Consumers, third party payers, and regulatory agencies are demanding accountability for cost and quality of services provided. Longterm care facilities are scrambling to set up quality assurance programs to meet these demands. Yet, the development and adoption of quality assurance programs are often misunderstood. Prepackaged programs developed by professional groups, regulatory agencies, and consultants are too often imposed on the nursing staff with little or no modification to reflect the philosophy or goals of the facility.
The purpose of a quality assurance program in long-term care is to ensure excellent physical and psychosocial care and improve the quality of life of the residents. To do this, a program must be developed that reflects the uniqueness and range of health deviations encountered in a facility, the types of services provided, and the health outcomes to be achieved. A facility's most valuable resource is a knowledgeable staff that has the ability to assess health problems and the environment of the residents and to develop individualized goals and service plans. Organizational systems must encourage maximum staff participation at all levels. In a successful quality assurance program, the talents and expertise of the staff would be used to build an individualized program or to modify prepackaged programs to individual agency objectives.
The following 1 0-step monitoring and evaluation process has been developed by the Joint Commission on Accreditation of Healthcare Organizations to use as a guide for long-term care staff in developing their quality assurance program:
1. Assign responsibility;
2. Del i neate the scope of care;
3. Identify important aspects of care;
4. Identify indicators related to these aspects of care;
5. Establish thresholds for evaluation related to the indicators;
6. Collect and organize data;
7. Evaluate care when thresholds are reached;
8. Take action to improve care;
9. Assess the effectiveness of the actions and document improvement; and
10. Communicate relevant information to the organizationwide quality assurance program.1
A strong quality assurance program can provide the basic structure for evaluating and improving the care and quality of life of our most vulnerable citizens; but not without full involvement of all the staff.
- 1. Joint Commission on Accreditation of Hospitals: Quality Assurance in Long Term Care. 1986; insert.