Tools and Practices in Long Term Care Quality Assurance


Quality assurance forms an integral component of health care management in long-term care (LTC) facilities. Scientists have developed various models and tools for accomplishing quality improvement. LTC facilities often require a standardized method to involve their administrators and personnel in problem-solving to enhance patient care and organizational outcomes. Various factors including the complexity of the organization, the knowledge and experience of their staff regarding the use of any model, and the usefulness of the model for the achievement of quality management and performance improvement objectives, determine the choice of a problem-solving model. However, how to implement these models and tools to achieve quality assurance in Long-term care facility poses some challenges to LTC facility staff. The concept of quality assurance has remained elusive for a long time. This paper explains the best quality improvement model and tools for assessing quality improvement in LTC facilities.

Problem-solving model of choice

The best model of choice is one that is compatible with the available resources of the facility including the level of knowledge of the staff. In addition, the model should be cost-effective and convenient to the employees. Thus, I will briefly discuss three problem-solving models and propose the best model for achieving quality management and performance improvement.

  1. The Ten Step Process: This model for quality improvement is not systematic. Again, it considers outside factors and output, which do not have an impact on quality improvement. The model does not directly involve the key players of a facility. For instance, how can the suppliers of an organization affect quality improvement?
  2. PDCA: It is a moderate model for improvement. Each step for the improvement of quality comprises various activities. A team of staff allocated for a single phase of the model does not concentrate on specific factors, which affects the accuracy of the information (North Carolina Department of Environment and Natural Resources, 2002).
  3. FOCUS-PDCA: I would advise our LTC staff and manager to consider the FOCUS-PDCA problem-solving model to help in achieving quality management and performance improvement. This model explains the basic parts of the performance improvement process (Hamami, 2007); therefore, it is easy to understand and implement. In addition, this model describes a systematic process of quality improvement. Based on Hamami (2007), the model involves the following steps denoted by the acronym FOCUS-PDCA.

Find an opportunity to improve: This component involves analysis of variation on important pointers including sentinel events, morbidity, and mortality.

Organize a team that is knowledgeable about the process: The team should comprise of persons who are directly engaged in the process targeted for improvement.

Clarify the existing knowledge of the process: This step involves data collection about the process using a Pareto chart or run chart or brainstorm and filling a flow diagram of the existing procedure, and identifying the defective area.

Understand the basis of process variation: Employ a cause and effect diagram to understand why the process is not working effectively.

Select the process improvement: This step involves choosing the most appropriate solution based on its cost-effectiveness and ease of implementation.

As explored by Shaw, Elliott, Isaacson, and Murphy (2007, p.139-143), the PDCA stands for:

Plan the improvement: This involves developing an action program of how the LTC staff will improve the process. This stage also involves planning data collection for monitoring improvement and change.

Do the improvement: This phase involves implementing the improvement and change as a pilot study on small scale.

Check the results: This phase involves evaluating the effect of the improvement and change by collecting data and comparing it with baseline data or data collected prior to improvement.

Act to sustain the gain: Do whatever is important to sustain the improvement, including education and training, policies development, and distribute lessons gained

Use of quality measurement tools in long-term care

There are various tools developed for quality improvement, although few have proven useful for quality improvement. One such tool is the National Surgical Quality Improvement Program (NSQIP) used to improve patient and organizational outcomes. NSQIP uses best practices, site visits, self-assessment tools, and performance measurements (PR Newswire, 2002). Between1991, when NSQIP data were originally collected, and 2000, the influence on the outcome of critical surgeries was remarkable: 30-day postoperative mortality was reduced by 27%.

In addition, electronic medical record systems and Bar Code Medication Administration (BCMA) programs are necessary tools for improving the quality of care and patient safety. In 2002, the BCMA program won the 2002 Pinnacle Award, which is a top honor award by the American Pharmaceutical Association Foundation (PR Newswire, 2002). Nevertheless, the staff should first understand how the program works.

Additional resources for educating staff in problem-solving models and quality measurement tools

The LTC facility manager should search for important tools for educating the staff from credible sources on the internet. However, the instructors must be cautious regarding the currency of the resources and their author(s) credibility. Other sources include reports and resources libraries. Resources for training staff also should be easy to understand and use illustrations to explain a concept.


The best models and tools for quality management and performance improvement are cost-effective and easily understood. However, the models should not be rigid. The staff teams can bend it to suit their situations.

Reference list

Hamami, A. (2007). FOCUS-PDCA model. Retrieved from Pharmacorner. Web.

North Carolina Department of Environment and Natural Resources. (2002). Plan-Do Check-Act: A Problem Solving Process. Web.

PR Newswire. (2002). VA Health System is ‘Best in the Nation,’ Says IOM. New York. Retrieved from ProQuest.

Shaw, P., Elliott, C., Isaacson, P., & Murphy, E. (2007). Quality & Performance Improvement in Healthcare A Tool for Programmed Learning. USA: AHIMA.

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