Five Elements
Element 1: Design and Scope
A QAPI program must be ongoing and comprehensive, dealing with the full range of services offered by the facility,
including the full range of departments. When fully implemented, the QAPI program should address all systems of care
and management practices, and should always include clinical care, quality of life, and resident choice. It aims for safety
and high quality with all clinical interventions while emphasizing autonomy and choice in daily life for residents (or
resident’s agents). It utilizes the best available evidence to define and measure goals. Nursing homes will have in place a
written QAPI plan adhering to these principles.
Element 2: Governance and Leadership
The governing body and/or administration of the nursing home develops a culture that involves leadership seeking input
from facility staff, residents, and their families and/or representatives. The governing body assures adequate resources
exist to conduct QAPI efforts. This includes designating one or more persons to be accountable for QAPI; developing
leadership and facility-wide training on QAPI; and ensuring staff time, equipment, and technical training as needed. The
Governing Body should foster a culture where QAPI is a priority by ensuring that policies are developed to sustain QAPI
despite changes in personnel and turnover. Their responsibilities include, setting expectations around safety, quality,
rights, choice, and respect by balancing safety with resident-centered rights and choice. The governing body ensures staff
accountability, while creating an atmosphere where staff is comfortable identifying and reporting quality problems as
well as opportunities for improvement.
Element 3: Feedback, Data Systems and Monitoring
The facility puts systems in place to monitor care and services, drawing data from multiple sources. Feedback systems
actively incorporate input from staff, residents, families, and others as appropriate. This element includes using
Performance Indicators to monitor a wide range of care processes and outcomes, and reviewing findings against
benchmarks and/or targets the facility has established for performance. It also includes tracking, investigating, and
monitoring Adverse Events that must be investigated every time they occur, and action plans implemented to prevent
recurrences.
Element 4: Performance Improvement Projects (PIPs)
A Performance Improvement Project (PIP) is a concentrated effort on a particular problem in one area of the facility or
facility wide; it involves gathering information systematically to clarify issues or problems, and intervening for
improvements. The facility conducts PIPs to examine and improve care or services in areas that the facility identifies as
needing attention. Areas that need attention will vary depending on the type of facility and the unique scope of services
they provide.
Element 5: Systematic Analysis and Systemic Action
The facility uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, its
causes, and implications of a change. The facility uses a thorough and highly organized/ structured approach to
determine whether and how identified problems may be caused or exacerbated by the way care and services are organized
or delivered. Additionally, facilities will be expected to develop policies and procedures and demonstrate proficiency in
the use of Root Cause Analysis. Systemic Actions look comprehensively across all involved systems to prevent future
events and promote sustained improvement. This element includes a focus on continual learning and continuous
improvement.
