Intersection of Quality Councils

Transcription

1 Intersection of Quality Councils By Mark Anderson, Chair, Care Providers of Minnesota Quality Council I have had the privilege of serving in two very different roles relating to quality improvement as a member of the American Health Care Association Quality Improvement Committee and as chair of Care Providers of Minnesota s Quality Council. The parallels between quality initiatives at the national level and quality initiatives at the state level have been exciting and inspiring at times. I wanted to spend a few minutes here noting the national committee work and the progress that is being made throughout the country on quality improvement, and then highlighting our comparable work here in Minnesota. AHCA Quality Improvement Committee Accomplishments Inaugural Quality Dashboard Building Blocks for Quality: Phase I: Quality Commitment Phase II: Achievement in Quality Phase III: Excellence in Quality 2010 and 2011 Annual Quality Reports Advancing Excellence 4,622 member participants, webinars, website improvements White paper: Quality Component of AHCA Website Re-design Success story submission form 2011 Friend of Quality Award 2010 and 2011 Convention programming 27 sessions 2011 and 2012 Quality Symposium programming Testimonials for AHCA programs Advancing Excellence, Quality Award Program, LTC Trend Tracker, Resident and Staff Satisfaction Surveys Person-Centered Care activities with Pioneer Network, Planetree, Greenhouse, and Eden Looking ahead to 2012, AHCA s Senior Vice President of Quality & Regulatory Affairs David Gifford, MD, offered an overview of AHCA s quality goals and staff recommendations for measuring those goals at the October Board of Governors retreat. After a lively debate about which targets have the potential to really move the bar on quality, the Board decided on these profession-wide targets: Decreasing hospital readmissions over 3 years Improving workforce (i.e., facility staffing) stability by reducing turnover Increasing overall customer/resident satisfaction AHCA will plan a formal rollout of their quality goals, launching the initiative at AHCA/NCAL s Quality Symposium on February 22 24, Now reflecting on Care Providers of Minnesota s work, it is clear we have been moving ahead in generally the same direction as AHCA. We rolled out our nursing facility dashboard earlier this year, and have begun work on a dashboard of sorts for our assisted living/housing/home and community-based services members. Our second annual quality report will be hitting the presses in about a month. We continue to promote participation in the Advancing Excellence campaign; Trend Tracker; and the AHCA/NCAL Quality Awards program. Clearly the data from Minnesota shows that we are believers. We have also made a proactive effort to build quality-related sessions into our education programs whenever possible. I continue to pursue the idea of developing/promoting a Minnesota-based Quality Symposium, and believe there continues to be a need for this type of program focus I am not giving up anytime soon! Finally, the Quality Council has been working on partnerships as well, and we are excited for future collaborations with the Minnesota Council for Quality.

2 Mark Anderson, Administrator, Good Samaritan Society Albert Lea Chair, Quality Council New Partnership with Minnesota Quality Council By Patti Cullen, CAE The Association s Board of Directors, at their November Board meeting, approved a partnership arrangement with the Minnesota Council for Quality, to include cross-promotion of events, joint programming, and partner discounts at events. While we are currently working out the specifics of the partnership opportunities, we want you to become familiar with the Minnesota Council for Quality and some of its work. (More details about the partnership will be available in the near future.) Founded in 1987, Minnesota Council for Quality is a nonprofit that advances continuous improvement and performance excellence within organizations, individuals, and communities. The Council helps leaders identify strengths and improvement opportunities and builds networks that bring information, resources, knowledge, and best practices to organizations desiring to improve. Today, the Council serves about 300 members, representing over 140,000 employees throughout and beyond Minnesota. A growing number of organizations using the Council s resources are healthcare providers, including some individual members of the Association. The following are a few of their key services: Organizational Assessments The Council offers organizational assessments that help leaders better understand and prioritize key strengths and improvement opportunities upon which plans can be created. Assessments facilitate the improvement, alignment, and integration of organizational processes; facilitate organizational/personal learning; and help leaders monitor progress. The Council has three assessment options available: the MN Quality Award and two abbreviated assessments that save resources and time, but still provide insights on improvement opportunities. Building Networks for Improvement The Council also provides services that broker information, resources, knowledge, and best practices: Improvement Clearinghouse: an online resource center that contains articles, white papers, a training/event directory, and links to other improvement sites. The Clearinghouse can be found on their website at Consultant Referral Network: an online yellow pages that acts as a dynamic search engine to locate improvement consultants, trainers, coaches, facilitators, and speakers, at Knowledge Forums: The Council offers monthly forums breakfast discussions in the Twin Cities, Rochester, Duluth, and soon virtually throughout the state that offer leaders and practitioners a network for sharing knowledge and best practices on organizational improvement and performance excellence. They also host the Lean Six Sigma Forum, workshops, webinars, and conferences throughout the state and throughout the year. Roundtables: peer learning groups of mid/upper level leaders that systematically tap the collective insights from a small, private cohort to address their organization s challenges. Alliances: relationships with 19 other nonprofits, professional/trade associations, and colleges/universities that have all agreed to offer their services at a discount to Council members. Partners include the University of Minnesota, University of St. Thomas, Minnesota Organizational Development Network, Association for Strategic Planning, Minnesota Chapter of the International Society for Performance Improvement (MNISPI), and over a dozen other organizations, including Care Providers of Minnesota (CPM). This alliance will entitle any CPM member to discounts on all Council services and events.

