Shifting the Leadership Paradigm From Regulatory Compliance to

Performance Excellence

Mike Dodge, Lucy Rogers, Barbara YodyAHCA Quality Improvement Committee

Team Leaders

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Learning Outcomes

• Articulate the seven leadership themes exemplified by AHCA/NCAL quality award recipients

• Describe the Quality First goals and new tools.• Show the resources and information available on

AHCA’s website• Present performance management and practical

application.• Highlight the 2011 goals and activities of AHCA’s

Quality Improve Committee

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Quality First Keeping the Promise

Lucy Rogers

Team Leader – Quality First

Quality First: Keeping the Promise7-5-5 Race for Quality

“Quality is the combination of care and

services that meet or exceed

customer needs and expectations.”

7 Principles – Added Definitions 5 Goals - Refined 5 Tools - New

Seven Principles

CQI Public Disclosure & Accountability Patient / Resident Family Rights Workforce Excellence Public Input & Community Involvement Ethical Practices Financial Stewardship

PrinciplesContinuous Quality Improvement (CQI) – This principle encourages a

collaborative approach to quality management that builds upon traditional quality assurance methods by emphasizing the organization and systems, with a primary focus on process, and utilizes objective data to analyze and improve these processes. In long term care CQI incorporates all the components that are necessary for quality care and services.  

Public Disclosure and Accountability – This principle seeks to encourage transparency of information that is shared with patients, residents and their families as well as sources of state and federal funding. It also promotes accountability to meeting – and exceeding – patient needs and expectations, while simultaneously exhibiting accountability of government funding for the care provided.

Patient/Resident and Family Rights – This principle embodies the critical importance for person-centered care and focus on individual outcomes through services provided. This is exemplified by presenting opportunities to patients and residents to best determine their care and shape the comfort of their environment.

Principles

Workforce Excellence – This principle recognizes that a strong organization empowers leaders and develops and supports a stable, qualified and well-trained workforce that is engaged and committed to excellence. 

Public Input and Community Involvement – This principle recognizes the interconnectedness of long term care facilities and the community. Facilities should strive to achieve positive visibility by promoting themselves as health care providers within the community, becoming involved in issues impacting the community and by sustaining a robust volunteer program that actively engages individuals of all ages.

Ethical Practices – This principle embodies the belief that all long term care providers should operate based on a foundation of trust. This includes promoting ethical business standards, corporate integrity and responsible financial stewardship.

Financial Stewardship – This principle recognizes that the vast majority of long term care providers rely on government funding (Medicare, Medicaid) to provide quality care and services – and that our profession must operate in a manner that uses these resources responsibly. As a profession, we will endeavor to retain appropriate levels of governmental funding to allow facilities to provide health care and services to those in need.

Five Vital Signs (Goals)Improve and Sustain

Performance in CMS quality measures Compliance with federal survey process High rates of resident / family

satisfaction High staff satisfaction rates Leadership / staff retention – reduce

turnover rates

Five Turbo Tools

AHCA / NCAL Quality Awards Advancing Excellence Phase II LTC Trend Tracker© Resident / Family Satisfaction Surveys Staff Satisfaction Surveys

Cold Hard Facts

Lack of understanding Lack of human resources Lack of time Lack of financial resources

Flowchart For Problem Resolution

Don’t Mess With It!

YESNO

YES

YOU IDIOT!

NO

Will it Blow UpIn Your Hands?

NO

Look The Other Way

Anyone ElseKnows? You’re SCREWED!

YESYES

NO

Hide It

Can You Blame Someone Else?

NO

NO PROBLEM!

Yes

Is It Working?

Did You Mess With It?

Quality Improvement Team 4 Goals

Improve participation in Advancing Excellence by conducting outreach to state affiliates, corporate and independent owners.

Identify key messages to increase participation in AHCA quality initiatives.

Obtain survey results / analyze to identify opportunities to enhance participation.

Increase Silver and Gold award participation in 2011.

Opportunities

Determine level of participation Determine understanding of tools Determine barriers to use Determine ways to reach the masses Determine ways to generate interest,

enthusiasm and participation

Team Activities

Identify AHCA’s non participating Advancing Excellence centers

Conduct online survey Obtain member testimonials for all

initiatives Draft article (s) for state affiliate

newsletters

MeasurementsUsing Five Turbo Tools

Benchmark using

* Family /resident Satisfaction data

* Associate Satisfaction data

* Advancing Excellence data

* Trend Tracker

* Advancing Excellence data

General Consensus

WIIFM

WIIFM

Obtain thorough understanding of “what is happening” in your center

Improve team spirit / participation Improve associate satisfaction Decrease turn over / increase retention Improve family / resident satisfaction Benchmark your center’s performance Improve bottom line Enhance public perception

Honestly….

Yes, it will take a commitment on part of leadership.

Yes, it will take additional resources initially – human and financial.

Is it worth it? YES!!!

