1. Advancing Excellence in Nursing Homes Making Nursing Homes Great Places to Live, Visit and Work
Carol Benner, National Director, Advancing Excellence in Nursing Homes Campaign
Tammy Rolfe,
LANEs Field Director, Advancing Excellence In Nursing Homes
Chris Condeelis
Senior Director of Quality
American Health Care Association

2. Learning Outcomes
Describe the role of Advancing Excellence in Quality First Keeping the Promise.
Review the eight goals and targets for improving the performance of nursing homes.
Describe the array of comprehensive, customized, evidenced-based resources that are available at no cost.
Demonstrate the use of Advancing Excellence website to benchmark and track performance.

3. Quality has evolved 7-5-5 7 Principles – no changes
5 – Goals – refined, consensus, measures sources
5 – Tools -- new

4. Why Update or Even Keep Quality First?
Our goals are more refined.
We have targeted 3rd- party data sources.
We can adjust our goals as our environment changes.

5. QFKTP Strategic Direction
Self-initiated – voluntary, proactive
Accountability, Transparency
Anchor point – across our membership
Positioning for the Affordable Care Act
Public Reporting
Pay for Performance
Bundling
Our progress includes - 7,500 pledged , more than 50% of nursing home leaders use resident and family satisfaction, continual growth in staff satisfaction, Advancing Excellence Phase I/II, Quality Awards , Trend Tracker, are just a few
Home Health, 500,000 lives campaign, lots of rick state-based programs

6. What is quality ?
“Quality is the combination of care and services that meet or exceed customer needs and expectations.”
AHCA/NCAL

7. QFKTP -- 7 Principles
Continuous 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.

8. QFKTP Principles – continued
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.

9. QFKTP – 5 Goals Improve and Sustain:
Performance in all CMS quality measures
Compliance with the federal survey process
High rates of resident and family satisfaction
High rates staff satisfaction rates
Leadership and staff retention, and reduce turnover rates
Customer-Focused Goals

10. QFKTP – Data to Measure Goals
Improve and sustain performance in all CMS Quality Measures
Source: CMS Nursing Home Compare
Update: Quarterly
Improve and sustain compliance with the federal survey process
Source: CMS OSCAR Data
Improve and sustain high rates of resident and family satisfaction
Source: My InnerView – National Survey of Customer and Workforce Satisfaction in Nursing Homes Report
Update : Annual
Improve and sustain high staff satisfaction rates
Update: Annual
Improve and sustain leadership and staff retention and turnover rates
Source :AHCA 2008 Nursing Vacancy, Turnover, and Retention Report
Update: Annual

11. CMS Quality Measure Performance (CMS Nursing Home Compare)
Quality Measure (QM)
2008
2009
% Difference
Physical Restraints
3.9%
3.1%
-.8%
High Risk Pressure Ulcer
11.6%
10.9%
-.7%
Pain
PAC Pain
20.6%
19.5%
-1.1%
PAC Pressure Ulcer
14.2%
12.7%
-1.5%

12. Federal Survey Process (CMS Nursing Facility OSCAR Standard Health Survey Data)
Average Citations
Sub Quality Care
2006
6.4%
2.9%
2007
6.8%
3.1%
2008
7.0%
3.4%
2009
4.1%

13. 86% of residents rated their nursing home as “good” to “excellent.”13
Resident and Staff Satisfaction (My InnerView, Inc.2009)
86% of residents rated their nursing home as “good” to “excellent.”
67% of staff rated their home “good” to “excellent” as a place to work.

14. 14
Retention Rates by Job Category (AHCA, Vacancy and Turnover Study, 2008)
Category
Retention Rate
Administrative
68%
Nursing
45%
Therapy
63%
Food Services
48%
Housekeeping
61%
Social Activities
66%

15. Shared Goals Quality First and Advancing Excellence
Quality First, Keeping the Promise – Goals
Advancing Excellence – Phase II
Goals
Resident and Family Satisfaction
Consistent Assignment
Leadership and Staff Retention and
Turnover
Staff Retention and Turnover
Staff Satisfaction
CMS Quality Measures
Pain, Pressure Ulcers, Advance Care Planning, and Restraints
Federal Survey Process
All of the Above