3 Patti Cullen, CAE Five Minnesota Nursing Homes Participate in QAPI Demonstration Project By Doug Beardsley Five Minnesota nursing homes are participating in a demonstration project to determine the issues involved in implementing a comprehensive quality assessment and performance improvement (QAPI) program, and to evaluate related tools, training resources and technical assistance to assist in its implementation. The Minnesota participants all volunteers are: Benedictine Health Center of Duluth* Ecumen Parmly LifePointes in Chisago City Good Samaritan Society Ambassador in New Hope* Perham Memorial Hospital and Home Sterling Park Health Care Center in Waite Park (Tealwood Care Centers)* * indicates a member of Care Providers of Minnesota The demonstration project, which involves 17 long-term care facilities in four states California, Florida, Massachusetts and Minnesota is part of a broader effort funded by the Centers for Medicare and Medicaid Services (CMS). The state policy and nursing home environments differ in the four states. In many ways, Minnesota nursing homes have a head start, because the state of Minnesota has a five-year history of providing incentives for nursing homes to conduct systematic performance improvement activities and has provided root cause analysis training opportunities. Minnesota is the only state with five facilities represented in the demonstration. In September 2010, CMS contracted with the University of Minnesota and Stratis Health to design and implement the demonstration project, led by Rosalie A. Kane, Ph.D., professor, Division of Health Policy and Management. QAPI requires a continuous, comprehensive, and active approach to quality, including medical care, quality of life, resident choice, and effective transitions. When fully implemented it will engage all nursing home staff and consultants in systematic attention to quality, explained Kane. As part of the demonstration project, the nursing homes will conduct a self-assessment to determine their specific needs. From there, they will have the opportunity to access a robust resource library of online training modules, QAPI-related tools, evidence based and best practice case studies, and other resources to help them develop and manage their own QAPI program. In addition, a QAPI project liaison will provide individualized technical assistance and help each facility monitor their progress along the way. The 17 nursing homes will also attend Learning Collaborative meetings, where they will exchange ideas and experiences, as well as provide feedback about the materials, the successes, and the challenges of the implementation process. Participating facilities will gain valuable insights into their own organizations, while fostering ongoing support and collaboration with the national network, said Kane. Most of all, their input will help generate best practices for all facilities to use when QAPI goes into effect nationally. QAPI in nursing homes is mandated by the Affordable Care Act, passed in March 2010, which requires that nursing homes must have an acceptable QAPI plan in place within a year after new QAPI regulatory standards are issued, and that CMS must provide best practice information and tools to assist them in implementing the new expectations. The existing quality assessment and assurance provision mandates a quality assurance