Regulatory Compliance to Performance Excellence

Mike DodgeTeam 1 Leader

Shifting the Leadership Paradigm

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Shifting the Leadership Paradigm From Regulatory Compliance to Performance

Excellence

AHCA’s DEFINITION OF QUALITY

Quality is the combination

of care and services that meet or exceed

customer needs and expectations.

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Why Continuous Quality Improvement (CQI)?

• Increasing expectations by residents. • Increasing expectations by families.• Increasing expectations by consumer advocates.• Increasing expectations by over-site agencies.• It is the right thing to do.

Long term care consumers are more open in expressing their expectations. They want safe, effective, timely, efficient, and

equitable care and services provided in a home-like environment and person-centered culture that maximizes

their quality of life.

Bernie Dana. (2008) Developing a Quality Management System: The Foundation for Performance Excellence in Long Term Care. American Health Care Association

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The Building Blocks to Quality

PHASE I PHASE II PHASE III Commitment Achievement Excellence

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A New Way of Thinking

OLD NEW

Regulations Customer Satisfaction

Schedules Resident ChoiceTask Oriented Systems OrientedReactive Proactive“We’ve always done it “Let’s find a

better this way.” way.”

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7 Common Themes• Choose a vision for what can be and then act on

it.• Commitment to continuous learning and growth.• Customer expectations define quality standards.• Leaders and managers lead by example.• Employees are satisfied and engaged.• An effective quality management system sustains

focus on performance.• A structure exists to sustain the center’s quality

journey.

Taken from: Olson, Douglas, Dana, Bernie, Ojibway, Stefanie Mapping the Road to

Quality Results Provider Magazine. April 2005. pp 69-72.

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Create a Vision for Becoming Better

• Begin with the end in mind. – Covey• Habits are things we repeatedly do. Make your mission a

habit. • Educate ALL stakeholders on your mission.

* Post your mission statement in the facility for all to see.* Begin with your staff on their 1st day of orientation!* Educate staff throughout the organization-Get them to tell you!

* Begin all meetings and stand-ups with your Vision and Mission.* Include Vision and Mission in marketing and advertising material.

• Teamwork is the ability to work together toward a common vision.

• Work to create synergies. • It is not your way …and not my way…it is a better way! (1

+ 1 = 3)

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Vision vs. Mission StatementsVISION

(Your destination)

A vision statement describes where a company wants to go. Provides direction and purpose. Inspires and unites. A picture of what will

be.

Disney’s Vision Statement- “To make people happy.”

MISSION(Your roadmap)

A mission statement explains how a company will get there. A broad statement distinguishing you from others. Defines your values.

Why are we here? What do we do? Whom do we serve? What do we stand for?

Starbuck’s Mission Statement- “To establish Starbucks as the premier purveyor of the finest coffee in the world while

maintaining our uncompromising principles as we grow.”

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Stakeholders• Who are your primary stakeholders?

▫ Person, organizations, or agencies that have a vested interest in the performance of your organization.* Patients/Residents*Advocacy Groups *Referring

Hospitals*Families *Government Agencies *Other care providers*Staff *Funding sources *Physicians

• What are the key requirements and expectations?*Person-Centered Care *Safety & Welfare*Compliance

• How do you learn of these values?* Surveys * Regulations *State Associations* Face-to-Face * Community Involvement *Performance

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Continuous Learning and Growth• Develop optimal leaders. Individuals who blend extreme

personal humility with intense professional will. – Collins.• Develop leaders throughout you center - within all rank and file.• Develop positive habits. A habit is what we repeatedly do. * The intersect of knowledge, skill, and desire. -Covey• Learn your talents and develop your weaknesses.• Become a life long learner-Read, Read, Read!• Be an agent for change. Encourage CAN DO attitudes and real-

time problem-solving.• Create a culture of education and learning.• Look to and learn from the best.• Learn in a variety of venues. (Books and Publications, Internet

Searches, Workshops, Seminars, State & National Association Meetings, etc)

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Customer Expectations Define Quality Standards• Identify your customers and define their

requirements and expectations. • Start with procedures that identify customer

service as an element within your organization.• Define customer “service” vs customer

“experiences.”• Survey your customers at least annually

(Independent vs face-to-face vs town hall meetings).

• Listen closely to your customers’ expectations, wants and needs.

• Incorporate satisfaction survey outcomes into strategic planning.

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Lead by Example• Too many leaders lead by title. (Take off the name badge!)• If you are leading and no-one is following...you are taking a

walk.• Talk the talk…walk the walk.• Be more “plow horse” than “show horse”.• Create a culture of team spirit. (Fishbowl vs. Silo)• Create an environment of highly effective communication.

▫ Timely responses▫ Encourage two way communication not just top to bottom▫ Open and honest communication.

If your actions inspire others to dream more, learn more, do more and become more,

you are a leader.

John Quincy Adams

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Employees are Engaged• Make your organization a place where people

want to come to work. • Define the expectations for your employees up

front.• Create a culture of positive employer-employee

relations. • Maintain an open-door policy and encourage real-

time problem solving.• Develop staff through effective coaching. Coach

for knowledge improvement excellence.• Hold staff accountable for their actions.• Conduct Employee Satisfaction Surveys and share

the outcomes.• Create a culture of employee empowerment.• Involve employees of all rank and file on

Committees, QA and QI Teams and in company events and activities.

