A Leap Forward in Care

Seniors Quality Leap Initiative is perfecting senior care through international collaboration

Over the past decade, there has been heightened interest in quality and safety performance improvement across senior care. Rightfully so, as a society with a steadily growing senior population needs to be sure its elders are in good hands. As a result, performance-oriented strategies have been put in place to improve clinical outcomes, while mandatory — and in some cases public — reporting on specific quality and safety indicators has been on the rise.

This trend, and an altruistic desire to do right by the aging community in need of care, gave birth to the Seniors Quality Leap Initiative.

The Beginnings of the Seniors Quality Leap Initiative

In 2010, despite the increasing attention to quality and safety, there was relatively little focus on benchmarking vital performance data within senior care. Inspired by a similar collaboration of 13 academic health science centers in Canada, and recognizing the inherent challenges of “going it alone,” executives from some of North America’s leading senior care organizations identified an opportunity to lead a global benchmarking initiative in their sector.

At the time, the goal was to establish a learning collaborative of seven to 12 major senior care organizations from Canada and the United States that would work together over a few years to achieve higher performance levels in quality and safety. Thus, the Seniors Quality Leap Initiative was established to engage leading long-term care providers in a novel effort to share performance data and the results of quality improvement initiatives.

Since its inception, SQLI has leveraged its strength as a community to identify improvements and best practices that have the greatest impact on long-term care residents’ quality of care and quality of life.

SQLI Today

Despite geographic differences — and two distinct systems of government, health policy, and funding models — SQLI is now a strong community of practice comprised of 16 long-term care/post-acute providers and 11 strategic, innovation, and academic partners across Canada and the United States. In its current model, SQLI connects health care leaders and quality improvement champions over topics and problems of mutual interest.

The organization shares resources and experiences, drives improvement through the review of highly performing organizations’ practices, collaborates on the identification of solutions, and coordinates its improvement activities in a way that respects the unique contexts of each organization. All of this ensures seniors get the care they deserve, no matter where on the continent they may be.

SQLI’s vision is to become North America’s leading post-acute and long-term care provider consortium for benchmarking clinical quality standards that reflect advancing innovative ideas to raise the bar for excellence throughout the industry.

Its mission is no less noble: to enhance the quality of life and quality of care for seniors by utilizing a structured approach to quality and performance improvement and disseminating recommendations to the broader post-acute and long-term care sector.

SQLI is the only international forum that:

• Allows for peer-to-peer comparisons of quality measures and the benchmarking of best practices
• Fosters the development of new and innovative approaches to quality assurance and improvement specific to the post-acute and long-term care sector
• Provides unique networking opportunity for leaders in senior care
• Facilitates novel research and educational initiatives through its diverse membership, including strategic and academic partners
• Integrates quality of life measurement into performance scores
• Sustains a data repository with universal tools and methodologies
• Showcases national and international experts in health policy, research, and patient care

All members of the SQLI consortium continue to demonstrate their commitment to open and transparent dialogue and to the exchange of data and best practices regarding quality care and quality of life.

Data Exchange and Benchmarking

The accurate and timely sharing of data across countries is not easy, but senior researchers and InterRAI fellows at the Institute for Aging Research in Boston (a Harvard Medical School affiliate) and the University of Waterloo in Ontario, Canada, work tirelessly at analyzing the quality of care and quality of life indicators from all 15 SQLI provider organizations.

Through the transfer of anonymized data, quality indicator report cards are generated, allowing providers to engage in thoughtful discussions about areas of strength and areas for improvement, both at the provider and SQLI consortium level.

Addressing Resident Pain – an SQLI Success Story

In January 2014, when reviewing quarterly report cards, the consortium identified a gap in organizational performance on quality measures related to residents’ pain. Unfortunately, several SQLI organizations were not performing as well on pain indicators compared to the US reference median — and there was also significant variation in organizational performance.

Practice and policy variations within organizations were apparent. Although many of the SQLI organizations had policies and practices regarding pain assessment/re-assessment, a number of opportunities for shared learning and improvement were identified. Recognizing the high prevalence of pain in the nursing home resident population (45-80 percent of nursing home residents experience some degree of pain), coupled with the fact that pain is often underreported, underassessed, and undertreated, this became a critical area for the SQLI community to address. Thus, addressing resident pain became the consortium’s first structured improvement project.

As a first step, the SQLI organizations completed a gap analysis to understand and examine what practice gaps may exist within their organizations pertaining to the management of resident pain. Using the InterRAI Clinical Assessment Protocols for Long-Term Care Assessment Instrument (v 9.1) as best practice, a survey was drafted to help each organization assess and evaluate their adherence to best practices around pain management.

The survey was intentionally detailed to gather as much information as possible about organizational practices in an easily tabulated format. The completed survey data was compiled and summarized with the gaps clearly identified into a heat map according to the evidence-based best practice domains. This made it easier for each organization to identify its gaps and clearly see which organizations may have practices that could be shared and modified.

Instead of a “one size fits all” approach, member organizations each developed an improvement plan based on the individual results of their gap analysis. The improvement plan outlined each organization’s current performance on the quality indicator, the changes that each organization will put in place to drive improvement as well as corresponding process measures that would be tracked and monitored at the organizational level.  Progress and learnings are shared quarterly within the membership. The changes each organization implemented included:

• policy changes
• building and delivering modified training and education focused on non-pharmacological interventions to manage and treat pain
• automated reminders in the health record
• audits
• new assessment tools

The results are impressive: The percent of residents with moderate or severe pain has improved by 8 percent (average of all SQLI organizations), with some organizations improving by over 20 percent. Similarly, the percent of residents with continuous pain has also improved by 8 percent (average of all SQLI organizations), with organizational improvements ranging from 4 to 22 percent.

Moving Forward

In the spirit of continuous quality improvement, SQLI is building on this successful approach and has identified the next area of focus for the consortium: improving resident quality of life. Using benchmarked data stemming from an internationally validated resident quality of life survey instrument (InterRAI Self-Reported Quality of Life Survey v 9.3), the SQLI consortium has committed to improving quality of life scores in its resident population.