4 committee to develop and implement appropriate plans of action to correct quality deficiencies, but did not specify how to implement the regulation, nor did it call for active, data-driven performance improvement. It is anticipated the new QAPI requirements will go into effect in CMS has outlined five required elements of a QAPI program: 1) Engage residents and all staff in defining quality issues. 2) Monitor and interpret feedback on quality. 3) Set priorities for more intensive team-based performance improvement projects. 4) Use root cause analysis to identify underlying reasons for quality challenges. 5) When indicated, make systemic changes to prevent problems that occur because of the systems of care. For now, long-term care facilities are encouraged to begin preparing for QAPI mandates by reviewing language on the QAPI elements, discussing QAPI at the level of boards of directors and corporate leadership, preparing their own staff, engaging other stakeholders (such as family members and residents), and identifying new opportunities for improvement. It is interesting to note that the AHCA/NCAL Silver Quality Award criteria are very closely aligned with the CMS elements of a successful QAPI program, Doug Beardsley dbeardsl@careproviders.org Minnesota LANE Receives Advancing Excellence Grant Minnesota s Local Area Network of Excellence (LANE) convener group made up of Stratis Health, Care Providers of Minnesota and Aging Services of Minnesota received a small grant for work performed as part of the Advancing Excellence (AE) in America s Nursing Homes campaign. The LANE convener group identified two initial goals: 1) to promote consistent assignments in nursing homes, and 2) to increase statewide registration of nursing homes in the AE campaign. As a result, more than 25 percent of nursing homes that chose the AE consistent assignment goal utilized the Advancing Excellence Consistent Assignment Tracking Tool to measure consistent assignment within their homes. Also, by increasing communications with nursing homes statewide, the number of Minnesota nursing homes that have registered for the campaign increased from 164 (42 percent) to 174 (45.2 percent). The LANE convener group will use the grant money to purchase recognition decals that will be sent to all homes that have registered for the AE campaign. The Minnesota LANE has also received grant approval for the second LANE performance challenge. Through July 2012, the LANE convener group will work to decrease rates of high risk pressure ulcers among a select group of MN nursing homes; increase use of the Advancing Excellence Pressure Ulcer Tracking Tool; and increase enrollment in the Advancing Excellence in America s Nursing Homes Campaign. To register for the campaign and/or to find valuable quality improvement tools and resources go to Questions about the campaign and/or assistance with registration should be directed to Kristi Wergin, program manager, Stratis Health at kwergin@stratishealth.org AHCA/NCAL Quality Symposium February By Doug Beardsley Join the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) for their 4th Annual Quality Symposium: Inspiring Excellence in Long-Term Care. The symposium will be held at the

5 Westin Galleria in Houston, Texas on February 23 and 24, This symposium features two days packed with information about current quality issues. A must attend event for long-term care quality professionals, it is a dynamic conference designed to provide a broad spectrum of programming to quality practitioners at all levels. The symposium is designed to be highly interactive, with idea sharing and networking opportunities. Choose from three tracks of education forums, view poster sessions from providers across the country, and hear from informative and inspiring keynote speakers. Examples of breakout education sessions include: Purpose Driven Teams Preventable Hospitalization Person-Centered Care and Performance Excellence Engaging Generation Y The Voice of the Customer: The Key to High Satisfaction Rates CMS Measures Appreciative Inquiry Costs of Turnover QAPI Medical Directors Strategic Planning Introduction to the Quality Award Program Also available is a Pre-Symposium Workshop, covering the following sessions: Fine Tuning Your Silver Application The Path to Mastery The Relationship of Person-Centered Care to the Baldrige Healthcare Criteria QAPI Find out more about this exciting program here, and register here. Doug Beardsley dbeardsl@careproviders.org DHS Announces New Round of Grants and Publishes Fall 2011 Quarterly Update for Minnesota PIPP By Todd Bergstrom The Minnesota Department of Human Services (DHS) has published the inaugural edition of the Quarterly Update for the Minnesota Nursing Facility Performance-Based Incentive Payment Program (PIPP). The quarterly update contains articles on: The 2011 Summer PIPP Conference Best practices A new and soon-to-be-released PIPP social networking site A feature on the St. Elizabeth s Nursing Home and Health Care Center PIPP project on culture change On October 17, 2011, DHS issued the sixth annual request for proposals (RFP) for nursing facility performancebased incentive payments. Since July 1, 2006, nursing facilities have had a chance to contract with the Department to earn performance-incentive Medical Assistance (MA) payments of up to five percent of the operating payment rate. The incentive payments are time-limited rate adjustments. DHS will implement the sixth round of performance-based incentive payments on or after July 1, Funding available to implement new projects under this provision for the fiscal year ending June 30, 2013 is equal to approximately $2.4 million (state share).

