Webinar Recording: Executive Strategies for Leading Quality Across Multi-Site Organizations

Catherine Soncrant

Good afternoon. I'll give everyone just a couple seconds to filter in. Thank you for joining us today. Okay, I'll go ahead and get started.

My name is Catherine Soncrant, Advanced Marketing Specialist at MatrixCare, and I will be moderating today's session. We're excited to be discussing executive strategies for leading quality across multi-site healthcare organizations. Today's session will focus on how leaders can move beyond compliance and create greater visibility, accountability, and performance improvement in their organizations.

Before we begin, I have a couple of housekeeping items. At the top right hand side of your screen, you'll see a Q&A box. Feel free to add your questions there and we will take them at the end of the session. You can also find a copy of the presentation in the handout section, also in the upper right hand box.

Now I'd like to introduce our speakers. Joining us today are Armine Khudanyan, CEO and co-founder of QAPIplus, and Lynn Peters, Vice President of Sales for Home Health and Hospice at MatrixCare. To get us started, I'm going to pass it over to Lynn, and we'll also kick off with a quick poll.

Lynn Peters

Awesome, and thank you so much, Catherine. As Catherine shared, my name's Lynn Peters. I'm the sales leader for our fabulous home health and hospice team. I also have the privilege of partnering with great partners such as Armine and QAPIplus.

This poll is a great place for us to start today because it really gets to the heart of our discussion. I'm sure you're in a similar spot, but most organizations aren't short on data. As a leader, you likely have reports, audits, dashboards, quality metrics, and compliance activity happening across your organization. The harder question is whether you as an executive leader can quickly see where your risk is emerging, understand which locations need attention, assign clear ownership, and know whether your improvement efforts are actually working.

That's the shift we're talking about today: moving from managing compliance to governing your performance. As we go through this discussion, I want all of you thinking about, and continuing to come back to, five practical executive questions, which Armine is going to go into in much more detail:

1. Can we see what matters across every location?
2. Can we detect risk early enough to act?
3. Does someone clearly own the follow-up?
4. Are we taking meaningful action?
5. Are we measuring whether that action is actually improving our outcomes?

This is what makes this about more than reporting. It becomes an operating model for leading quality at scale.

Looking at the poll results, it looks like some of you could identify risks immediately without needing a report. Some of you would be directionally accurate. And I love the folks who said, honestly, I'd be guessing. This is great information for us to work with as we continue through today's discussion.

So Armine, if you're ready, let's jump in. I'd love to ask you: when you think about the difference between managing compliance and truly governing performance, what is the practical distinction that leaders need to understand?

Armine Khudanyan

Thank you so much, Lynn, and thank you everyone for joining. There's a shift happening in healthcare right now. In the past, and over many years, we've always thought about compliance. All of the work we've done in quality has centered around compliance: preparing for surveys, completing audits, reviewing reports, and documenting activity across the organization. Those responsibilities remain essential.

However, today's executive leaders need to think beyond compliance, because compliance tells us what has already happened. It's documentation of what has already occurred. Performance governance is different because it helps us influence what happens next, and this is where quality work makes the biggest transformation.

During this shift, high performing organizations monitor through leading indicators. This means they're able to identify risks early and take action before issues escalate. So the question is no longer "are we compliant," but "are we continuously improving across every location, every branch, every clinical team." That's the shift we'll focus on today as we walk through a practical framework for performance governance.

I'd like to introduce what we refer to as the five pillars of performance governance. Over the years, we've worked with organizations of many sizes, single site and large multi-site, multi-state organizations. We've found that the highest performing organizations consistently ask five questions:

1. Do we have visibility into performance across every location? This matters because to detect risk, executives need to know where to look and where to get that information.
2. Can we detect risk before it becomes a survey finding or a patient safety concern?
3. Are we set up to detect risk in a meaningful way?
4. Is there clear ownership for addressing this risk? This is one of the most important areas: who owns the metric.
5. Are we taking meaningful action through structured improvement plans, and do we have the follow-up to ensure those interventions are actually making a difference?

These five areas are what separate organizations working with lagging indicators from those working with leading indicators. When leaders ask these questions consistently, quality becomes proactive rather than reactive.

