Lasting improvement in nursing homes does not happen through one-time education or short-term corrective action alone. It requires leadership, reliable data, staff engagement, QAPI structure, and practical support that helps facilities turn goals into everyday systems of care.
Qsource’s Leading and Sustaining Systemic Change Collaborative demonstrates how nursing homes can achieve measurable progress when quality improvement is guided by leadership, peer support, and evidence-based tools. Conducted from April 2015 through September 2016 under the QIN-QIO 11th Scope of Work, the collaborative included 940 nursing homes across Tennessee, Alabama, Mississippi, Indiana, and Kentucky.
The initiative focused on strengthening nursing home quality through systemic change. Goals included improving the national nursing home composite quality measure score, improving resident mobility, reducing antipsychotic drug use in residents with dementia, increasing resident satisfaction and quality of life, and building stronger care systems.
Using the IHI Breakthrough Collaborative Model for Improvement, Qsource provided facilities with customized onsite consultation, quality improvement skills training, evidence-based tools and resources, ongoing education, peer mentoring, and an active nursing home collaborative. The work gave facility leaders practical strategies, change concepts, and actionable steps they could bring back to staff through QAPI.
One facility’s experience shows how this support translated into meaningful change. Jefferson County Nursing Home entered the project with a low star rating of 2 and joined the collaborative to improve its quality scores. After reviewing internal data, the team focused on pain management and reducing opioid use. At the start, 25% of residents reported moderate to severe pain. The facility set a goal to reduce that number to 9% by the end of the project.
To support the goal, the facility implemented a pain assessment tool at admission and repeated assessments monthly. Nurses entered data into a shared tracking system, and results were reviewed during monthly QAPI meetings. Residents who repeatedly reported high pain were connected with therapy or restorative programming, including non-pharmacological interventions for pain. Through consistent review and process refinement, the facility reached its 9% goal.
Across the broader collaborative, the outcomes were equally meaningful. Facilities in five states improved composite quality scores, including 85 facilities in Indiana, 29 in Mississippi, 68 in Tennessee, 45 in Alabama, and 38 in Kentucky. The collaborative also achieved an average 13.2% reduction in antipsychotic use across the five states.
For nursing home leaders, this case study reinforces a clear message: sustainable quality improvement is possible when facilities are supported with structure, coaching, data, peer learning, and leadership-driven QAPI. The goal is not simply to improve a measure. The goal is to improve the systems behind the measure so better care can be sustained over time.
Qsource helps nursing homes and healthcare organizations move from quality goals to measurable results. From QAPI and performance improvement to clinical coaching, data review, and survey readiness, our team brings decades of hands-on experience to help facilities strengthen care and improve outcomes.
Explore more examples of Qsource’s impact through our testimonials and case studies:
https://www.qsource.org/testimonials