6 View the request for PIPP proposals issued on October 17, 2011 (proposals will be due February 15, 2012) and download the PIPP Quarterly Update Fall 2011 (PDF) from the DHS PIPP website at Please contact Todd Bergstrom at the Association office if you have questions about the PIPP program. Writing the Silver Award By Christine Bakke Todd Bergstrom Writing a Silver Award application is an amazing process. It can be exhausting, invigorating, insightful, and exciting all at the same time. When we decided to attempt the application, we asked for a group of volunteers to assist in generating the ideas for ways to meet the criteria and then review the application as it was written. We had a group of ten people who worked diligently on the application for almost four months, and these volunteers came from multiple departments within our organization. We began our process meeting every other week, brainstorming ideas for each of the criteria in the application. One individual was tasked with taking the notes from the meeting and turning it into our written application. Prior to each meeting, the application was sent to all team members to review the prior weeks work and make suggested changes. As we neared the submission deadline, our team started to meet weekly to ensure that the application was as close to perfect as we could make it. By the time we submitted the application we were all exhausted. I don t think that a week went by without someone asking me when we would find out if we won the award. It was a long wait until July, but I will never forget how I felt when I was told we received the award. As one of the Silver Examiners, I happened to be at the meeting when the Examiners were voting on the awards. I did not participate in the voting, but remember how overwhelmed I was that night when my colleagues shared that St. Ben s would be receiving the Silver Award. When I came back to work the next week, everyone kept asking if we had received the award, but I couldn t tell anyone until we received the official notification. The day finally came when the official notification was sent out. The smiles on peoples faces, the way they stood a little taller, and the pride they have shown in our organization have been priceless. We were able to take a couple of the volunteers who assisted in writing the award to Las Vegas and most of the volunteers were able to join us at the Celebration of Caring dinner (see photo below). We purchased the silver lapel pins AHCA offers to silver award recipients for our staff to wear and it is fun to see so many people wearing them every day. I am now being asked by several of the staff when we are going for the Gold. I tell them I am not sure when we will start writing the application, but that we are well into our journey. One important note I do share frequently is: this is not about winning awards, and no one should go into this with that in mind. The journey is about continuously making life better for our residents, their families, and our staff. The award is only the recognition of our efforts. Christine Bakke, Care Center Administrator

7 St. Benedict's Senior Community AHCA Establishes Quality Cabinet Howie Groff to Serve as Vice Chair By Patti Cullen, CAE The American Health Care Association (AHCA) Board of Governors last month endorsed the establishment of a Quality Cabinet to coordinate and direct their collective efforts as they advance quality of care and quality of life issues on behalf of the membership and those we serve. AHCA s Quality Cabinet will help to guide their Quality Improvement, Clinical Practice, Survey/Regulatory and Workforce Committees efforts. Former AHCA Chair and 2011 Friend of Quality awardee Mary Ousley chairs this new, overarching advisory cabinet. Former AHCA Board of Governors Member, National Center for Assisted Living Chair, and Care Providers of Minnesota Board and Executive Committee member Howie Groff has agreed to serve as vice chair of this new Quality Cabinet. Groff s response, when asked about this new volunteer assignment, was: Quality has always been a front and center focus for our organization, so it is an honor to be asked to lead this heightened focus within AHCA. There is a clear crossover of issues and strategic directions with the various committees, and I believe the establishment of the Quality Cabinet will aid greatly in coordination and collaboration of strategic initiatives for AHCA. It is clear that the current chairman of AHCA, Neil Pruitt Jr., is focused on the importance of quality improvement. As Capitol Hill focuses on the budget deficit action/inaction, Pruitt stated in a recent interview that even with the reimbursement reductions, the priority of AHCA and its members is moving the quality agenda forward despite the gloomy Medicare and Medicaid funding outlook. The most recent AHCA quality report showed long-term care providers improving in nearly all measurements, but the squeeze from reduced Medicare/Medicaid is becoming evident. Details about the specific role of the new Quality Cabinet will become evident after the first of the year. In January the Board of Governors will be meeting to finalize the Association s quality goals, which will be rolled out at the fourth annual Quality Symposium, scheduled for February The goals will likely be focused on these four key initiatives: 1. Unnecessary rehospitalization reduction; 2. Staff turnover reduction; 3. Increased resident satisfaction; and 4. Anti-psychotic drug reduction. The AHCA Quality Cabinet will be staffed primarily by David R. Gifford, MD, MPH, senior vice president of quality and regulatory affairs. Prior to joining AHCA last May, Dr. Gifford served as the director of the Rhode Island State Department of Health since March 2005, where he led efforts to revamp the nursing home survey process to promote resident centered models of care. Dr. Gifford previously served as chief medical officer for Quality Partners of Rhode Island, where he directed CMS national nursing home-based quality improvement effort. He is a board certified geriatrician who has devoted most of his career to nursing home quality and understands the needs of nursing home residents, having worked as a geriatrician and medical director in a number of nursing facilities. Patti Cullen, CAE pcullen@careproviders.org MAGEC Fellowship to Focus on INTERACT Implementation By Patti Cullen, CAE For the last few years, the Minnesota Department of Human Services (DHS) has offered the Nursing Facility

