Category: Quality Improvement Activities (QIAs)

October 12-17, 2020 is National Dialysis Technician Recognition Week

Each year, the National Association of Nephrology Technicians / Technologists (NANT) recognizes hemodialysis technicians for the vital contributions they make to the nephrology field. It’s essential to make recognition, including rewards, part of your everyday culture. But that doesn’t mean National Dialysis Technician National Recognition Week should go unnoticed. These extra-special perks will remind all your NCTs and NBTs how much you care. Click here to download resources you can use in your facility to express appreciation.

National Dialysis Technician Recognition Week

January 2019 Learning and Action Network (LAN) Webinars

The ESRD National Coordinating Council will host four January webinars to introduce 2019 QIA projects, all to be held 3-4 PM EST.  Find more information and register at the links provided:

National QIA Webinars

The ESRD National Coordinating Council will host four January webinars to introduce 2019 QIA projects, all to be held at noon PST. Find more information and register at the links provided:

Learn New Approaches to Healthcare Improvement Using IHI’s Framework

To support your participation in the Network’s 2018 quality improvement activities (QIAs), we invite you to review the Institute for Healthcare Improvement’s (IHI) Model for Improvement, an approach that IHI uses as the framework to guide improvement work. Developed by Associates in Process Improvement, the Model for Improvement is a simple, yet powerful tool for accelerating improvement. It is not meant to replace change models that organizations may already be using, but rather to accelerate improvement.

Learn about the fundamentals of the Model for Improvement and testing changes on a small scale using Plan-Do-Study-Act (PDSA) cycles. The Plan-Do-Study-Act (PDSA) Worksheet is a useful tool for documenting a test of change. The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act). Additionally, root cause analysis (RCA) is a process widely used by health professionals to learn how and why errors occurred.

To learn more about the Quality Improvement Essentials Toolkit and view all available tools, visit

Facility Involvement in Learning & Action Networks: A 2018 CMS Requirement

All facilities participating in Network QIAs are required to participate in national Learning & Action Networks (LANs) to support QIA activities. LANs provide a forum for bringing together healthcare professionals, patients, and other stakeholders around an evidence-based agenda to achieve rapid, wide-scale improvement.

Staff members at facilities participating in QIAs will be asked to participate in ESRD National Coordinating Center (NCC) LAN webinars associated with the QIA their facility is working on.  The Network may also select additional facilities that may benefit from an identified LAN topic. Patients and their family/caregivers will also be asked to participate in an effort to advance the work of the QIA.

The ESRD NCC LAN will support facilities in more efficiently achieving the goals of the QIAs and sustaining the improvements, by:

  • Creating a diverse forum (patients, organizations, and stakeholders) for addressing problematic issues
  • Using measurable and clear goals with proven effective practices to drive decision making
  • Setting the pace and tone for goal related activities and to create an open sharing of practice and data

Initiating change methodology which rapidly tests small quality improvement changes specific to the area of work

A Snapshot of the 2018 ESRD Network Statement of Work – What it Means to Your Facility

In October 2017 ESRD Networks received a new statement of work (SOW) from the Centers for Medicare & Medicaid Services (CMS). This document outlines the quality improvement activities (QIAs) that each Network is required to implement within its service area during 2018. This new SOW includes many changes to the requirements of the previous SOW. While the number of QIAs reduced from eight to four, the scope of the QIAs expanded significantly:

The number of facilities required to participate in QIAs has increased; this increase, in turn, significantly expands the number of patients that will benefit from the quality improvement activities being conducted. Any facility that is working with the Network on a QIA will be required to participate in national Learning & Action Network (LAN) webinars, hosted by the ESRD National Coordinating Council (NCC) on behalf of CMS (See article in this issue, “Facility Involvement in Learning & Action Networks: A 2018 CMS Requirement”). The QIAs are patient centered, and each participating facility is encouraged to have patients work hand-in-hand with management and the facility’s QAPI teams to ensure the success of the QIA’s goals. A brief description of each QIA, its scope, and the CMS goals follow.

Reduce Rates of Bloodstream Infections (BSI)
Fifty percent of the Network’s facilities, those with the lowest semi-annual pooled mean rates of BSI, will participate in the BSI QIA. Staff at these facilities will receive education and training on implementation of the CDC Core interventions and will be invited to the NCC LAN BSI events. Those facilities selected for participation in this QIA will be subdivided into three intervention cohorts, each of which will have different focused goals, activities, and measures of success.  Network staff will work with each of these cohorts on specific quality improvement measures to achieve the goals of the QIA.