16. Quality First: Keeping the Promise 5 Tools
Advancing Excellence Phase II
AHCA/NCAL National Quality Award
AHCA LTC Trend Tracker®
Resident and Family Satisfaction Assessment
Staff Satisfaction Assessment

17. Thank-You for What You Do
“The leaders who work most effectively, it seems to me, never say “I” They think “we”; they think “team.”
“They understand their job to be to make the team
function. They accept responsibility and don’t
sidestep it, but “we” gets the credit…. This is what
creates trust, what enables you to get the task
done.”
Peter Drucker

18. America’s Nursing Homes Campaign
About the
Advancing Excellence in
America’s Nursing Homes Campaign

19. Campaign Overview
Largest national coalition (30 organizations) of nursing home stakeholders
Voluntary for nursing homes (43% registered!)
Based on measurement of meaningful goals
Initially a two-year campaign started in 2006
Just celebrated our 4th birthday!
Incorporated in 2010
And, the data show that it works!!!!

20. Why Join? Participate in a Quality Improvement method that works
Advancing Excellence tools are free, evidence-based and user-friendly
Up-to-date information on the website to help nursing homes quality of care and life
Robust website
Periodic newsletters
Participation encouraged for consumers and frontline staff in addition to nursing home leaders *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

21. Campaign Benefits Focuses on meaningful issues
Drives nursing homes to a culture of data and QI
Increases staff retention and focus
Improves customer satisfaction
Saves money due to improved quality and staff retention
Prepares for Pay-for-Performance
Brings stakeholders to the table
Complements other initiatives
Gets nursing homes ready for QAPI *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

22. About Quality Improvement

23. Why is Nursing Home QI Important?
It’s the right thing to do
Affordable Care Act strengthens QA requirements in nursing homes
With the shift to MDS 3.0 and the change in quality measures, nursing homes are more accountable than ever for quality.

24. Quality Assurance/Performance Improvement (QA/PI)
The Affordable Care Act, Section 6102 requires CMS to strengthen QA requirements in nursing homes
CMS must provide technical assistance to nursing homes in order to meet new requirements.
Law requires implementation by December 31, 2011
QAPI Plans must be submitted to HHS Secretary one year later *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

25. QA/PI Meaningful problems or issues Measureable Benchmarks/data-driven
Evidence-based interventions
Evidence of improvement

26. Quality Assurance Quality Improvement Proactive Reactive
Aggregate Data
Organizational process
Improves overall performance
Always measureable
Concurrent
Monitoring is continuous
Positive change
Reactive
Single episode
Organizational mistake
Prevents something from ever happening again
Sometimes anecdotal
Retrospective
Monitoring based on audit
Sometimes punitive *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

27. QI Model for Improvement Three Questions and the PDSA Cycle
What are we trying to accomplish?
How will we know that we have been successful?
What changes can we make to achieve our goal? *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

28. QI Model for Improvement
Aims are time-specific and measureable
Dependent on change
Uses P-D-S-A cycle to test small changes
* All improvement requires change; not all change means improvement
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

29. PLAN-DO-STUDY-ACT *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

30. PDSA

31. PDSA www.nhqualitycampaign.org *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

32. Example 1 What are we trying to accomplish? I want to lose weight
How will we know that we have been successful?
Size 6 dress
Lost 20 pounds
What changes can we make to achieve our goal?
(First, have to figure out what process I have to change)
Change medicine? Eat less? Eat differently? Exercise? *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

33. Example 1
Aim
Lose 10 pounds in two months using the bathroom scales to measure
Plan
RCA: what has caused weight gain?
Poor eating practices Do
Change eating behavior and start Weight Watchers
Study
After two weeks, there is a 2-pound weight loss
Act
Keep doing the same thing and monitor closely *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

34. Example 2 What are we trying to accomplish?
I want to increase profits in my pizza store
How will we know that we have been successful?
10% $$$ increase at the end of the 2011
What changes can we make to achieve our goal?
First, have to figure out what process I have to change
Better marketing? More cooks? Efficient delivery practices? *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

35. Example 2
Aim
Increase profits by 10% by December 31, 2011 using monthly profit reports to measure
Plan
RCA: what’s caused the loss of profits?
Bad economy Do
Distribute coupons in neighborhood newsletters
Study
After three months, sales are increasing!
Act
Standardize the new marketing procedure