The challenge isn't having more data. It's having visibility into the information that drives performance. Executive leaders need a real-time view of organizational health so they can identify risk and prioritize interventions. At the executive level, there are four main focus areas: compliance, patient safety, clinical quality, and performance improvement. Together, these give leaders a comprehensive picture of organizational performance and help them move from reacting to problems to proactively managing them. I like to call them strategic focus areas, because executives can drown in data, but grouped into these four areas, it becomes manageable and focused.

Lynn Peters

I love that, Armine. I do have a quick question for you though. There's so much data available, and I love these four areas, but when executives are looking across multiple branches or locations, what are the handful of indicators you think they should pay closest attention to?

Armine Khudanyan

Absolutely. These are the four areas every executive should have visibility into, and each one supports a different organizational objective.

Compliance reduces regulatory and reimbursement risk. It identifies documentation gaps before they become survey findings, reimbursement risk, or ADR denials.

Clinical quality is about improving outcomes, whether that's detecting OASIS measures where improvements are or aren't happening, or looking at HOPE measures showing poor symptom control or management. Any of these areas is where clinical performance shows up at every location.

Patient safety protects patients and reduces preventable harm. It's about having insight into any variance, trends, or gaps in patient safety data so an executive is alerted before harm occurs.

Performance improvement, which is what's near and dear to my heart, is where we drive measurable organizational improvement. This turns insight into action and ensures interventions have sustainable, measurable results. There always needs to be a way to measure the metric you're working with. That's how you know if you've actually improved. This is how high performing organizations move away from a checklist of activities and into real world results.

Together, these four areas give leaders a complete picture of organizational performance and help them make data-driven decisions, where you let the data lead you toward the decision you're going to make.

Lynn Peters

Now let's take a closer look at each of these areas, starting with compliance and how executive visibility can reduce regulatory and reimbursement risk.

Armine Khudanyan

This is where I like to talk about AI, because the value of AI isn't reviewing more charts. It's giving leaders the visibility to identify risk and intervene sooner. For example, imagine one branch consistently scoring 98% on a documentation metric, and another branch dropping to 72%. That gap should tell an organizational leader something specific: is there a difference in training? A leadership difference? Some operational variance?

If you look at it from a corporate point of view, you may just see that your scores in a certain area are lower overall. But with branch-level visibility, you may see that one or two branches are driving lower compliance rates for the entire organization. That allows an executive to focus resources and efforts on those specific locations, and the impact can compound across the health of the organization.

The challenge is that manual chart audits have limits. Most quality teams can only review a small sample size, which means important trends may go unnoticed. That's where AI can reveal exposure: recurring issues, gaps, or emerging vulnerabilities an organization should have its eye on early. The real executive value that compliance visibility brings is the ability to intervene before smaller gaps become larger survey findings, denials, or reimbursement issues. AI in no way replaces quality leaders. It enables them to make better decisions earlier. These gaps also act as a signal to detect risk, which is the next part of performance governance.

Lynn Peters

I love that, particularly what you shared about the variation you can see between branches and locations, and how AI-related tools can surface that better for leaders instead of looking at averages. That leads into another question I have for you, Armine: what are some of those early warning signs that a branch could see if they're drifting into quality survey or patient safety risk?

Armine Khudanyan

Absolutely. This is one of the most important concepts of performance governance: being able to see these indicators, and I'll refer again to the difference between lagging and leading indicators.

Lagging indicators mean that by the time a survey finding, an ADR denial, or a patient safety event occurs, it's already too late. Now you're reacting to it, doing root cause analysis, in damage control mode. Leading indicators give you the opportunity to prevent an ADR before revenue is even lost, instead of spending resources responding to a patient complaint after the fact. In today's regulatory environment, with enhanced oversight from regulatory bodies, any patient complaint can lead to a full complaint-driven survey. So an early warning sign warrants executive intervention to prevent it from escalating. Where visibility tells us what is happening, signal detection tells us where to focus.

So what are those leading indicators?