The graphic to the right identifies the three cohorts and the following lists the goal for each cohort:

  • Each facility in the BSI cohort will work to reduce its semi-annual pooled mean rate of BSI by 20%.
  • Facilities in the Long-term Catheter (LTC) cohort will work to reduce the LTC count by two percentage points.
  • Facilities in the Health Information Exchange (HIE) cohort will work to participate in an HIE or in some other evidence-based effective information transfer system.

Improve Transplant Coordination
This year Network staff will work with 30% of the facilities in our service area to increase, by 10 percentage points over baseline, the number of eligible patients on the transplant waitlist.  Network staff will work with transplant centers and in-center facilities to meet this goal. Network staff will work with facilities to monitor patient progress using the Seven Steps to Waitlist Process outlined in the table to the right.

Promote Appropriate Home Dialysis
The Network staff will work with 30% of the facilities in its service area to increase the number of patients trained in a home modality.   The goal is to increase the initiation of home training by 10 percentage points over baseline.  In collaboration with physicians and in-center staff, Network staff will work to create a culture of “home first.”  Network staff will work with facilities to monitor patient progress toward the goal of initiating home training using the Seven Steps to Home Modality Training as outlined in the table to the right.

Population Health Focused Pilot QIA (PHFPQ): Vocational Rehabilitation
For the PHFP QIA, the Network will focus on supporting ESRD patients in attaining gainful employment through vocational rehabilitation. Working with 10% of the dialysis facilities in its service area, the Network will seek to increase referrals to approved vocational rehabilitation programs by 5%, with the ultimate goal of increasing in enrollment in vocational rehabilitation services by 2% from baseline to re-measure. Additionally, Network staff will identify a disparity within the target facilities and work with the targeted population to decrease the gap in services.

New Priorities and Goals Planned for ESRD Stakeholders

The Department of Health and Human Services (HHS) National Quality Strategy (NQS) is a national effort to align public- and private-sector stakeholders to achieve better health and healthcare for all Americans. It was developed “through a transparent and collaborative process with input from a range of stakeholders. More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided comments.”

The Centers for Medicare & Medicaid Services (CMS) contracts with End Stage Renal Disease (ESRD) Networks to implement the NQS principles and HHS Secretary’s priorities in the ESRD community. Starting in December 2017, Networks will launch a set of new quality improvement activities, data reporting requirements, and educational programs that reflect updated priorities and goals.

HHS Secretary’s Priorities

  1. Reform, Strengthen, and Modernize the Nation’s Health Care System
  2. Protect the Health of Americans Where They Live, Learn, Work, and Play
  3. Strengthen the Economic and Social Well-Being of Americans Across the Lifespan
  4. Foster Sound, Sustained Advances in the Sciences
  5. Promote Effective and Efficient Management and Stewardship

CMS Goals

  1. Empower patients to make decisions about their health care
  2. Usher in a new era of state flexibility and local leadership
  3. Support innovative approaches to improve quality, accessibility, and affordability
  4. Improve the CMS customer experience

Utilizing Attributes to Improve Care

All Quality Improvement Activities (QIAs) led by the Network incorporate the following six attributes, as directed by CMS, to support and improve QIA initiatives.  The six attributes are:

  1. Rapid Cycle Improvement:The Network regularly assesses the value of interventions and technical assistance used our QIAs. Interim adjustments are made based on feedback received from participating facility staff and patients/family members/care partners as well as from ongoing monitoring of performance.
  2. Customer Focus:Patients representing the diversity of the population in the Network’s service area, as well as other stakeholders, are involved in all aspects of Network QIAs. This “customer” input helps to shape the design and the ongoing operations of activities.
  3. Ability to prepare the field to Sustain the Improvement: The Network provides a framework and education for participating facility staff that will support them insustaining or continuing improvement once the formal Network QIA is completed.
  4. Valued placed on Innovation: The Network encourages ideas and suggestions from the community we serve, and we strive to create an environment that nurtures and promotes suggestions that would enhance the value of our work with the facilities in our service area. In this way we solicit and/or create of new ideas that maximize improvement.
  5. Commitment to Boundarilessness: The Network strives to identify and engage all members of the care team, patients, care partners and other representatives of stakeholder that can contribution to the success of QIAs. .
  6. Unconditional Teamwork: The Network is committed to work with all stakeholders to share best practices and spread effective improvement activities.

The Network encourages dialysis facility staff members to incorporate these attributes in all aspects of your day to day practices. Commitment to activities that support these attributes will help identify gaps in care, assist in engaging patients to embrace change, and achieve improvement goals.