The Illinois LANE Critical Access Nursing Home Pilot Project Susan Gardiner, RN, BSN, LNHA Director of Clinical Services, Illinois Council on Long Term Care Lisa Bridwell, BA Quality Improvement Facilitator, IFMC-IL Illinois Quality Improvement Organization 1

Advancing Excellence in America’s Nursing Homes Making Nursing Homes Better Places to Live, Work and Visit!

Campaign Overview Largest coalition of nursing home stakeholders Voluntary for nursing homes Based on measurement of meaningful goals National coalition of 29 organizations Initially a two-year campaign started in 2006, incorporated in 2010!

What the Campaign Does Provides free, practical and evidence-based resources to support quality improvement efforts in America’s nursing homes. Committed to providing support to those on the frontlines of nursing home care. Promotes open communication and transparency among families, residents, and nursing home staff.

3 11 Founding Organizations Alliance for Quality Nursing Home Care American Association of Homes and Services for the Aging (AAHSA) American Association of Nurse Assessment Coordinators (AANAC) American College of Health Care Administrators (ACHCA) American Health Care Association (AHCA) American Medical Directors Association (AMDA) Centers for Medicare & Medicaid Services (CMS) and its contractors, the Quality Improvement Organizations (QIOs) and State Survey Agencies National Association of Health Care Assistants (NAHCA) NCCNHR: National Consumer Voice for Long Term Care The Commonwealth Fund The Evangelical Lutheran Good Samaritan Society

Campaign Benefits Focuses on meaningful issues Drives nursing homes to a culture of 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

National Steering Committee Policy Framework Resources Statewide LANES Local Leadership and Guidance Recruitment Education NURSING HOME Focus on Meaningful Issues Implementation of Interventions How the Campaign Works

Local Area Networks of Excellence (LANEs) Learning networks Coalitions of nursing home stakeholders Partnerships Collaborative Diverse organizations, often with different agendas, come together to improve quality of care and life for residents.

Illinois LANE Members HCCIHealthcare Council of Illinois LSNLife Services Network IDPH Illinois Department of Public Health CMS Centers for Medicare & Medicaid IPC Illinois Pioneer Coalition IFMC-IL Quality Improvement Organization for Illinois Illinois Department of Aging: Ombudsman

LANE Roles and Responsibilities Provides statewide leadership to coalition of stakeholders Raises and maintain awareness about the campaign Recruits nursing homes Provides technical assistance Communicates key campaign messages Acts as a “change agent” to improve the lives of those living and working in nursing homes 11

12 Resources

Purpose of the CANH Project To improve care in selected nursing homes To strengthen LANEs To develop a model of nursing home improvement that can be used across the country

Critical Access Nursing Home Project Critical- Access Nursing Homes (CANHs) are in inner city neighborhoods serving largely minority communities of generally low socio-economic status. Why are they termed “critical”? The community depends on these nursing homes to provide post-acute and long-term care services. Not having high quality nursing homes close to where people live complicates discharges from local hospitals and forces elderly residents to go to more distant nursing homes far from family and friends.

Locations of CANH Project Chicago, IL E. Chicago, IN Cleveland, OH Macon, GA CANH Faculty: Barbara Frank and Cathie Brady B & F Consulting, Carol Benner Leading Age, Dr. David Smith Drexel University © B & F Consulting, Inc.

Illinois LANE Illinois LANE Co-Conveners are: IFMC – IL (Illinois Quality Improvement Organization) Lisa Bridwell IPC (Illinois Pioneer Coalition) Enza Levy 16

Staff Stability: The Foundation for Clinical Improvement Learning Session One November 16, 2010 Facilitated by Cathie Brady & Barbara Frank B&F Consulting Critical Access Nursing Homes An Initiative of Advancing Excellence in Partnership with the Illinois LANE

Better Census and Revenue Improved Quality and Satisfaction Staff Stability

CANH’s Three Goals Help each nursing home get better stability and outcomes Form “mutual aid” and collaboration among nursing homes Strengthen collaboration among state agencies and organizations as they learn so they can help nursing homes in similar positions

What a difference management makes! Five Management Practices Associated with Low-Turnover, High Attendance and High Performance: High quality leadership at all levels of the organization Valuing staff day-to-day in policy and practice, word and deed High performance, high commitment HR policies Work systems aligned with and serving organizational goals Sufficiency of staff and resources to care humanely

Audience: Corporate Leaders Administrators and DON’s Content: See the value in collaboration with each other Build relationships with LANE members and state agencies so they can be seen as a resource Attendance and scheduling PPT Recruitment and hiring PPT Orientation Meeting 9/2010