8 Performance-Based Incentive Payment Program (PIPP), an innovative program designed to promote projects that result in measurable quality improvement in the state's long-term care facilities. PIPP projects last from one to three years. For , 30 nursing facilities from six organizations have chosen to implement INTERACT for their PIPP projects. INTERACT is an acronym for "Interventions to Reduce Acute Care Transfers." The INTERACT Program includes clinical and educational tools and strategies for use in everyday practice in long-term care facilities. INTERACT is a quality improvement program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities. The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. In support of this effort, the Minnesota Area Geriatric Education Center (MAGEC) has created a training program to help carry out INTERACT. The participating facilities have committed over 100 key staff members to this program. The training will last one year and involve several daylong in-person sessions, plus other experiential learning opportunities. The kickoff meeting was held on October 25, 2011, and attended by over 100 nursing home facility staff, as well as MAGEC faculty and staff. The morning presentations and overview were given by Joe Ouslander, M.D. and Gerri Lamb, Ph.D., co-directors of the INTERACT project. All facilities will also work with a mentor to help carry out the program. MAGEC has established a special website page about the INTERACT program that is geared toward the nursing facilities that have opted in to the INTERACT pilot program for as their performance improvement project. The INTERACT website includes its own resources and tools and can be accessed at And the Award Went to Patti Cullen, CAE pcullen@careproviders.org After we received 150 nominations to review, we had three days of recognizing individuals and programs at Care Providers of Minnesota s convention. To choose only 14 from the outstanding pool of possible award recipients was difficult, but the Recognition Committee persevered, and selected the 2011 Care Providers of Minnesota Award recipients. If you were unable to see and congratulate all of them in person at the Convention, you can put a face to each name here Care Provider of Minnesota Award Recipients Adult Volunteer of the Year Mary Lynch Cerenity Senior Care, White Bear Lake Mary started out raising funds for Cerenity through a walkathon; now she volunteers nearly every day! Aide Caregiver of the Year Joy Ferguson Golden LivingCenter Olivia Joy lives up to her name, providing exceptional care to the residents for over 32 years. Champion Award Pastor Basil Owen Woodbury Senior Living Compassionate, caring, and creator of the Eternal Butterfly Program, Basil is Woodbury s champion. Community Partnership Award AseraCare Hospice & Home for Life Volunteers paired with dogs from the animal sanctuary provide pet therapy to hospice patients.

9 Dare to Be Great Robert Letich & Camden Care Center For the chutzpah to take 25 residents on a Caribbean cruise! Distinguished Service Award Stacy Wihlm (formerly) Luther Memorial Home Started out as a CNA; got her BS; then back to Luther as their licensed social worker for 16 years! Employee of the Year Sandee Horton Parkinson s Specialty Care Her title is director of HR & operations, but Sandee does it all with compassion and caring! Excellence in Assisted Living Award The Commons on Marice Eagan, MN The most prestigious award a housing member can attain. One of the committee members said it best: I want to live at The Commons on Marice. Leadership Award Tina Hedalen, RN Golden LivingCenter Lake Ridge A leader whose approach to patient care is, Resident first, resident safe. Life Enrichment Award Margaret Wachholz Woodbury Senior Living Her weekly themes and costumes have brought a zest for life to Woodbury residents! Nurse Caregiver of the Year Deb Kurz Parkinson s Specialty Care Her skills, experience, a genuine caring for those being served, and understanding what a nursing staff needs make her exceptional! Rising Star Molly Ahlm, RN Golden LivingCenter Lake Ridge The nomination stated: Look no further; here s the winner. They were right. Superstar Award Darla Pallow, RN Golden LivingCenter Lake Ridge The daily superstar at Lake Ridge, she always puts residents first! Youth Volunteer of the Year Nicolas Alan Striebel May Creek Senior Living Campus His willingness to help and listen makes a huge difference to those who live and work at May Creek! Being the chair of the Board of Directors has its perks! One of them is choosing individuals for special recognition due to their work and contributions to the Association and the profession without going through the nomination process. The following are deserving individuals chosen by Gail Sheridan, chair, Board of Directors, for special

