Getting Started

On-Time Quality Improvement Manual for Long-Term Care Facilities

This section addresses the following questions:

  • How do we assess readiness to implement On-Time?
  • What resources are needed to implement On-Time:
    • Technology?
    • Staff?
    • Facilitator?
  • What is the overall workplan?

Readiness for On-Time

A nursing home is ready to implement On-Time if the following are true:

  • High pressure ulcer rates and priority on reducing in-house pressure ulcer incidence rates. Typically, On-Time nursing homes have an in-house pressure ulcer incidence rate greater than 2 percent on at least one nursing unit.
  • Leadership commitment and endorsement and support of top leadership to enhance care processes related to pressure ulcer prevention. While frontline staff are the cornerstone of On-Time, a nursing home is not ready to start On-Time without the support of top leadership.
  • Experience with quality improvement (QI). A nursing home is more likely to implement On-Time successfully if it has experience with QI, such as implementing a QI project in the last 6 to 12 months or participating in State or national quality improvement efforts, such as the Advancing Excellence Campaign.
  • Existing health information technology (Health IT) for Certified Nursing Assistant (CNA) daily documentation or in planning stage. Facilities that have electronic documentation in place for CNAs are less likely to experience project delays. The facility does not depend on vendor timelines since software is installed already and CNA staff are familiar with using computers for daily documentation. This eliminates time and costs associated with new software training.

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Resources Needed


The technology requirements are:

  • Facility has an Health IT system for CNA daily documentation.
  • Vendor software meets the On-Time requirements for standardized CNA data elements and On-Time reports.


Table 1 illustrates next Health IT steps for a facility given their current state of CNA documentation:

  • CNA staff are completing daily documentation on paper.
  • CNA staff are documenting electronically but using software that has not met On-Time requirements.
  • CNA staff are documenting electronically and using software that has already met On-Time requirements.


Table 2 provides descriptions of the Health IT steps.

As of September 2010, 10 vendors were compliant with On-Time.i



Table 3 provides information on staff resources needed to implement On-Time, responsibilities of each, and estimated time commitment.


Facilitation Skills and Experience

Based on experience to date, On-Time facilitation requires three categories of skills and experience:

  • Clinical informatics: Serve as liaison between facility and Health IT vendor.
  • Project management: Oversee the project, develop and manage the workplan, and establish plans for impact monitoring data collection and reporting.
  • Process improvement: Facilitate the team's implementation of On-Time process improvements.
Facilitation Responsibilities

One or more people assume facilitation responsibilities. Responsibilities and time commitment vary throughout the implementation process and depend on level of support from facility leadership and available internal IT resources, e.g., IT department.

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On-Time Work Plan


Each team reviews the generic On-Time work plan (Table 4) and customizes to their specific situation.

In addition, On-Time implementation efforts have involved collaborative working sessions with other participating facilities. At these meetings, facility team members (1) discuss and compare experiences and outcomes to date, (2) discuss issues and problems with the project and ways they could be addressed, and (3) share successful strategies for implementing and sustaining On-Time process improvements.

i The vendor names are provided for informational purposes only. Their inclusion does not imply endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services: American Data—ECS (Electronic Chart System), EHealth Solutions—SigmaCare, Healthcare System Connections, HealthMedX—Vision, Lintech—Clinical EMR Suite, Mylex Corporation, Optimus EMR, PointClickCare—Point of Care, Reliable, and Resource Systems—CareTracker.

Page last reviewed January 2011
Internet Citation: Getting Started: On-Time Quality Improvement Manual for Long-Term Care Facilities. January 2011. Agency for Healthcare Research and Quality, Rockville, MD.