36. Example 3 What are we trying to accomplish?
Decrease number of in-house acquired
pressure ulcers
How will we know that we have been successful?
No pressure ulcers and no deficiencies
What changes can we make to achieve our goal?
First, have to figure out what process I have to change
Right supplies on hand? Hire wound care nurse?Identification and care of residents at risk for PUs? *
To get these key national stakeholders to invest in AE,, someone had to be able to demonstrate the value of participating in a national campaign.
4 of the more compelling benefits of engaging in this particular Campaign are Increased Staff retention
Cost savings
,Improved customer satisfaction
And preparation for a pay-for-performance
I probably don’t need to say a lot about the importance of staff retention and customer satisfaction except to underscore that they can be among the most important drivers of quality.
And quality saves money. Perhaps not in the direct line items of your budget but certainly in the costs associated with poor quality – worker’s comp claims resulting from staff injuries, civil liability, to name a couple
Third, , as CMS continues to experiment with pay for performance models and demonstration, it is clear that any P4P will likely be based on measures that are clinical, compliance, and outcome oriented. Customer satisfaction may also be included in this group.
And, hopefully, as we move away from a survey to survey existence so that we can focus on continuous quality improvement, it’ll be to our benefit to have the key LTC stakeholders sitting around the table getting along than it will be to have them pointing fingers and competing with one another

37. Example 3
Aim
Decrease in-house acquired pressure ulcers from 4% to 2% by December 31, 2011 using AE tool to measure
Plan
RCA: what’s caused the pressure ulcers?
Lack of prevention Do
Set up prevention protocol that includes ID, hydration, turning and positioning, use of devices to prevent, etc.
Study
No new pressure ulcers for two weeks
Act
Standardize the new marketing procedure

38. Campaign Phase 2 Goals Staff Turnover Consistent Assignment Restraints
Pressure Ulcers
Pain (long and short-stay)
Advance Care Planning
Resident/Family Satisfaction
Staff Satisfaction
In Phase 2, we reordered that goals and we did that for a reason. Before you can really improve quality or the QMs, you have to stabilize the workforce. This is a real change for me…
About the staff turnover – probably should be STAFF STABILITY
In addition to just turnover, need to measure absenteeism, retention, cost…. QPRI
Here is a comparison of the Phase 1 and Phase 2 goals.
You can see that the goals are re-ordered in Phase 2 and that we have added
Advance care Planning and measurement of Staff Satisfaction. The two pain goals are merged into one.

39. Quality in Nursing Homes
To improve care, we need to stabilize the work force.
We need to reduce turnover, improve staff retention.
We need to improve relationships between staff and staff, staff and residents.

40. Keep QI Simple Focus on important, meaningful issues.
Make sure that your goal is measureable.
Figure out what change/process you need to make.
Involve the care team
Make QI come alive
Celebrate your success

41. Advancing Excellence QI Tools
About the
Advancing Excellence QI Tools

42. Advancing Excellence Tools
Staff Turnover Calculator
Consistent Assignment Calculator
Pressure Ulcer Monitoring Tool
Restraint Monitoring Tool
Pain Monitoring Tool
Advance Care Plan Monitoring Tool
Suggested tools for measuring Staff Satisfaction and Resident and Family Satisfaction
Find these tools at

43. The Campaign Tools Evidence-based, tried and tested…they work!
Developed by experts
Similar to one another and user-friendly
Excel worksheets
Simple how-to instructions
Macros and formulas built-in
Monitoring built-in
Downloadable and ready to use
Free

44. The Campaign Resources
Resources for each Campaign goal include:
Implementation Guide
Webinar
Fact sheet for consumers
Fact sheet for CNAs
Additional resources include:
Videos
Research references
Resources are regularly updated

45. Staff Turnover, Consistent Assignment
Using the AE Tools
to improve
Staff Turnover, Consistent Assignment
and Pressure Ulcers

46. A Major Shift In Thinking
It’s ALL about STAFF
Enough
Competent
Caring
Compassionate
Consistent

47. + = Formula for Success Staff Stability Consistent Assignment
Happier Staff Better Care and Clinical Outcomes Higher Resident and Family Satisfaction Cost Savings

