Applying a quality control circle framework to facilitate out-of-bed and physical activities in a long-term residential care facility: a quality improvement project

INTRODUCTION: Residents in long-term residential care facilities (LTRCFs) commonly exhibit low levels of routine out-of-bed activity (OBA), which are closely associated with functional independence, activities of daily living (ADL), and quality of life (QOL). However, evidence on feasible and rapidly effective implementation strategies to enhance routine OBA in long-term care settings remains limited. OBJECTIVE: This project evaluated the effectiveness of implementing a Quality Control Circle (QCC) framework to improve routine OBA among LTRCF residents and its short-term effects on ADL performance, with an emphasis on feasibility and early clinical benefit to support practice implementation. METHODS: A multidisciplinary QCC team was established in a long-term residential care facility. Guided by the Plan-Do-Check-Act (PDCA) cycle, a structured 12-step QCC framework was developed through statistical analysis, group discussions, and brainstorming to identify barriers to routine OBA facilitation. Standard operating procedures for routine OBA and 13 targeted action plans were integrated into daily care workflows. Short-term process and outcome indicators were evaluated. RESULTS: Following implementation, routine OBA participation increased from 23% at baseline to 65% post-intervention, corresponding to an improvement rate of 182.61% and an achievement rate of 241.52% relative to the predefined project target. Mean ADL scores improved from 70.58 to 80.08, representing a statistically significant 9.5-point increase (t = 18.01, p < 0.0001). Additional benefits included improved multidisciplinary communication, problem-solving, and team collaboration. CONCLUSION: The QCC framework effectively enhanced routine OBA participation and ADL performance in a long-term residential care setting. Although long-term sustainability requires further evaluation, the demonstrated short-term feasibility and early functional benefits support early implementation in clinical practice.