Quality / Advocating Care Excellence May 20, 2010 Shelley Sabo Director, Workforce and Quality Programs
Learning Objectives Understand the Advocating Care Excellence Program and how it relates to personcentered care Discuss benchmarking tools and how to utilize them to develop operational changes to enhance customer satisfaction Identify the Guiding Principles of Quality Implement a system of performance measures to enhance quality
Why Do We Need Guiding Principles? To establish a strong philosophical foundation for policy and operational issues facing our profession. To provide a framework to help assisted living communities provide assistance with physical, health-related, social, emotional, cultural, intellectual, and spiritual needs of the residents.
Why?...cont. To assist providers, family members, and staff in providing quality care and services. To promote full disclosure of information to prospective family members and residents. To promote the focus to be on overall performance, data collection, benchmarking, customer satisfaction, and workforce development.
Guiding Principles The ideas and terms used in these documents are intended to provide an aspirational framework to promote a general understanding or quality principles in assisted living and are not standards of care.
Guiding Principles for Quality in Assisted Living Purpose: Tools and resources that providers and staff may use in their provision of quality services and care in their assisted living communities.
Definition of Quality Quality is the combination of care and services that meet or exceed customer needs and expectations.
Five Guiding Principles for Quality in Assisted Living 1. Person-centered care 2. Ethical practices and financial stewardship 3. Facility mission and vision statements 4. Quality improvement 5. Workforce
# 1: Person-Centered Caring Focuses on meeting the resident s needs. Decision-making is directed by the resident and the staff assistance is not task oriented. Based on the concept that staff truly know the resident they are caring for, their history, their needs and preferences, and most importantly, their expectations.
How Do We Accomplish Person Centered Caring? Encourage personal development of your residents Maximize their decision making authority, independence, and dignity Promote their involvement and that of their families Support lifestyles that promote health and fitness Develop positive relationships with them Help them through the transition process with love and attention
Transitioning into Assisted Living Emotional experience May be defined on how staff and management respond Staff training on coping skills and emotions Supportive attitude and willingness to help Resource: Transitioning into Assisted Living
# 2: Ethical Practices and Financial Stewardship All providers should operate their residences based on a foundation of trust. Consumer disclosure, ethical business standards, responsible financial stewardship. Operate with integrity. Resource: Power of Ethical Marketing.
# 3: Facility Mission and Vision Statements Incorporates your facility s purpose and values Focuses on customer satisfaction Challenges a facility to boldly embrace progress while always adhering to core values Staff training in both is key to success
# 4: Quality Improvement Core elements of quality improvement: data collection analysis of facility s performance against defined objectives and benchmarks identification, development, and implementation of process improvements consistent reassessment for continued effectiveness
Performance Outcomes, Data Collection and Benchmarking Benchmarking: a standard by which something can be measured or judged. Define your benchmarks based on baseline data from your facility s initial data collection or based on local, state, or national data information.
Areas of Care and Operations to Benchmark Staff turnover Falls (with injuries and without) Medication errors Customer satisfaction Grievances
Performance Analysis Lots of different ways to analyze- you need to find the right fit for your facility. Don t be afraid to try different methods and change approaches. Flow charts, storyboards, etc. Displays are great for staff, residents and family members.
Improved Processes and Plans of Action Alternative solutions and processes Utilize staff that are key to current process and also staff that are unrelated to the process Creation of action plan and implementation of a to do list Responsibilities Measurement
Reassessment The key to continuous quality improvement is the continuous step. A one time review will guarantee failure. Residents change, expectations change and so must our processes to meet those expectations.
