The “Performance Improvement Project” (PIP) element of the Centers for Medicare and Medicaid Services (CMS) new “Quality Assurance and Performance Improvement” (QAPI) program is to have a plan in place to focus on a particular problem in one area of a long-term-care facility.
This forms the fourth element of the CMS’s QAPI program, which all long-term-care facilities must have in place by November 28, 2017.
The CMS’s official handout, titled “QAPI at a Glance,” says that a PIP “involves gathering information systematically to clarify issues or problems, and intervening for improvements.”
In this regard, the CMS says, a facility must conduct PIPs to “examine and improve care or services in areas that the facility identifies as needing attention.”
The CMS documentation adds that areas which need attention will vary depending on the type of facility and the unique scope of services they provide.
What are the basic building blocks of a successful PIP? Here are some guidelines:
First, compartmentalize the topics selected for PIP assignment when they fall into the following categories:
– High risk: these are the issues which represent the greatest risk to the facility in terms of legal impact, financial repercussions, damage to reputation, regulatory noncompliance, or harm to residents or staff.
– High volume: these are the issues which affect the greatest number of residents or staff.
– Problem prone: these are the issues which occur frequently. In addition, these can be ranked by severity.
Once the categories have been populated, it can easily be seen which issue requires the most urgent attention of a PIP to address the problem.
Secondly, draw up PIP team members based on their relationship to the issue under review. This can include residents and/or family members if necessary and possible.
This PIP team will be entrusted with the establishment of goals, identifying needed resources, and documenting all the processes they follow.
To aid in this, the PIP should be encouraged to use the “Worksheet for Creating a Performance Improvement Project” contained in the “Prioritization Worksheet for Performance Improvement” CMS handout.
This tool will create a prioritization process which will allow the PIP team to quickly move to a solution of the most pressing problems.
When drawing up improvement procedures, the PIP team must ensure that they have a clear idea of what it is they are trying to accomplish, and how they will know that the change will be an improvement.
All PIP projects must be recorded in a log titled “Performance Improvement Project Inventory Sheet”, which must be periodically reviewed and monitored by the QAPI leadership team to ensure that progress is being made.
A comprehensive PIP plan will consider the following categories when drawing up actions and interventions:
– Systems: This involves identifying the methods, procedures, and routines to be used.
– People: This involves identifying the leaders, staff, residents, families, and others with skill or understanding of the issue.