10 recognition Member of the Year Sharon St. Mary Good Samaritan Society University Specialty Care & Stillwater Sharon is a breath of fresh air and never afraid to speak what s on her mind! Chairperson s Choice Award David Meillier A friend of the Association since 1964! Chairperson s Choice Award Park River Estates Care Center s Resident Council Foundation Honored for raising over $20,000 in scholarship funds through their annual auction. Lifetime Achievement Award Curtis Jenson Retired, administrator at Pioneer Memorial Care Center. The epitome of a rural administrator! Lifetime Achievement Award Larry Penk Retired, administrator at Inter-Faith Care Center for 28 years AHCA/NCAL Quality Awards Process Is in Full Swing! By Doug Beardsley The AHCA/NCAL National Quality Award Program provides a pathway for providers of long-term care services to journey towards performance excellence. The program is based on the core values and criteria of the Baldrige Performance Excellence Program. The Quality Award program has three progressive step levels. Applications are judged by trained examiners who provide feedback on opportunities for improvement to support continuous learning. Facilities must achieve an award at each level to progress to the next level. Many Care Providers of Minnesota members have been active participants in this impressive program. Care Providers of Minnesota boasts 96 members who have received the Bronze Award, 19 who have received the Silver Award, and four who have received the Gold Award. Bronze Commitment to Quality applicants begin their quality journey by developing an organizational profile, including vision and mission statements, an awareness of their environment and customers expectations, and a demonstration of their ability to improve a process. The bronze application deadline is February 15, Silver Achievement in Quality applicants demonstrate a level of achievement in their quality journey through good performance outcomes that have evolved from how they embrace the core values and concepts of visionary leadership, focus on the future, resident-focused excellence, management by innovation, and focus on results and creating value. The silver application deadline is March 1, Gold Excellence in Quality applicants must show superior performance over time that is based on their systematic approaches to leadership, strategic planning, focus on customers, measurement, analysis and knowledge management, workforce focus, process management and results. Gold applicants address the complete Baldrige Criteria for Performance Excellence in Health Care. The gold application deadline is March 1, Applicants for the 2012 National Quality Award program are required to submit a non-refundable $75 Intent to Apply fee by January 12, 2012 at 8 p.m. EST. Click on the following links to find out more about the intent to apply process: Intent to Apply submission instructions

11 2012 Intent to Apply process Once your intent to apply process is completed, be prepared to meet the submission deadlines: Bronze application deadline February 15, 2012 Silver application deadline March 1, 2012 Gold application deadline March 1, 2012 Providers have a number of excellent resources available to help them with the Quality Award process on the AHCA/NCAL website. Find out more here. Doug Beardsley dbeardsl@careproviders.org Advancing Excellence in America s Nursing Homes Expands Resources By Doug Beardsley Advancing Excellence in America s Nursing Homes is a national, voluntary partnership of nursing home groups, federal and state government agencies, foundations, quality improvement experts, practitioner groups, and advocacy and consumer groups working together to make nursing homes better places to live, work and visit. For the campaign, Advancing Excellence has identified eight meaningful areas in which improvements are needed to make nursing homes better places to live and work, and has set measurable goals in each of these areas to improve the care and quality of life for residents. Through Advancing Excellence, nursing homes can both demonstrate what they do well and determine what they need to do better. Through its many resources, the campaign helps nursing homes and their staffs set goals, gives them tools to help them improve, and offers them real-time information on how they are doing. Currently, 49% of the nation s nursing homes are participating in Advancing Excellence. In Minnesota, 47% of our nursing homes are enrolled in Advancing Excellence, a participation rate we would like to see increased. Quality improvement is a constant process no matter how well you are doing, there is always something you can do better. Joining this campaign gives you access to a wealth of free resources, including web-based education sessions, tip sheets, newsletter, and updates on the most current research on how to improve resident care, staff stability and public trust. Staff Retention Resources Implementation guide Audio recording and handout CNA fact sheet Consumer fact sheet Consistent Assignment Resources Implementation guide Audio recording and handout Video CNA fact sheet Consumer fact sheet Minimizing Restraints Resources Implementation guide Audio recording and handout

