QI, PI, QA – Making Sense of Alphabet Soup (Part 1)

Few things strike as much fear in the hearts of home health agency managers like quality improvement.  For the record, QI, PI, QA all mean the same thing: by what means does your agency ensure you deliver quality care and service?  Most of our clients emphatically state that they give excellent care.  While we don’t doubt this, the challenge in health care is to prove it.  And as we all know, what isn’t measured isn’t managed and what isn’t managed usually falls by the wayside.  So where do you start?

This four-part blog series will explore the basics of QI and provide some suggestions on developing your QI process.

First of all, think about the areas in your agency where you experience the most challenge.  Is it performing supervisory visits on time?  Receiving all visit notes in a timely manner?  Making sure they reflect the POC? Medication reconciliation?  Managers can usually rattle off several areas of deficiency where their efforts fall short of the mark.  Tackle those first!

This is a good time to bring up the issue of auditing.  Objective audit means that you have pre-set criteria that are critical to optimal performance (or compliance with regulations) and you assess your agency’s reality against those criteria.   Auditing is a snapshot of today – the good, the bad and the ugly.  It’s not a process where you find something wrong or missing and you scramble to fix it so you can report your performance at 100%.  That defeats the purpose.  By means of the audit process, you are assessing the quality and accuracy of your agency’s policies and processes, and your staff’s compliance. Consider it supervision on steroids, if you will.

Give yourself a score.  For example, what percent of the time did your agency’s supervisory visits occur as per policy?  Obviously, the goal is 100%, but be honest.  What is it really?  Don’t worry about failing to miss the mark.  The QI arena isn’t focused on perfection, because it isn’t realistic. What surveyors want to see is that: you know the areas that are critical to compliance; you regularly review performance; you approach things methodically, consistently, and objectively; you don’t assume you know the cause – you study it with the input of other professionals; you brainstorm ideas and solutions; you select the best ones; you implement them in a systematic way; you address training needs; you monitor performance; and you adjust and re-evaluate periodically.

In Part II of this four-part series, we will review the guidelines of a typical QI study.