Best Practices

Updated on September 23, 2014

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.6 Listed below you will find best practices graded according to the level of evidence. To view a description of the levels of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747


Updated on September 23, 2014

“Some is not a number, soon is not a time.”
Don Berwick, former President and CEO of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Key Measurement Guidelines 
  1. Choose measures that support the team’s aim statement
  2. Consider qualitative and quantitative measures
  3. Use existing data collection systems, whenever possible
  4. Integrate measurement into the daily routine
  5. Use a set of five to seven measures to track progress throughout your QI project

Suggested measures for QI initiatives are listed in the table below:

Type of Measure Indicator Numerator Denominator

1.  Average number of primary PSWs* per resident who provide care over a one month period

Total number of PSWs who were the primary PSWs per resident in the previous month (average number of PSWs per resident)

Total number of residents in the LTC home on the last day of the month
Process 2. Percentage of staff turnover each month Number of voluntary FT and PT  PSW resignations**  for the entire LTC home over previous month Total number of active FT and PT PSW’s for the entire LTC home on the last day of the month
3. Percentage of agency PSW hours each month Number of paid PSW agency hours in the previous  month Total number paid PSW hours in LTC home in previous month
Balancing 4. Percentage of total PSW paid hours that are paid sick hours each month Number of PSW hours that were paid as PSW sick hours in previous month Total number of PSW paid hours in the previous month
* Definition of primary PSW: The PSW who is primarily responsible for the activities of daily living, including dressing, eating, toilet use, and personal hygiene
** Guidelines for exclusion: Death, Retirement, Long Term Disability, Compassionate Care leave, Maternity/Parental

Run Charts

Collected measures can be presented graphically by plugging the monthly results into a run chart.

Tools & Resources

Updated on September 23, 2014


QI Tools


For a more comprehensive list of tools and resources, visit the following links on our HQO website:



Consistent PSW Assignment
QI Resources


Updated on September 23, 2014


Consistent assignment (also known as permanent assignment) refers to having the same Personal Support Workers (PSWs) consistently caring for the same residents when they are on duty. When PSWs are consistently assigned they have the opportunity to provide resident-centred care focused on understanding of preferences and routines, creating comfort and security and supporting early detection of emerging health problems. Some homes use rotating assignments with the belief that it offers advantages, however research has shown staff morale and burnout is exacerbated by rotating staff.1

The good news is that residents’ quality of life and staff satisfaction can be improved through consistent assignment. There are many advantages to consistent assignment, for both residents and staff, including:2

  1. Better care for residents
  2. Improved job satisfaction
  3. Staff feeling valued
  4. Staff feeling empowered
  5. Strong foundation for resident-centred care
  6. More familiarity with residents’ needs and desires
  7. Fewer “call-outs” (missed shifts)


Call to Action

Consistent assignment is a suggested practice for long-term care homes to provide resident-centred care. Improvements in consistent assignment of PSW’s have been shown to positively impact outcomes for staff and residents. For example, one facility in the U.S. saw a 75% reduction in the incidence of pressure ulcers after implementing consistent assignment, and after a year of implementing consistent assignment, facilities in California found that staff turnover rates fell by 29%.2 Quality improvement consistency of assignment change ideas in long-term care homes aim to promote consistent PSW assignment by tailoring solutions to each individual home.

While the tools and information provided in this quality improvement resource focus on the process of quality improvement for the home, the ultimate goal is to provide residents with the best possible care.

  1. Residents First Change Package: Roadmap to Consistency of PSW Assignment.

    Toronto: Health Quality Ontario. 2010.
    Available from: http://www.hqontario.ca/portals/0/documents/qi/rf-change-package-consistent-assignment-en.pdf

  2. Farrell D. Consistent Assignment: A Key Step to Individualized Care. 

    Fast Facts Resources for Nursing Home Professionals. 2007 Dec;21.
    Available from: http://www.chcf.org/~/media/MEDIA LIBRARY Files/PDF/F/PDF FF21ConsistentAssignment.pdf