12 CNA fact sheet Consumer fact sheet Minimizing Pressure Ulcers Resources Implementation guide Audio recording and handout Video CNA fact sheet Consumer fact sheet Pain Management Resources Implementation guide Audio recording and handout Video CNA fact sheet Consumer fact sheet Advance Care Planning Resources Implementation guide CNA fact sheet Consumer fact sheet Staff Satisfaction Resources Implementation guide CNA fact sheet Consumer fact sheet If you are enrolled in Advancing Excellence, you are encouraged to use the campaign s tools and resources in any way you find helpful. View a summary of the campaign s library of resources here. Access their many resources here (select the Resources tab at the top of the page). If you are not currently enrolled in the campaign, please consider enrolling and utilizing the program s many free quality improvement resources. Unsure if your facility is enrolled? Find out here! Doug Beardsley dbeardsl@careproviders.org Training to Serve Resources and Training Available By Patti Cullen, CAE Training to Serve (TTS) assists Minnesota providers of aging services with education and tools to help them meet the needs of lesbian, gay, bisexual, and transgender (LGB&T) persons as they age. Training to Serve ( utilizes the acronym LGB&T to refer to the lesbian, gay, bisexual and transgender communities. As explained in TTS' training sessions, LGB&T best depicts the differences in sexual orientation (LGB) and gender identity (T). Training to Serve grew out of a 2007 survey done by the Metropolitan Area Agency on Aging (MAAA) in collaboration with researchers from the University of Minnesota and GLBT Generations (a local advocacy group on GLBT aging issues) to assess service provider readiness to work with this population. The survey results suggested that agencies are not adequately prepared to serve older GLBT people, but have a great interest in

13 improving their skills to better serve this community. In 2008 representatives from MAAA, GLBT Generations, University of Minnesota and MN Department of Human Services came together to develop the TTS training curriculum. The working group discussed various models for funding, hosting and marketing the curriculum. TTS training helps senior service providers develop skills to more effectively work with LGB&T clients. Minneapolis ranks fourth among U.S. cities in percentage of gay, lesbian and bisexual residents. There are an estimated 21,000 LGB&T older adults living in the Twin Cities Metro Area. Many LGB&T older adults do not have the same support networks that are available to heterosexual peers. LGB&T older adults are five times less likely to access senior services than heterosexual peers. By not accessing these services, LGB&T older adults are more susceptible to experiencing increased isolation, depression, substance abuse, and institutionalization. Gay, lesbian, bisexual and transgender people face unique issues and challenges in accessing services for older adults and caregivers. A survey by GLBT Generations (2002) showed that 90% of LGB&T older adults do not believe they will be treated well by providers of aging services. However, the same survey showed that 96% of respondents were interested in receiving services from programs that were identified as LGB&T sensitive and 94% believed there was a need for LGB&T-specific senior housing and social services. Resources on LGB&T aging can be found on the Training to Serve website at Training to Serve curriculum is offered in either two- or four-hour versions. Skilled trainers lead each session. 2 hour segment = $300 per session (up to 20 attendees) Terms and concepts 101 LGB&T history timeline What s unique about LGB&T aging Video case study Personal and organizational action plan Take-home resources 4 hour segment = $450 per session (up to 20 attendees) Terms and concepts 101 LGB&T history timeline What s unique about LGB&T aging Video case study Personal and organizational action plan Take-home resources Scenarios tailored to the service type Elder testimony A break To request a training, contact: Training to Serve 2365 N. McKnight Rd Ste 3 St. Paul, MN info@trainingtoserve.org Phone: Patti Cullen, CAE pcullen@careproviders.org Annual AHCA/NCAL Quality Report Demonstrates Measurable Improvements

14 By Todd Bergstrom On October 12, 2011, AHCA/NCAL and the Alliance for Quality Nursing Home Care released an annual report on the state of care in America s nursing and rehabilitation centers. Relying on government data and expert analyses from leading quality researchers, the report shows that America s nursing facilities are continuing to build upon quality improvements reported in previous years, including measurable improvements in nine out of 10 quality measures since View the full report at Here are a few snapshots from the report: Change in Severity of Illness for Skilled Nursing Facility Residents Customer and Workforce Satisfaction Todd Bergstrom