48. Proving The Link - References
A Case For Consistent Assignment: When caregivers get to know their patients more intimately, it opens the way for improved quality and a reduction in staff turnover, Provider Magazine, June 2006
A Keystone For Excellence: Implementing consistent assignment provides a strong foundation for achieving the goals of the Advancing Excellence in America’s Nursing Homes program,
Provider Magazine, July, 2007
Predictable scheduling: Nursing homes can boost quality, bottom line with consistent assignment, Modern Healthcare, August 2010
Interventions Table: Staff Retention: An overview of information published between regarding successful or potentially successful interventions to retain staff

49. What is Staff Stability?
Low staff turnover
High staff retention
Low use of agency staff
Rare call-outs, absenteeism
High staff satisfaction

50. Staff turnover is one component
of staff stability

51. National Nursing Home Turnover Data
AHCA’s Staff Vacancy and Turnover Report 2007
CNA
65.6% RN
41.0%
LPN
49.9%

52. Staff Turnover – AE Goal
Goal 1 - Staff Turnover:
Nursing homes will take steps to minimize staff turnover in order to maintain a stable workforce to care for residents.
Amazing Resources on the Website:
QPRI Staff Stability Toolkit
PHI Coaching and Supervision Guide
AE Staff Turnover Tracking Tool
WEB EX on how to use the tool

53. QI Process for Staff Turnover
PLAN
Use the AE tool to calculate what the turnover rate is
Decide if this is something that needs to change
If yes, ask why? Is it low-pay, too much work, geographical area, lack of leadership?
Decide on a plan

54. QI Process for Consistent AssignmentDO
Talk with staff and explain what is going on
Implement changes in hiring practices
Study
After two weeks or so, use the AE Tool and see how you are doing
Talk to the staff to see how they are doing

55. QI Process for Consistent Assignment
ACT
Using the measurement from the AE Tool and the feedback received from the staff, tweak the hiring practices.

56. The Staff Turnover Calculator Tool
Only nationally available standardized way to collect turnover data
Developed for QIO’s 8th scope of work and modified to make it better over past 6 years
Used to collect and analyze monthly data
Provides an Annualized Turnover Rate
Monitoring on AE website

57. Staff Turnover Calculator

58. Instructions TAB

59. Common Qs & As TAB

60. CNA Calc TAB

61. CNA Trending TAB

62. Data Entry on AE Website
Enter staff turnover data on AE website at least monthly
Print off a copy of the tool for simplicity and as a record
Your data are confidential– others cannot see it
Use the provided trend graphs for QI meetings
Provide feedback to staff and others through data and graphs

63. Consistent Assignment

64. What is Consistent Assignment?
The same person takes care of the same resident every time he or she is on duty…

65. The Case for Consistent Assignment
How Would You Feel?
To never know who your caregiver might be
To always have caregivers that don’t know
your preferences or routine
To know that you may not see the person
who cared for you today again
There is a possibility that a single resident could have over 20 different caregivers in a week!

66. Consistent Assignment
Builds positive relationships
Increases resident and family satisfaction
Quicker awareness of clinical problems
Improves staff accountability
Improves communication between shifts and with other disciplines
Improves staff satisfaction
Improves clinical and quality outcomes!!!

67. A Step-By-Step Guide to Consistent Assignment Roll-Out
A How-To Manual
A Step-By-Step Guide to Consistent Assignment Roll-Out
This handout is an adaptation from information David Farrell presented during an AHCA webinar held November, 2007
The webinar materials are available for free
(See handout for link)

68. Can Any Nursing Home Do This?
Yes !!
If the Nursing Director and Administrator are
on board with PASSION!
If the culture is already open for dialogue
If the staff feel empowered and not threatened
If everyone realizes that consistent assignment is a different way of thinking and behaving
If everyone realizes it is best for the resident

69. Consistent Assignment – Goal Definition
Goal 2 – Consistent Assignment:
Being regularly cared for by the same caregiver is essential to quality of care and quality of life. To maximize quality, as well as resident and staff relationships, the majority of nursing homes will employ “consistent assignment” of CNAs.

