QAPI Self-Assessment Tool

The use of this tool is not mandated by CMS for regulatory compliance nor does its completion ensure regulatory compliance.

Directions:

Use this tool as you begin your work on QAPI and then for annual or semiannual evaluation of your organization's progress with QAPI. This tool should be completed with input from the entire QAPI team and organizational leadership. This is meant to be an honest reflection of your progress with QAPI. The results of this assessment will direct you to areas you need to work on in order to establish QAPI in your organization. You may find it helpful to add notes under each item as to why you rated yourself a certain way.

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* Name of Your Facility:

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* Please enter your six digit CCN (CMS Certification Number/ Medicare Identification Number)

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* Please provide your Email Address

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* Your facility is located in which of the following states?

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* Please provide the dates of when you plan on completing the QAPI Self-Assessment Tool.

Date of this Review:
Date of the Next Review:

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* Rate how closely each statement fits your organization.

  Not Started Just Starting On Our Way Almost There Doing Great
Our organization has developed principles guiding how QAPI will be incorporated into our culture and built into how we do our work. For example, we can say that QAPI is a method for approaching decision-making and problem-solving rather than considered as a separate program.
Our organization has identified how all service lines and departments will utilize and be engaged in QAPI to plan and do their work. For example, we can say that all service lines and departments use data to make decisions and drive Improvements, and use measurement to determine if improvement efforts were successful.
Our organization has developed a written QAPI plan that contains the steps that the organization takes to identify, implement and sustain continuous improvements in all departments; and is revised on an ongoing basis. For example, a written plan that is done purely for compliance and not referenced would not meet the intent of a QAPI plan.
Our broad of directors and trustees (if applicable) are engaged in and supportive of the performance improvement work being done in our organization. For example, it would be evident from meeting minutes of the board or other leadership meetings that they are informed of what is being learned from the data, and they provide input on what initiatives should be considered. Other examples would be having leadership (board or executive leadership) representation on performance improvement projects or teams, and providing resources to support QAPI.
 
17% of survey complete.

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