Five Elements of QAPI

Element 1: Design and Scope

A QAPI program must be ongoing and comprehensive, dealing with the full range of services offered by the facility, including the full range of departments. When fully implemented, the QAPI program should address all systems of care and management practices, and should always include clinical care, quality of life, and resident choice. It aims for safety and high quality with all clinical interventions while emphasizing autonomy and choice in daily life for residents (or resident’s agents). It utilizes the best available evidence to define and measure goals. Nursing homes will have in place a written QAPI plan adhering to these principles.


QAPI is the merger of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI). QA and PI combine to form QAPI, a comprehensive approach to ensuring high quality care. Both involve seeking and using information, but they differ in key ways:

  • QA is a process of meeting quality standards and assuring that care reaches an acceptable level. Nursing homes typically set QA thresholds to comply with regulations. They may also create standards that go beyond regulations. QA is a reactive, retrospective effort to examine why a facility failed to meet certain standards. QA activities do improve quality, but efforts frequently end once the standard is met.
  • PI (also called Quality Improvement - QI) is a proactive and continuous study of processes with the intent to prevent or decrease the likelihood of problems by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems. PI in nursing homes aims to improve processes involved in health care delivery and resident quality of life. PI can make good quality even better.

ELEMENT 1 - Design and Scope of QAPI in your Facility

Involving All Staff in QAPI

For successful implementation, QAPI cannot be imposed from the “top down.” Rather, all levels of staff in nursing homes must be involved in planning and improving systems and processes in order to get effective results. Direct care staff have valuable and unique input which are vital to the success of performance improvement. It’s easy to say all levels of staff should be involved, but harder to put into practice.

All staff must know they contribute as individuals to the big picture: the successful achievement of the resident’s goals for quality of life and quality of care. Involving all levels of staff in QAPI can be challenging. “I don’t have time to leave the floor” is a commonly heard sentiment from nursing assistants in response to a request to attend meetings. Organizations need to have adequate levels of staffing in order to cover the absence of a direct care staff member to attend meetings. This is even more of a challenge in homes that are facing shortages of staff. Nursing assistants may not be accustomed to voicing their opinions in the company of directors, supervisors, physicians, and other senior nursing home staff. Let direct care staff know that their experiences with the residents are invaluable to the QAPI process. Their hands-on knowledge of the resident and the day-to-day processes of the nursing home are necessary to the QAPI discussion and planning.

QAPI Five Elements



Element 1 – Design and Scope

Learn the basics of QAPI

  • Review QAPI five elements
  • Understand how QAPI coordinates with QAA
QAPI Five Elements QAPI at a Glance QAPI News Brief - Volume 1

Assess QAPI in your organization

QAPI Self-Assessment Tool

Create a structure and plan to support QAPI

Guide to Developing Purpose, Guiding Principles and Scope for QAPI Guide for Developing a QAPI Plan