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Deciding what you want to change and communicating that intention is the first step of the quality improvement cycle. This page provides a general description of the goal and its benefits to share with your team.

Consistent assignment occurs when residents are consistently cared for by the same caregivers. Consistent assignment has been shown to increase caregivers' familiarity with residents and to strengthen relationships between caregivers and both residents and their family members.

  • How Does Consistent Assignment Benefit Residents?

    Residents do not have to explain to new caregivers how to care for them day after day.

    Staff can respond to resident needs more quickly, confidently and naturally when they know the residents.

    Residents are more comfortable with the intimate aspects of care when they know their caregivers.

    Residents with dementia are much more comfortable with familiar caregivers.

    Residents can have stronger relationships with staff.

    Staff are more likely to detect residents’ clinical problems early when there is consistent assignment.

    Residents have more choice and control.

    Residents participate more in activities.

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  • How Does Consistent Assignment Benefit Long-term Care Staff?

    Staff members know individual resident’s preferences, needs and routines.

    Staff give better care and can be more organized when residents and team members are known.

    Having meaningful relationships with residents increases staff job satisfaction.

    Staff absenteeism decreases.

    Staff have more positive attitudes.

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  • How Does Consistent Assignment Benefit Long-term Care Communities?

    Communities have better staff and resident satisfaction.

    Providers have better quality measures and fewer survey deficiencies.

    Providers have fewer family complaints.

    Communities have decreased staff injuries.

    Communities have lower staff turnover and absenteeism, which help reduce costs.

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Step 2 – Tracking Tool  >

Tracking Tool

The Campaign Tracking Tools allow you to document your work, monitor outcomes and the processes related to your outcomes. To achieve a data-driven quality improvement project, collect data for several months to establish a solid baseline and set a target for your improvement; then continue collecting data -- charts within the workbooks and trend graphs on the website provide you and your team with the feedback you need to determine if the changes you are making are being fully implemented and if they are having the expected impact on your outcomes. Keep your workbook up-to-date on a daily or weekly basis and look at data often to support a rapid cycle quality improvement project. Download the data tracking tool and collect data for a month or so to determine your starting point.

Questions? Contact the NNHQI Campaign Help Desk: Help@nhQualityCampaign.org.

Before you start, read our Tip Sheet on Testing Change & Starting Small (PDF).

Step 3 – Examine Process  >

Examine Process

This set of probing questions will help you evaluate your current processes and provide guidance for ways to make improvements.

  • How do we know that we may have a need for improvement in consistency of assignment?

    • Are families complaining that the CNAs don’t seem to be familiar with their relatives’ preferences?
    • Have CNAs been telling the charge nurses that the prior shift of CNAs is not doing the work the way it should be done?
    • Our residents are asking what has happened to CNAs they like.
    • Residents have expressed disappointment that things are not being done the way they prefer or the way they used to be done.
    • Our absenteeism rates are high.
    • In filling out the Consistent Assignment Data Tracking tool, we noticed that our level of consistency does not meet the recommended levels.
    • We have been tracking consistent assignment with the Advancing Excellence tool and see that we are not doing as well as other homes in our area.
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  • Which groups are most affected?

    • Are there variations in consistency of assignment by unit, shift, day of the week, time of the year, charge nurse?
    • Are team assignments decreasing consistency of assignments?
    • Do any units have a policy of rotating workers?
    • Who makes the assignments? Is this consistent across shift, unit, and day?
    • Is consistency different with fluctuating staffing levels? What is the reason for this and what has been tried to improve consistency?
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  • Processes and Resources to Consider

  • What practices are we using?

    • Do we have discussions with staff at all levels about the reasons for consistent assignment?
    • Do we routinely review consistency of assignment with charge nurses, schedulers and supervisors?
    • Have staff at all levels been able to voice concerns about consistent assignment?
    • Do people making assignments have real commitment to consistent assignment? If not, what has been done to address this?
    • Do front line staff have input into their assignments?
    • Do residents have input into front line staff assignments?
    • Do nurses have input into their assignments?
    • Is consistency of assignment recorded by actual practice or by scheduled worker?
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  • What policies do we have?

    • Do we have a clear policy about consistency of assignment?
    • Is the policy generally known and accepted in our home?
    • Are there unit-level policies or practices that undermine consistent assignment?
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Step 4 – Create Improvement  >

Create Improvement

The Science of Change

  • The Circle of Success is a quality improvement framework and a guide to finding the resources you need on the website.
  • Quality Improvement Methods are evidence-based approaches for creating systemic change. This collection includes quick-start instructions, templates, and mini-videos.

Step 5 – Engage  >

Engage

Engaging stakeholders creates a robust and successful quality improvement project. Use these fact sheets to start the conversation and encourage everyone to be involved. A story board is a wonderful, visual way to engage your community in the project, keep everyone in the know about new changes that are being tested, and share your challenges and successes along the way.

Step 6 – Monitor & Sustain  >

Monitor & Sustain

Once you make a change or an improvement, it’s important that you continue to collect and submit your data to ensure your improvements are working.

Adobe PDF Illustrated instructions for entering data
Illustrated instructions for transferring data from your Tracking Tool (Excel workbook) to the Campaign website. This step takes just a few minutes, and provides you with real-time trend graphs displaying your progress over time. These are the graphs that allow you to monitor the effect of the changes you are making during your quality improvement project. Graphs are customizable and downloadable and are perfect for sharing with your QI Team, staff, and community.
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!
Website CMS QAPI Website
QAPI is a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes. The activities of QAPI involve members at all levels of the organization to: identify opportunities for improvement; address gaps in systems or processes; develop and implement an improvement or corrective plan; and continuously monitor effectiveness of interventions.
Video The Domestic Lean Goddess - PDSA
This fun 6-minute video shows the Plan-Do-Study-Act (PDSA) cycle, a common quality improvement method, applied to an every day situation: getting the kids to school on time. Applying the four steps of the PDSA cycle pinpoints the root cause and allows effective action to take place.
Adobe PDF Tip Sheet on Testing Change & Starting Small
Testing change, the essence of a PDSA cycle, is likened to perfecting a recipe before preparing it for guests. You may try it several times in advance for a smaller group, adjusting it each time in response to feedback. This tip sheet includes ideas for how to start small with your QI project and data collection.

Step 7 – Celebrate Success  >

Celebrate Success

Too often we let accomplishments pass by without notice because we are already moving on to the next step. But, it's important to take a moment to celebrate accomplishments, big and small.

A celebration program can create a spirit of community in your nursing home. Use visible awards such as certificates, plaques and other tangible rewards that can be proudly displayed. Try giving a spontaneous award from time to time to acknowledge people who are going the extra mile.

Adobe PDF Success Stories
Do you have a story about a successful performance improvement project? Tell us about it! We provide an online form with specific prompts to guide you. Get started by reading other stories of success.
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!


More resources on their way. Please check back soon.

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