From Data to Knowledge to Action

“I am overwhelmed by what I have to do when we’re working short. If I start doing the CNA's job, I’ll never get all my meds passed and my charting done. It’s just too much. I’m not going to do the personal care. I just keep my focus on my work and get as much done as I can.” “I gather my staff in the morning and I tell them ‘we have to work together. We’re like sticks. If we work apart, each of us can be broken. If we stick together, we can’t be broken. We’ve got to stick together to get the work done. And let’s have fun doing it.’ Then I just pitch in and we get through the day.” Exercise: Floor Leadership How two Charge nurses start their day

CANH Faculty overview – Staff stability; foundation for clinical improvement  Impact on resident outcomes  Impact on survey results  Impact on staff, injuries etc.  Better Jobs, Better Care Learning Session One November 2010

Outcome of Drill Down Group Activities Absenteeism/Tardiness Staff’s lack of policy knowledge Staff to Staff to communication November 2011 Action Items

Relationships Closest to the Resident Matter Most Interdisciplinary and Interdepartmental Collaboration CNAsResidents Charge Nurses Quality of workQuality of care © B&F Consulting Inc

Dimensions of Relational Coordination Interdisciplinary ~ Interdepartmental Across Shifts and Days Communication Frequent Timely Accurate Problem-solving Relationship Shared Goals Shared Knowledge Mutual Respect © B&F Consulting Inc

January 2011 Learning Session Two Positive chain of leadership Systems that support relationships Valuing your staff “All Hands on Deck”

LANE Support Updates (Between Learning Sessions 1-2) Focus Groups addressing New Hires One Facility utilized LANE member to conduct focus groups to gather information of why employees separate in the first 90 days. Developed a cheat sheet to help new employees Increased awareness/attention to the needs of new hires Preceptor Program/Consistent Assignment Another Facility incorporated information from the orientation meeting in their preceptor program and as they develop their strategy for consistent assignments Implementation of Call Out Log Information at STAND UPS One facility used this information to follow up with those who called off to communicate she cares if they were sick and identify any future potential issues that my cause future call offs.

LANE Support Updates ( Between Learning Sessions 1-2) Development of an Employee focused Survey addressing attendance/absenteeism Exercise: If it was a perfect world……. Unintended [positive] outcomes: – One facility realized the need to in-service on their policies after ranking their staff – “Caught You Caring” develops – Increased attention to communication among staff and residents

Assignments and Goals Move toward changing hours for department head lunch Involve leadership with All Hands on Deck to promote teamwork Establish nurse manager meetings to provide feedback on challenges they face On site follow-up by LANE Building upon existing Quality Improvement rounding program Orientation practices and identifying the qualities of a good trainer or mentor

And then the snow fell……

March 2011 Learning Session Three Systems and People Development presentation Key messages: – Improvements in staff stability and engagement lead to improved quality and satisfaction resulting in better census and resources for more improvement – Relationships closest to the resident matter most

Accomplishments  Improved morale  Increased leadership from charge nurses  Improved attendance  Tracking call-offs; report brought to stand-up meeting  Interview process: skills and qualities  Monthly turnover tracking  Reports of tremendous teamwork during blizzard

Accomplishments  Met census goals and decreased readmissions  Implemented consistent assignments and as a result call-offs decreased  Extending orientation on a case-by-case basis  Implemented Family Satisfaction Survey

Summary of Barriers Survey response rates Loss of project leader Administrator and key management staff turnover Process for obtaining and financial support for special programs (gift cards etc.) Pathways of communication up the chain of command up to and including corporate Mechanism for direct care staff to communicate directly with corporate staff Slowed or stalled data collection No overlap between shifts Internal struggles between management staff

May 2011 Learning Session Four Two Events Leadership Meeting Corporate Leaders/DON/Administrator- retrospective review discussed successes/barriers resulting overwhelming support from Corporate Corporate leaders working with facility managers on solutions to barriers. Learning Session Follow up from Leadership Meeting frontline staff moving forward and working on additional data driven goals. (Clinical and Organizational Goals) Overall Goals Outside organizations reporting improved resident care 37

A Model for Change Outcomes Care Planning Person-centered Care Organizational Workplace Practices

39 Second, Care for the Residents Individualized/ Person-centered Care MDS/Data Collection IDT Care Planning Communication Critical Thinking Problem-Solving Monitoring

40 Third, Do it the Best Way We Can… Outcomes Quality Assurance Performance Improvement Structure Process

Reactive Single episode Organizational mistake Prevents something from happening again Sometimes anecdotal Retrospective Monitoring based on audit Sometimes punitive Proactive Aggregate Data Organizational process Improves overall performance Always measureable Concurrent Monitoring is continuous Positive change Quality Assurance Performance Improvement

Thank You!