Clinical documentation and compliance is always number one. Clinical documentation is the foundation of quality and compliance, because if it's not documented, it can't be defended. Executives should always ask: can we defend the care we provided? As a clinician, I've been guilty of this myself: the care you provide at the bedside doesn't always translate into documentation, because a subtle decline can be missed until there's an ADR and a denial, and a leader says, "but we took such great care of the patient." Sometimes that decline ends in a patient passing away, and without documentation for skilled need or medical necessity, that work ends up in a denial, which is what we always want to prevent. Leaders should monitor audit trends, documentation deficiencies, and recurring patterns.

When I was on the other side as a QAPI leader, I used to play a game with our quality team: if CMS surveyed us today, what documentation issues would we most likely be cited on? We'd come up with our top three, and assign someone specific to each one, so one person owned one metric and one finding. That really makes a difference.

Documentation is only one part of the story, though. Beyond documentation, it's about patient safety and clinical outcomes, which is our leading indicator number two, because patient safety is one of the earliest signals of organizational health. Even small spikes in falls, medication variances, or infections aren't isolated events. They're early warning signs, and executives need to ask: are our patients safe right now? If there's any hesitation answering that, that's when you dig into the metrics.

I urge all executives to review patient safety trends monthly, not just individual events but patterns. I'm not talking about one-off situations. I'm talking about emerging trends that tell us what we can do today to prevent the next patient from being harmed. And harm doesn't have to mean a patient was seriously hurt. It's habits. I always tie this back to patient education. As an example, medication reconciliation: if a patient says, "I'm supposed to take two Tylenol, but I take one and wait to see if my pain is better before I take the second," that habit may seem harmless with that medication. But if a clinician doesn't catch it as a medication error, that same habit could repeat tomorrow with a high-risk medication, an anticoagulant, or a blood pressure medication. Patients skip a dose because their blood pressure "was normal," and repeated over time, that habit eventually catches up with the medication that really can't be skipped. Patient safety protects the patients we serve, and it's critical to spot these patterns early enough to prevent the next one. There's never a safety event too small to report.

Which brings us to our next leading indicator: financial performance. Financial performance starts with clinical quality and documentation, because it's the last step of compliance. Small reimbursement issues often become significant financial losses if they aren't detected early. Every executive should ask: where is revenue at risk? Not because financial performance is what matters most, but because it's how organizations remain healthy and able to continue operating.

Denials, ADRs, and missed filing deadlines aren't just billing issues. They're early signs that a process needs improvement, or a signal of operational inconsistency that should be mitigated before it impacts the organization. Leaders should monitor denial trends, ADR activity, missed deadlines, and revenue leakage patterns across every site, because not all denials are the same. Technical denials may point to a workflow issue, while documentation or medical necessity denials often signal documentation or training gaps. It's important for executives to know that ADR denials aren't one-size-fits-all, and to use the reason and cause as a performance improvement project in itself: training material for clinicians so it prevents a future denial. These are great moments of education for the whole organization. The goal isn't just to recover lost revenue. It's to spot reimbursement risk early enough to prevent the loss entirely.

When no one owns the risk, it lingers, which is where accountability becomes critical. Great outcomes start with what we call a prepared workforce. Even the best processes can fail without consistent execution, so executive leaders need to answer: do we have the right people doing the right things? This drives compliance, retention, and consistent quality across every site, every location, every state. Leaders should ensure competencies and training are completed and verified, and that supervisory visits catch issues before surveyors do.

I want to give a shout-out to supervisory visits specifically. A lot of organizations don't do them often enough, or don't follow through on their impact, but a surveyor should never be the first one observing a clinician on a visit. There's so much to be learned from supervisory visits. Organizations should normalize them with timely feedback and real opportunities for improvement. This is one of the most valuable ways of understanding risk: seeing the interaction between clinician and patient at the bedside, where there's a wealth of information to capture. These visits shouldn't feel intrusive. Feedback should be delivered respectfully, in a coaching style.

Having the right people is central, and clinicians should always be clear on what's expected of them, so whenever care is delivered, everyone understands what metric is being looked at and what process is being monitored. Even with supervisory visits, or care delivered at home, how often do we as quality leaders create a policy or standard operating procedure, and then a bedside clinician looks at us and says, "that's not how it goes in the home"? We need to be in tune with whether our policies actually align with the care being provided at home. That's how you avoid clinicians consistently breaking policy, and instead build open communication where they speak up and say a policy or procedure needs to change. That safety net, being able to bring issues to leadership, lets you mitigate a problem before it turns into an issue from not following policy.

