When they survey centers, [surveyors] see cookie-cutter studies and on-time start studies that are great if you can affect change with that,” she says. But surveyors prefer seeing QAPI projects that make lasting changes, such as correcting processes for maintaining equipment. “Surveyors like seeing the issues you’re having at your own center,” DiMarino explains. “They love that you did facility review and matched your policies to your processes.”
At DiMarino’s center, all nurses, techs, front-end, and other staff meet every other year to discuss successful previous QAPI projects and brainstorm new initiatives. The day includes lunch and is meant to be a fun, morale-building activity. By celebrating previous QAPI projects, DiMarino says employees are inspired to work on new projects.
DiMarino encourages employees to choose something they are passionate about that they could improve. If someone says the instruments are not lasting as long as they should, then the employee could start a review of instrument handling and use, DiMarino suggests. One employee led a QA project on recycling, studying how much it would cost the facility and how it would work.
“She looked at everything we had thrown away prior to patient use and found we were filling dumpsters weekly with trash,” DiMarino recalls. “We had a company picking up our trash once or twice a week. But after the recycling program launched, the trash pick-ups dropped to once every two weeks.”
Not only did the ASC reduce its trash output, this recycling initiative saved the facility money.
Once the group selects some feasible projects, DiMarino says a QA committee, which meets quarterly, considers the ideas. The QA committee and ASC leaders make certain the projects might be feasible and do not affect patient safety or privacy. “We say to the committee, ‘Here are the studies we have come up with, here are the ones we’re working on for this quarter, and here’s the data we are collecting,’” DiMarino says.
Once the projects begin, DiMarino gives staff sample notification reports, encouraging employees to use these to make the program more robust through documentation. A few items listed on a QA notification report include source of data, assessment of data, changes implemented, and follow-up.
Participants need at least two quarters to collect data and additional time to analyze, assess, and implement corrective actions. “I check in with them monthly during the project, asking, ‘How is it going? Do you need any help?’” she says. “The hardest part is some employees have a difficult time determining what the performance goal is and ensuring it is quantitative in nature.”
When the first results emerge, the QA committee views the data and either gives the go ahead to the project or stops it, often because the early results met the ASC’s goals and no further action was required, DiMarino explains. The ASC’s doctors receive a full report of all quality improvement findings and any changes that are implemented.
The staff has been very motivated by the QAPI process, and morale is at its peak, DiMarino reports.
“It’s a team-building experience that empowers everyone,” she explains. “It’s not just the nursing staff, but the techs that clean instruments, the receptionist — everyone is involved and treated equally with regard to being a member of the team.” At each QAPI meeting, employees listen to each person describe his or her study and findings before voting on the ones they like best. DiMarino hands out gift card awards to the first-, second-, and third-place winners.
Employees are involved in a process that makes them feel as though they are making a difference, DiMarino says.
“Everyone is extremely important, and we strive to ensure they feel that way, as well,” she says. “They’re making changes and improvements that were their idea.”
Financial Disclosure: Consulting Editor Mark Mayo, CASC, MS, reports he is a consultant for ASD Management. Nurse Planner Kay Ball, PhD, RN, CNOR, FAAN, reports she is a consultant for Ethicon USA and Mobile Instrument Service and Repair. Editor Jonathan Springston, Editor Jill Drachenberg, Author Melinda Young, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, Author Stephen W. Earnhart, RN, CRNA, MA, Accreditations Manager Amy M. Johnson, MSN, RN, CPN, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.