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Continuous Quality Improvement Systems• Establish a quality improvement system that will work best

for your organization.HCANJ (Health Care Association of New Jersey) (2009). (Performance Improvement (PI) Plan and Template

• Link strategic planning and goals with your organizations vision and mission and core values.

• Self-assessment.• Face the brutal facts-prioritize areas in need of

improvement• Develop a balanced set of measures.Customer

SatisfactionRegulations

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Sustaining Quality

• Formal and informal systems to support quality initiatives.

• Form a Quality Improvement (QI) Team▫ Key personnel▫ Commitment of team collaboration▫ Commitment to improving

• Quality Scoreboard of Key Indicators▫ Benchmarking▫ Data Gathering▫ Analysis (Monthly, Quarterly, Annually, Year-to-Year)

What gets measured…gets improved.

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Begin Your Quality Journey• Climate survey

▫ Are You Ready for CQI? Facility Assessment Survey.

• System evaluation▫ Developing a Quality Management System: The Foundation for

Performance Excellence in Long Term Care.▫ Guidelines for Developing a Quality Management System (QMS) for

Long Term Care Providers.

• Fact Finding/Brutal Facts▫ Investigation of systems▫ Prioritizing

• AHCA Quality Award Bronze Application▫ www.acha.org Quality Improvement ACHA Quality Award Program

Applicant Resources

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Performance Management:A Road to Success

Barbara YodyTeam 3 Leader

Success Stories From the Field

Performance ManagementA Road to Success

What gets measured….gets improved!

Performance Management System Provides a framework for the quality journey Relates to all 7 of the Common Themes Can include the LTC Vital Signs

….. Through a Balanced Scorecard

Performance Management System Provides a framework for the quality journey Relates to all 7 of the Common Themes Can include the LTC Vital Signs

….. Through a Balanced Scorecard

Balanced Scorecards

“ Strategic planning and management system that aligns business activities to the vision and strategy of the organization, improve internal/external communications, and monitor organization performance against strategic goals.”

Balanced Scorecard Institute

Balanced Scorecards

Originators: Drs Robert Kaplan & David Norton – developed a performance measurement framework that added strategic non-financial performance measures to the traditional financial metrics

Goal: to give managers and executives a more “balanced” view of the organization’s performance

Financial

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Internal Business Processes

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"To succeed financially, how should we appear to our shareholders?"

"To achieve our vision, how will we sustain our ability to change and improve?"

"To achieve our vision, how should we appear to our customers?"

"To satisfy our shareholders & customers, in which business processes must we excel?"

Vision and Strategy

Balanced Scorecards

Four Perspectives Customer

Customer focus – patient-centered care Customer satisfaction

Financial Revenue & expenses Days in A/R Risk assessment Cost-benefit data

Balanced ScorecardsNursing Home EnvironmentResearch literature review revealed 6 key areas facility characteristics & ownership resident characteristics staffing indicators clinical quality indicators deficiencies, complaints & enforcement action financial indicators

Harrington et a. Gerontologist 2003 Apr; 43 Spec No 2:47-57

AHCA Quality CommitteeTeam # 3 - Positive Practices & Processes"How do I get there from here....success stories from the field"   

TEAM GOAL: To identify, collect and disseminate examples from the field of the practical application & execution of empirically proven best practices in skilled nursing settings

Team 3 – Positive Practices & Results Survey Results Objective: Determine support of goal to share

success stories from the field Audience: State Associations & Quality

Award Examiners Respondents: 34 State Associations and 54

AHCA Senior & Master Quality Award Examiners

Core set of questions asked of both audiences

Is collecting & sharing practical applications a worthwhile endeavor for AHCA Quality Committee?

Degree in which collecting & sharing stories would benefit members/profession

Important Tools for SharingState Associations

Important Tools for SharingAHCA Award Examiners

Priority Areas of ImportanceState Assn versus Award ExaminersState Assn - Top Six

1. Pressure ulcers

2. Falls prevention

3. Pain Mngt

4. Customer Satisfaction

5. Staff Satisfaction

6. Restraint Reduction

Examiners – Top Six

1. Customer Satisfaction

2. Pain Mngt

3. Staff Satisfaction

4. Nurse Orientation

5. Pressure ulcers

6. Falls prevention

Survey Conclusions

Interest in sharing practical applications of best practices

Alignment in what content areas are most important Agreement in methods of finding the stories from the

field Agreement in method of sharing the “how-to’s”

AHCA website Publications

Profile of a Success Story Requires a Measure

Baseline rate or count compared to after improvements were implemented

Need to express % improvement Require an analysis of process steps

Team review of work flow Requires description of specific process change

Who did what differently? Includes staff involved & resources needed

Best if staff closest to process works to identify changes Share learning

Challenges, barriers, advice

What’s Your Story?