Quality Assurance for Activity Programs
Smashwords Edition
Richelle N. Cunninghis, EdM, OTR/L
Elizabeth Best-Martini, MS, CTRS, ACC
Idyll Arbor – Smashwords Edition
Idyll Arbor, Inc.
39129 264th Ave SE
Enumclaw, WA 98022
(360) 825-7797
Editor: joan burlingame, CTRS, HTR
Cover photograph “Between a Rock and a Hard Place” by Thomas M. Blaschko.
(c)1996 Idyll Arbor, Inc.
(c)1990 Geriatric Education Consultants first published under the name Quality Assurance for Activity Programs: A How To Manual.
International copyright protection is reserved under Universal Copyright Convention and bilateral copyright relations of the USA.
This book contains original reproducible forms exclusive with Idyll Arbor, Inc. and fully protected by copyrights.
The original purchaser of this book is authorized to reproduce and use the individual items in this book for the development of a quality assurance program. However, the reproducible forms collection in this book may not be reprinted or resyndicated in whole or in part as a reproducible handout book or collection, for duplication for students, or for any other purpose without the written permission of the publisher.
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ISBN 9781611580021
Table of Contents
Developing Quality Assurance Programs
Steps in Designing a Quality Assurance Study
Identifying Issues and Selecting Study Topics
Common Quality Assurance Issues
Establishing Indicators and Developing Criteria
Determining Methodology and Collecting Data
Assessing Outcomes and Identifying New Issues
OBRA Quality Assurance Regulations
Joint Commission on Accreditation of HealthCare Organizations
Publisher’s Note:
The term “activity professional” is used throughout this book. By “activity professional” we mean an individual who provides activity services to residents in long term care settings including those who are (but, of course not limited to):
Activity Assistant, Certified
Activity Consultant, Certified
Activity Director, Certified
Art Therapist
Dance Therapist
Horticultural Therapist, Registered
Music Therapist, Registered
Occupational Therapist, Registered
Occupational Therapy Assistant, Certified
Recreational Therapist, NCTRC Certified
Social Worker
This book is also intended for students who are preparing to be activity professionals.
Chapter 1: Introduction
Ever since we started providing health care to others, we have been interested in improving the results. The process has become more formalized over time. Today it is called by various names including quality assurance, quality improvement, total quality improvement and improving organizational performance. When the process works well, it helps you identify how good your work is without making your work harder.
Today, quality assurance is the process of identifying problems, determining the worst problem, figuring out how to fix it and making sure that the problem does not return. To work as an activity professional today you need to know how to set up a quality assurance program, how to identify problems, how to correct them and how to monitor your progress.
You may ask, “Why do I need to create more paper work when I know what is wrong?” The answer is because the law says so and because managed care companies want to be sure that they are getting the most for their money. These days knowledge of quality assurance techniques is just as important as knowledge of the disease process, physiology, anatomy and the therapeutic process itself.
One federal law that requires quality assurance is the Omnibus Budget Reconciliation Act of 1990 or “OBRA.” It requires that facilities know how well they are meeting the needs of their residents. Facilities must have a quality assurance program in place, along with a committee to identify areas that needed improvement. The law also requires a facility to design ways to improve the delivery of services and to follow-through with the changes. While the law allows the activity professional to be one of the committee members, up to now they were seldom chosen.
On July 1, 1995, the OBRA regulations were updated. There were many changes made to the original interpretation but the most significant changes were in the survey process and how the regulations are enforced. One change made it easier to identify the severity of violations. (A violation occurs when a service or piece of equipment is below standards and, therefore, potentially harmful to the resident.) The authors of the newly changed regulations realized that not all violations were an equal threat to the resident’s health. To help staff make decisions about which problems to address first and to help surveyors provide consistent surveys from one facility to the next, a “grid” was developed. This grid helps identify an incident’s severity and scope. (Scope looks at how often it occurred and how many people it affected.)
The grid also includes the penalties that may be applied by the survey team to assure “Substantial Compliance.” (Substantial compliance is the term used to indicate that a facility is meeting the minimum expectations for providing quality services.)
A facility is expected to provide services that meet each resident’s physical, social, emotional and psychological needs. However, in reality, errors happen, residents’ needs are missed or not addressed, staff call in sick and other problems arise. Even the best facility has difficulty providing quality services all of the time. Because of this, each facility must have an ongoing program to identify problems, determine needed changes, make those changes and monitor the results. For such a system to work, everyone must be involved at some level.