70. Consistent Assignment – Objectives
The Objectives:
The Advancing Excellence Campaign has defined consistent assignment as at least 85% of long stay residents in the nursing home having a maximum of eight CNA caregivers over a four-week period, and at least 85% of short stay residents having a maximum of eight CNA caregivers over a two week period.
You may find out that your numbers are higher than 8 and that is OK! If your number is 12, you may want to get it down to 10 Set your goal

71. QI Process for Consistent Assignment
PLAN
Use the AE tool to calculate how many CNAs are caring for each resident
Decide if this is something that needs to change
If yes, ask why and how your staffing patterns contribute to the number of different CNAs taking care of residents. Ask the right questions: Is simply a matter of scheduling? High number of “difficult” residents? Too many call-outs?
Educate everyone about consistent assignment
See the “How-To Manual” slide and handout

72. QI Process for Consistent AssignmentDO
Talk with staff and get buy-in to change
Explain value of consistent assignment
Use best practices of others to change scheduling practices
Pilot consistent assignment on one unit
Provide resources

73. QI Process for Consistent Assignment
Study
After two weeks or so, use the AE Tool and see how you are doing
Talk to the staff to see how they are doing

74. QI Process for Consistent Assignment
ACT
Using the measurement from the AE Tool and the feedback received from the staff, tweak the scheduling method.

75. Using the Consistent Assignment Tool
ONLY national standardized tool that will allow comparisons
Download the Excel-based tool on to your computer and save it with a name
Set up the tool by adding names of residents and staff
The tool is resident-centered not staff-centered and counts the number of caregivers taking care of residents NOT the number of residents being cared for by the caregiver

76. Using the Consistent Assignment Tool
The tool is resident-centered not staff-centered and counts the number of caregivers taking care of residents NOT the number of residents being cared for by the caregiver
Tool calculates the average number of unique C.N.A.’s per resident for the past 7 days in weekly increments - ready for data entry into the Campaign website
Use the tables from the Excel worksheet to brief your QA Committee and provide feedback to the staff

77. Consistent Assignment Calculator

78. Instructions TAB

79. Common Qs & As TAB

80. CNA Tab

81. Residents TAB

82. Week 1 TAB

83. Summary TAB

84. Pressure Ulcer Tracking Tool

85. Pressure Ulcers– Goal Definition
Goal 4 Pressure Ulcers:
Nursing home residents receive appropriate care to prevent and appropriately treat pressure ulcers when they develop

86. QI Process for Pressure Ulcers
Define and Measure Pressure Ulcers
Determine current pressure ulcer data in your nursing home, state and nation
Identify facility information and tracking
Investigate Reasons and Sources of Pressure Ulcers
Identify current practices and approaches
See Pressure Ulcer Care Process Framework

87. QI Process for Pressure Ulcers
Identify and Implement Solutions to Improve Pressure Ulcer Rates
Use interventions that address the specific problem. Use appropriate resources for solutions that are known to work.
Monitor and try different interventions if necessary.
Re-evaluate performance practices and results
Continue internal data collection on results and processes
Provide feedback to staff and others
No Data Entry Required – Populated from MDS
Use trend graphs from 2007 to 2010

88. National Pressure Ulcer Data
Some Key Campaign Objectives: By December 21, 2011
The national average for high risk pressure ulcers will be below 9%
30% of nursing homes will report rates of high risk pressure ulcers at or below 6%
22,500 fewer residents will have pressure ulcers compared to 6/06
Most Current Quarter 2, 2010 high risk pressure ulcer data
10.8 %

89. Knowing Pressure Ulcer Data
It is important to know your national, state and facility specific data
You can find these on the Campaign website
Due to MDS 3.0 the Quality Measures are going dark
Last QM data expected to be posted Feb 2011 for Q3 2010

90. Using the Pressure UlcerTool
Internal QI is essential now in the absence of QM’s
Use the AE Pressure Ulcer Tool to collect and analyze monthly data
Nationally standardized way to collect this data
Amazing graphs and trending
Go to website, click on goal and tool, download tool – save to PC with an extension such as date or name

91. Special Tool Features
Allows nursing home to monitor in-house acquired and admission acquired by source
Shows were pressure ulcers come from
Provides multiple graphs for ongoing monitoring
There are currently no questions and answers tied to this tool

92. Pressure Ulcer Tool - Data Entry Section

93. Pressure Ulcer Tool - Graphs and Trends

94. Monthly Notes

95. Thank You. Questions. ccondeelis@ahca. org cbenner@aahsa
Thank You! Questions?