Quality Assured Activity Programming

Simply stated, Quality Assurance is a method of evaluating and monitoring services rendered within a department. The Activity Department should be an active participant in the facilities' Quality Assurance program. Many Activity Directors dread QA time, and often leave the analysis and report writing for the last minute, when in actuality, Quality Assurance should be occurring all of the time.

The Activity Director should utilize standards, policies, and regulations to guide the Quality Assurance process and set criteria. Once the criteria have been set, it is important to utilize a variety of tools and systems to collect data. The creative Activity Director utilizes data collection tools that have multiple purposes. For example: utilize an "Activity Evaluation Audit" to evaluate the appropriateness and quality of group activities, but use that same tool to evaluate the staff performance, which is useful information for the employee's performance appraisal. Another example is: utilize a "Sensory Program Record of Responses" to monitor resident responses to various stimuli for care plan compliance and evaluation, but use the findings from that survey (if positive outcomes are found) in a report to the Administrator demonstrating the need for additional multi-sensory equipment.

Next, the Activity Director should establish timelines to ensure that all data is retrieved in a timely manner throughout the course of the year. Data may be collected in a variety of ways such as audits, surveys, checklists, etc. Often times, residents, family members and facility staff may participate in the data collection process as well. Once the data is collected, the Activity Director must write a report to indicate the findings, by utilizing the facility's specific process, protocol, and format. Statistical information usually includes numbers, percentages, and values, and is often best illustrated in a table, chart, or various types of graphs.

The next step in the Quality Assurance process includes analyzing the data. Do the findings indicate need for improvement in a certain area? If there are issues, or concerns, provide further investigation to determine the scope and severity of the problem. At this point, the Activity Director should identify a plan of correction with goals, timelines, and expected outcomes. The plan should provide a detailed description as to what the Activity Department, and/or other departments will do to improve or correct various issues.

Once the recommendations have been made, all designated departments and individuals must follow through with their responsibilities, otherwise there is no chance for improvements. The issue at hand should be closely monitored and re-evaluated as often as needed. If there have been little or no improvements, further analysis and recommendations will need to be made. If there have been significant improvements, it should be proudly noted in the next Quality Assurance report and the decision to monitor the identified area is up to the discretion of the Activity Director. It is, however, recommended that the Activity Director continue to monitor to ensure that the problem is corrected.

There are many different aspects of the Activity program that can be evaluated and monitored. Sample topics include:

- Supplies/equipment
- Environment
- Budgeting
- Programs
- Activity Audits
- Resident Satisfaction
- Quality Indicators
- Staffing
- Resident Rights
- Resident Council
- Calendars/Calendar Analysis
- Continuum of care
- Quality of Life Surveys
- Population Analysis
- Documentation
- Departmental Review

Activity Directors also play an important role in the Quality Assurance meeting. It is the time to demonstrate professionalism, knowledge, and purpose of the activity program. The Activity Director may be asked to give an overview of the area measured, report the findings, and state recommendations for further action, so it is important to be well-versed on the subject and have copies available, including any graphs, charts, tables, etc.

Activity program interventions should also be included in Quality Indicator monitoring. There are many ways in which the Activity Department can assist in improving or enhancing the services of another disciplines. For example:

- Residents who were physically restrained (remove restraints during activities; provide task-oriented activities for diversion; encourage movement and physical activity to promote strengthening.)
- Prevalence of falls (involve resident in specially designed fall-prevention program; provide manipulatives, pat mats, activity aprons for diversion; encourage movement of lower extremities to promote strengthening)
- Residents who had moderate to severe pain (encourage prayer or spiritual expression; provide aroma therapy for relaxation such as lavender; encourage resident to experience the multi-sensory room for pain relief and relaxation)
- Residents who have become more depressed or anxious (encourage resident to participate in discussion, remotivation, and reminiscence groups; provide manicures and make-up session; encourage physical activity and exercise)
- Incidence of cognitive impairment (evaluate the environment, involve residents in cognitively stimulating activities such as word games, trivia, discussion groups, and educational programs)

When we take on the role of Activity Director, along comes with that the responsibility of ensuring the activity program meets the needs and interests of the residents and follows standards of practice, regulations, and policies. Therefore, set criteria, choose the appropriate tools, gather statistical data, report the findings, analyze the data, make recommendations, and follow-up, and when done with all of that, start again!