Lynn Peters

Absolutely. That is so compelling, Armine. I'm really glad you walked through that with everyone.

But of course, identifying problems is only the beginning, right?

Armine Khudanyan

Performance governance is really about ensuring that improvement actually occurs. Organizations often measure effort instead of impact: completed meetings, education sessions, and action plans. Those don't necessarily improve quality. Better outcomes improve quality. Just because an organization goes through the motions of performance improvement doesn't mean improvement is actually occurring. Executive leaders should stay in tune with that and ask: are we really improving outcomes? Are we solving our problems, or just documenting them?

If an intervention didn't improve the outcome, instead of just closing the improvement plan, sit with your team and ask what interventions to add, remove, or change, and try again. Quarter after quarter, it's important to ask whether these metrics are measurable in the first place. What does it mean to improve? What are we going to look at? Be clear that progress toward these goals is measurable and documented.

These are the five indicators that give leaders a comprehensive view of organizational performance. But visibility alone isn't enough. Once risk is identified, someone must take ownership of it. This is where the governance framework goes into action: when someone owns and is responsible for the risks and patterns that are identified.

Lynn Peters

I love that, Armine, and I think those five executive questions are so powerful because they're straightforward and become a quick gut check for leaders before they even start digging in. Just so key to that visibility you were talking about.

You mentioned AI earlier, and obviously all we hear about right now is AI, AI, AI. I'd love to understand from you what role you see AI playing in helping leaders identify patterns that could be difficult to catch manually.

Armine Khudanyan

Absolutely. I don't think AI will ever replace clinical expertise. It amplifies it. It helps leaders detect patterns across hundreds, sometimes thousands, of records that would be nearly impossible to identify manually. So when I think of AI audits, I think AI supercharges human ability to identify risk. I call it risk detection at scale, because you can take it to that next level and objectively identify risk.

An interesting question came up recently about peer-to-peer reviews: how would you use AI when a physical therapist needs to read a physical therapy note, or an occupational therapist needs to read an occupational therapy note? It's interesting, because AI is very objective. It looks for evidence to answer compliance questions. Running the same audit question against hundreds of records, whether focused on therapy, nursing, or billing, AI gives you a clear picture into your performance. There are no bells or whistles, no ifs or buts. It just surfaces what you have, whether you're doing a good job or not.

That's my favorite part of using AI as an audit tool: it doesn't have that subjective clinician read of "well, I understand what they meant, so I'll mark this compliant." Once the logic and the rule are there, it's black and white. It's valuable for giving that objective, at-scale risk detection. None of these patterns alone may seem significant, but bringing them together creates a warning system that lets leaders intervene before risk becomes reality.

Lynn Peters

I just wanted to jump in quickly, because one thing I wanted to emphasize is that fourth bucket, stalled improvement, and how AI can raise that to you before you even realize improvement initiatives might not be making progress. That's often where I feel like the work can stop, where you don't actually see improvement. I love that this is one of the places AI can bring that risk forward.

Armine Khudanyan

Absolutely. Sometimes as an educator or quality leader, you may be providing feedback or training, but your training may not be focused on the right area or the right clinician. This is another one of my favorite parts of AI: you can run audits based on clinician. If you choose a specific clinician, or a discipline type like physical therapy or a registered nurse, and audit based on clinician, you don't have to review hundreds of charts. If a specific clinician isn't documenting something properly in one record, that's probably happening across every record they touch.

This amplifies your impact. When you look at documentation compliance at the clinician level, you might notice that 2% of your clinicians are causing 90% of your documentation gaps. That's a completely different picture, and a completely different intervention. I always joke, and it's true because I've seen it in practice, that every time training is provided, it's always the good documenters who show up and take it seriously. The clinicians who need more support or development are rarely the ones engaged in training. It's great to use AI audits to give one-on-one feedback to employees, so they can read the objective findings for themselves. Then it clicks: "okay, I understand my goals aren't measurable." It's consistent, data-driven feedback that shows clinicians where their documentation gaps are and how to improve, which is very valuable.