15 NCAL Performance Measurement Initiative Use of Resident, Family, and Employee Satisfaction Surveys Released in September 2011, the National Center for Assisted Living (NCAL) Performance Measures Survey measures nine operational areas for assisted living communities (ALCs) dealing with resident and family satisfaction, employee satisfaction, resident occupancy rates, use of resident family councils, use of family councils, use of mission and vision statements, implementation of safety programs, levels of nurse availability, and criminal background checks for new staff members. View the full study (password protected) on the NCAL website. Performance Measurement Reports Show Assisted Living Providers Improving Quality Services By Doug Beardsley The National Center for Assisted Living (NCAL) recently released two reports covering 10 different performance measures, revealing that assisted living providers are making great strides in delivering quality services to residents in their communities. This is the second consecutive year that NCAL conducted the Performance Measures Survey and the profession-wide Assisted Living Staff Vacancy, Retention and Turnover Survey. Key findings of NCAL s 2011 Performance Measures Survey include: 89% of assisted living communities measured resident and family satisfaction 79% of assisted living communities measured employee satisfaction 88.5% of assisted living communities had a resident council that meets at least quarterly 94% of assisted living communities had a mission statement 94% of assisted living communities reviewed incident reports for residents 94% of assisted living communities reviewed incident reports for staff 85% of assisted living communities had a safety committee 97% of assisted living communities had a licensed nurse available to the staff and residents 24 hours a day 99% of assisted living communities conducted criminal background checks on all new employees

16 Approximately 25 percent of NCAL s membership participated in the 2011 report, compared to 16 percent in Appendix A of the report is a table comparing 2010 and 2011 data. In 2011, 96.7 percent had a licensed nurse available to staff and residents 24 hours a day, compared to 93.6 percent in NCAL also released the 2010 Assisted Living Staff Vacancy, Retention and Turnover Survey (VRT), a national survey that collected retention, vacancy, and turnover data from about 600 assisted living communities. Members of the American Seniors Housing Association, the Assisted Living Federation of America, and LeadingAge also participated in the report. Data covers five major job categories and more than fourteen job positions. Comparison of assisted living staff statistics that were generated from the 2009 and 2010 surveys shows a significant increase in staff retention across all job categories and a decrease of staff turnover. Read the full reports through the links below: Findings of the NCAL 2011 Performance Measures Survey Findings of the NCAL 2010 Assisted Living Staff Vacancy, Retention, and Turnover Survey Doug Beardsley dbeardsl@careproviders.org The Just Culture Model for Preventing Medication Errors By Eydie Miller, Scenic Hills Alternative Care Preventing medication errors. It s a priority for us all. In any given year, staff members at our sites document over 50,000 medication passes. Let me say it again, fifty thousand times. If I were a statistician, I would be able to apply a probability formula and and project how many errors might occur in a year. And I could pretty much guarantee that some of the errors would come from of our best staff. How should providers deal with this issue? Is an aggressive medication error policy which does not allow for any errors really the best policy? Does the provider share some responsibility in terms of creating an environment which would minimize potential errors? At Scenic Hills, we have implemented a Just Culture Model where we acknowledge that medication errors are going to happen and encourage staff to inform their supervisors that an error was made. This allows us the opportunity to create policy, training, and management-related solutions that will further minimize the errors that occur. It is also key in terms of creating a healthy and trusting work environment where staff can seek support and offer input into viable options for solving ongoing challenges. This is not to say that all errors are equal. As a result of our Just Culture Model, we have developed a Tiered Medication Protocol. This recognizes, within reason, that staff will make mistakes. It also ensures a policy which has client health and safety at its forefront. And most importantly, it shows that the company as a whole takes on as much responsibility as the employee when it comes to facing and creating quality solutions to the inevitable challenges of our industry. The Tiered Medication Protocol is as follows: A Tier-1 Medication Error is one that causes no harm to the resident. It may include, but is not limited to: medication documentation and signature errors. Disciplinary action typically includes verbal warnings, corrective instruction from the house manager and RN, and possible retraining if it is a recurring issue. A Tier-2 Medication Error is one that can cause potential or temporary harm to the resident. A Tier-2 medication error includes, but is not limited to: wrong individual, wrong doseage, wrong medication, wrong time, wrong method, or medication charted but not given. Progressive disciplinary action could include written warning, immediate retraining by RN and house manager, and mandatory attendence at medication

17 administration training class. A Tier-3 Medication Error causes potentially life threatening harm, permanent harm, near death, or death to a resident. Tier 3 medication errors are the highest severity medication errors and result in immediate termination. If policy is unyielding and punitive, Just Culture will not prevail. Staff will be, at the very least, hesitant to come forward to seek additional support and training. Critical systemic gaps will remain unaddressed and client care will be compromised. If, however, the right staff are in place and are properly trained, adopting a Just Culture workplace will not only assist in reducing medication errors, but will also begin to radically transform the workplace and the quality of care for all of the residents.