Putting quality improvement processes in place can win awards, but also helps build teamwork, motivation, and communication.
The pursuit of quality is a constant in long term care, and little is more representative of that than the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) National Quality Awards Program. As of 2021, nearly 2,000 providers have received the Bronze award, nearly 700 have received the Silver, and 49 have received the Gold. Award recipients consistently perform better than the national average in several areas, including hospital readmissions and off-label use of antipsychotics. They also have higher ratings regarding surveys, staffing, and quality metrics.
But the awards are about more than numbers. Pursuing the awards opens doors to new and innovative opportunities, and it equips organizations and teams to more adeptly manage crises and change, thrive, and be resilient.
“The awards program represents a journey. It’s a framework for a better resident experience and quality of life. It enables staff to work better, smarter. You can set deployment goals and introduce team-building activities such as contests between departments,” said Tammy Kelly, PT, LNHA, RAC-CT, director of resident assessment instrument and clinical reimbursement at Commonwealth Care of Roanoke. “And you gain employee enthusiasm and engagement.” She noted that it also can be used as a metric in the value-based payment system for incentive payments. “There are so many things you can weave into this.”
Mike Hensley, managing partner and owner at Burgess Square Healthcare and Rehab Centre in Westmont, Ill., observed, “We were always striving for quality before the awards journey, but this is a systematic way for facilities to achieve quality goals that give AHCA a foothold in Washington, so they can show policymakers and others that their members are committed to excellence in patient care and achieving quality outcomes.”
The Ripple Effect … or a Wave?
As teams sharpen their skills, taking a hard look at the systems and processes and making changes and improvements in pursuit of the Quality Awards, their accomplishments flow into other areas. For instance, Hensley said, “We were named the number one skilled nursing facility provider in Illinois by Newsweek, and we were in the top 60 in Illinois as identified by U.S. News & World Report. Our quality improvement efforts as we pursued the awards set us up for these accomplishments.”
On a local level, Hensley said, “we received positive media recognition, and this was invaluable.” Of course, such acknowledgement takes some effort, he noted, saying, “When we received the Gold award, it was a major accomplishment and a heavy lift, and we did it during the pandemic. We promoted the prestigious value of this achievement. Then we were named number one by Newsweek, and that really caught fire with physicians, hospitals, and potential residents.”
From Stick to Carrot
Particularly during the pandemic, long term care providers came under scrutiny and were often unfairly portrayed in the media. The focus was often negative and critical. Genuine opportunities to celebrate are empowering and essential.
Hensley said, “When you look at the operations of nursing centers and organizations, we are measured in an infinite number of ways on everything from staff retention and turnover to outcomes. But almost 100 percent of these measurements involve a negative outcome associated with the grade or rating. For instance, if you are cited too many times, your star ratings go down. We have so many sticks coming at us but few carrots.”
The Quality Award process is something providers can strive for, he said, that has a positive outcome “beyond what we do every day.” He noted, “When we went through the awards, it was the pursuit that was the important part. We are always improving our quality, and we had concrete results to celebrate and many carrots in a world where there are so many sticks.”
From Assessment to Action and Teamwork
Going through the process helps connect the dots. Kelly said, “As I was writing for the Bronze award, I started connecting things. Then we wrote for the Silver, and it opened a whole world to us—with new and better processes and systems. It created a ripple effect.”
At a time when it is more essential than ever to have cohesive, committed teams, Kelly observed that writing for the awards “brings disciplines together.” She explained, “Your teams begin to understand and appreciate the whole picture. You establish sustainable processes and systems and concentrate on things beyond the daily minutia. You step back, let it run, and focus on other opportunities for quality improvement. As the teams and processes become more efficient, the energy you previously put into putting out fires you can now direct toward broadening your perspective and moving your organization forward.”
Using the Baldrige criteria employed in the Quality Awards program for ongoing process improvement, she suggested, enables you to look at opportunities to continue building on your processes and systems and for other resources such as grants and research partnerships. “This process makes us more comfortable opening doors and inviting people in,” Kelly said.
Opening doors also enables providers to strengthen relationships. Kelly said, “As part of the Baldrige criteria, you take a deep dive into who your stakeholders are, and you identify who you work well with, as well as those who have a strong need for your services but you’re not well-connected with—such as a hospital system.” She said that her organization has been able to make closer connections with area hospital systems so they can move patients more effectively through the continuum, and communicate and share information effectively. “If we can break through the blame game via such efforts and share information more transparently, we become allies instead of just a referral source and receivers.”
Weathering Whatever Comes
While data is still being collected, it seems clear that Silver and Gold Quality Award recipients weathered the pandemic more efficiently and effectively. “A word we use a lot in the program is sustainability, and going through the awards process helps organizations build that,” said Kelly. This means that when a crisis takes focus away from other efforts, facilities can go on autopilot for a time and don’t fall apart. She explained, “Going through the application as a team and setting up interdisciplinary processes build confidence, teamwork, and oneness of thought so when things get difficult, there is more stability and agility. The team is able to pull together when things feel like they’re burning down around us. We have solid ground to stand on.”
During the pandemic, organizations learned that transparency builds trust. Kelly observed that Quality Award participants already knew this. These organizations have already assessed and addressed how and with whom they share information, and what information various audiences need access to. They realize, she said, that “if people don’t have good information, they make it up; and when
this happens, things go sideways.” Going through the awards process and sharing information, she said, builds confidence in your ability to communicate both “when things are great and when they’re not so good.”
Lisa Pearson, MSN, RN, CIC, director of infection prevention and quality improvement at South Davis Community Hospital in Bountiful, Utah, said, “At the beginning of the pandemic, we recognized that staff wanted information. There was a lot of fear that could be felt everywhere. Having information was essential, so we created a newsletter—The COVID Connection—containing the information staff needed.” At the same time, she said, “we already had key people in place who knew what they needed to do. We formed a task force with key leaders, and we created a systematic process to respond to new guidance and information with daily team meetings.” As a result, she said, they reacted less with fear, and they made decisions that were data-informed instead of based on emotion.
Hensley noted, “We were much better equipped to handle the pandemic, and we were able to respond to the almost daily changing guidance. We could rely on our processes and provide our staff with great stability in uncertain times.”
Pearson agreed, “Going through the awards program teaches you not to have a reactive approach where you’re putting out fires all the time. Instead, you become proactive and are able to mitigate many small problems before they become big ones.” She added, “Since you have streamlined and efficient processes in place, it saves time, and you have happier staff and better outcomes.”
While the Quality Awards aren’t a panacea, Hensley noted their value for improving—or at least stabilizing—staffing. He said, “If you are a quality nurse, wouldn’t you rather work for a five-star Gold award facility? It’s easier to retain and recruit good staff when you demonstrate your commitment to quality and make it clear that you engage and value staff in these efforts. It also may be a deterrent to those who just want a job and don’t have any real interest or passion for long term care.”
Even with a strong staff, it can be challenging to ask people to do the work of writing for Quality Awards. However, Hensley stressed, “pursuing this milestone is worth it. It engages our staff and gives them purpose beyond what they are doing every day. It makes a weak team strong and a great team exceptional.” He suggested that it can be easier to pursue the awards if “you take it in small steps and celebrate milestones.”
For those organizations that feel like they’re just staying above water, Pearson suggested, “You are the perfect candidate for this. It will teach you to develop processes; identify blind spots; and better support staff, residents, families, and other stakeholders. The awards aren’t just a vanity project. They will help you not only survive but thrive.”