Lynn Peters

Love that. That's a great example.

This is a topic near and dear to my heart: creating not only accountability, but a culture where people strive for feedback and don't feel like data is being used to punish them. What advice would you give leaders around creating that kind of environment and accountability without making teams feel like data is being used against them?

Armine Khudanyan

The number one rule of performance improvement is that accountability should never be punitive. Of course, organizations need to keep clinicians accountable for their skills, knowledge, and actions. However, it should never be punitive. It should be about support, coaching, and continuous improvement.

Performance doesn't improve because data exists. It improves because someone owns the outcome, and there's a system of feedback that's a loop, not a one-way street. It's not an organization simply telling clinicians or employees where the issues are, because when issues occur, it's usually not a people problem. It's a system problem. If you look back at almost any event, whether it's a sentinel event or not, you'll usually see that a lot of system failures occurred before it got to that clinician. But blame and punishment directed at that clinician doesn't solve the issue. Organizations need to look at improvement and error reporting as a system and organizational issue, not just a person or clinician problem.

Performance doesn't improve because everyone is responsible for it. There really just needs to be one person responsible, because when everyone is responsible, it's almost like no one is. It's all of our responsibility, but one person should be accountable. And when that accountability fails, it shouldn't be punitive. It should be about what processes failed to get us here. In healthcare, there's not a single clinician who wakes up in the morning thinking, "I'm going to make a mistake" or "I'm not going to give it my best." That never happens. So whether it's burnout, not having access to policies and procedures, or being afraid to ask leadership for help, any of these factors is an organizational failure, not a person's failure.

Lynn Peters

Absolutely. Thank you for covering that. I think that was really critical for us.

Once you do identify a risk, Armine, what does a strong response plan need to include so it doesn't just sit on someone's to-do list, and actually advances or improves whatever it was developed for?

Armine Khudanyan

This is a great question, because it's where most organizations tend to struggle. Every risk needs an owner, and every owner needs a plan with measurable outcomes. Performance improvement isn't about how many problems we can find. It's about how consistently we solve them.

Whenever a metric falls below a goal, the first step should be to assign ownership. By assigning ownership, half of the work is already done. From there, launch improvement initiatives with a defined action and a timeline. Interventions need a due date and a tracking methodology, and that follow-through has to happen, because that's where organizations often fail to see improvement. Interventions get done, and that's the metric of the quarter, but by the time the next quarter rolls around, so many other things have happened that follow-through on the first one doesn't occur. So a lot of this work gets lost because there's no follow-through.

It's important to track progress, not just track results, but to disseminate results to everyone, every single clinician, every single employee. Everyone should know what improvement project the organization is working on at any given moment. Everyone should be involved and aware, and that makes a big difference.

Lynn Peters

That's a great point, that transparency is so important, because it also takes away some of that fear of being punished or penalized.

As we look at this further, what does it look like when a multi-site organization is actually closing the loop well? What separates the organizations or people who improve from the ones that tend to stay stuck?

Armine Khudanyan

What separates organizations that improve from those that feel stuck is discipline in following through. That discipline makes the difference, and when one person owns the outcome, it's much easier for the organization to have that person bring it back and close the loop and say, "this is what we've done, this is the progress we've made," whether it's good progress or bad progress. It's closing that loop that makes the organization-wide difference.

It's almost like a muscle you practice. With practice, an organization gets better and better at identifying a gap, setting measurable outcomes with timelines, proper ownership, and proper follow-through. When that loop is closed in that format, this is what we call performance governance, instead of just having an incident and mitigating the outcomes that come from it. Otherwise, all of these separate events never come together to create one unified lesson for the organization, along with a preventative measure. That's the most valuable part of any of this work: the lessons learned and the preventative action that follows.

Lynn Peters

That's great. I have one final question for you today, because this has been fabulous. I know I've learned a lot, and I hope everyone listening and participating has too. Armine, if an executive listening today wanted to take one step towards stronger performance governance, where would you suggest they start?

Armine Khudanyan

I think the organizations that will lead the future aren't the ones with the most data. They'll be the ones that turn data into action faster than anyone else. If you keep practicing that muscle of performance improvement, it comes through visibility, risk detection, accountability, using technology to amplify leadership, having the right tools, and really being adaptable to change.

It's very difficult, especially when you have good processes, to change good processes. But everything changes, and those tools change as the world changes. Every organization needs leadership that isn't afraid to move, isn't afraid to change, and adopts a better, faster way of doing what we used to do before.

Lynn Peters

Awesome. I love it. Well, thank you so much, Armine. This brings us back to one of the most important themes from today's discussion: performance governance isn't just about having more data or more dashboards. It's really about creating a repeatable leadership discipline for turning information into action.

For all of you as home health and hospice leaders, this matters because risk can show up in so many ways for you. It could be documentation gaps, patient safety trends, or workforce readiness issues. The organizations best positioned are the ones that can see these signals earlier, assign ownership faster, take action more consistently, and follow up to make sure that action actually changed the outcome.

We all know technology and AI will play an important role by expanding visibility and helping identify patterns that might otherwise be missed. But the real value comes when that visibility is paired with leadership judgment, accountability, and a consistent operating rhythm. If there's one takeaway from today, it's this: compliance helps prove what happened, but performance governance helps leaders influence what happens next.

With that, Catherine, I'd love to open it up for questions.

Catherine Soncrant

Wonderful, thank you so much. I do have a couple of questions. We'll go through them pretty quickly since we're coming up on time.

Does QAPIplus integrate with MatrixCare to scan or audit these charts?

Lynn Peters

That is a great question. We are currently integrated with QAPIplus as a key partner. I'd love to follow up with this person and provide more detail, and honestly, we'd love to do that with anyone who has interest. Armine, would you want to add to that?

Armine Khudanyan

Absolutely. MatrixCare has been a great partner. We're in a constant, consistent quest to have data interoperability, to help organizations use their own data and see these improvements in real time. So yes, we're always working to be as integrated as possible.

Catherine Soncrant

Awesome. Our next question is similar: is this currently integrated with MatrixCare, meaning is there a two-way flow of information between MatrixCare and QAPIplus?

Lynn Peters

Yes, we are integrated, absolutely. That's something our team would love to walk someone through, to really show what those integration points are and how they can benefit any organization.

Catherine Soncrant

Perfect. We have one question I'll answer quickly: yes, you will receive the slides from this presentation. You'll find them in the upper right hand corner, the paper clip icon, and we'll also send them out as a follow-up.

I think we have time for one last question: what are the top leading indicators that agencies should track for both home care and hospice? Armine, I'm going to let you take that one.

Armine Khudanyan

Of course. I'd really divide indicators into the four buckets we discussed: compliance, which covers your documentation and compliance risks; patient safety, which is all the incident reports you gather, data coming in from the outside; and data generated within your organization, which includes record reviews, audits, ADR risk, and billing practices. So any data you get from the outside, patient complaints, satisfaction, incidents, and any data you get internally, it's important to pair with good performance improvement action plans, signed accountability and ownership, measurable outcomes, and a process for tracking and documenting the effort. That's the process, in a nutshell, that high performing organizations use to get themselves into that rhythm.

And then, how do you see HOPE driving the future? I think HOPE is a structured way of putting documentation and quality into a standardized system of quality measurement, almost like what OASIS did for home health. It's a great way for organizations to see their response time and effectiveness in managing symptoms, and a great way to practice providing care at home proactively, before a patient needs to be hospitalized or feels their care can't be managed at home. It's a great practice in managing symptoms and helping patients and families feel comfortable having their end of life cared for at home, comfortably.

Catherine Soncrant

Okay, well, with that, we are over time by a couple of minutes, so we're going to go ahead and wrap it up there. Thank you, Lynn and Armine, for joining us today and going over all of this important information, and thank you to everyone who joined us today. I hope you have a lovely day. We'll be following up with everyone, and we'll be sending out the slides.

Lynn Peters

Thank you so much. Have a wonderful day, everybody. Bye-bye.

Armine Khudanyan

Thank you. Thank you, everyone. Thank you.