My InnerView- NCAL s Data Partner Began partnership in February 2008 Toolkit created for state affiliates and NCAL members to educate providers about the importance of data collection http://www.myinnerview.com/ncal.php 800 NCAL communities to participate in customer satisfaction through MIV- 2010 goal Currently at 650 members Resident/family and staff satisfaction are part of NCAL performance measurement initiative
Customer Satisfaction Three groups Resident Family Employee Different residents with different wants, needs and desires- very challenging Common satisfaction measures that providers can benchmark against each other
Customer Satisfaction cont. Satisfaction data can be a tool for communicating your success to the larger community Communicates the story of quality Use it for advocacy efforts
Measurement of Customer Satisfaction Requesting the customer to complete a satisfaction survey or tool Allowing anonymity Having an unbiased third party collect and compile the data Communicate the results and targeted areas of improvement to the specific customer population
Grievance Resolution Process Defined process Resource: NCAL s Turning Complaints into Compliments
Beyond Customer Satisfaction Effective complaint management helps identify what makes customers unhappy, which can improve: Customer loyalty Resident retention Risk management Goodwill Living and working environments
Understanding Complaints Complaints are a normal part of every service business Complaints can be routine, serious, or somewhere in between Dining services, cleanliness, policies, activities, missing clothes, billing issues, and more Theft of resident property or alleged mistreatment, abuse, or neglect of residents
Understanding Complainers: Some Tell Everyone Dissatisfied customers (and their family members) tell an average 15 other people about a negative experience. Others will complain to everyone but you. These conversations can seriously affect your facility s reputation and the ability to attract new residents.
Understanding Complainers: Some Tell Nobody As many as 33 percent of people won t pursue a complaint that is serious enough for them to remember a year later. Why the silence? Fear of retaliation by staff Fear of being asked to move out Fear that rates will be raised Human nature
Understanding Complainers: Some Never Stop Constant complainers take patience and understanding, including understanding their motivations. Don t become immune to constant complainers as important changes or issues might be missed. Remember that aggressive complainers often need a timeframe for resolution.
Effective Complaint Management Has a clearly defined process through which residents and families can register their concerns. Addresses concerns sincerely and promptly, regardless of the type of complaint.
Is The Customer Always Right? People will answer this question differently. Regardless, staff should respect the resident/family member s opinion.
Change Your Complaint Culture: Encourage Complaints Get rid of the blame game Don t automatically reward staff for reducing the number of complaints Be a role model for your staff; keep in mind that deeds mean more than words Encourage staff to ask residents/families What can we do better? Behavioral change brings culture change
Complaints Are An Opportunity An effective complaint process treats resident or family member complaints as opportunities for improvement. Effective complaint management is essential for continuous quality improvement.
Quality of Life and Quality of Care One of the greatest challenges is to measure quality of life Individual expectations and standards can be difficult to measure against a facility benchmark Factors to measure that contribute to quality of life and quality of care:
Components that Could be Measured for Quality of Life Embracing a person-centered approach to caregiving Facilitating positive relationships and the provision of personally rewarding activities Meeting of one s religious and spiritual well-being Respecting one s privacy and dignity Encouraging independence
Measurement of Quality of Care Same challenges as with quality of life Individual expectations and standards Create a set of factors to measure quality of care on a regular basis
Satisfaction with: Ancillary services Staff (meeting scheduled and unscheduled needs) Medication management systems Service planning and adherence to the plan Timeliness of communication from facility management and staff
# 5: Workforce Facility leadership is key to meeting the needs of our residents through the development and support of our workforce. Happy staff = happy residents= happy families=solid operational performance Enhanced work environment leads to increased staff retention, increased staff satisfaction, and decreased staff accidents and incidents.
Workforce cont. Elements that lead to an enhanced work environment: organization commitment to staff training and education for all levels of staff career ladders and lattices recognition and reward programs
Workforce cont. Resources needed to complete the job Management training for supervisory level staff (ongoing vs. one time) Timely and concise communication from management to staff Employee satisfaction
NCAL s Guiding Principles for Quality Quality management is an ongoing program based on the changing needs and expectations of the residents and families. Raises the bar of excellence Toolkit for communicating advocacy tells our story refute erroneous or negative publicity
Advocating Care Excellence (ACE) NCAL s program to house all quality resources and tools for the membership NCAL Quality Web site Has all training tools created to date Links to collaborative partners (MIV, CEAL, AALNA, NAHCA and Provider Management) Links to all of NCAL s Guiding Principles http://www.ahcancal.org/ncal/quality/ Pages/AdvocatingCareExcellence.aspx
Current Resources and Tools NCAL s Guiding Principles Assisted Living Quality Consumer Information Leadership Dementia Care (coming soon)
Current Resources and Tools Inservice Training Programs Transitioning into Assisted Living: A Guide for Residents and Their Families Transitioning Out of Assisted Living: A Guide Turning Complaints to Compliments Ethical Marketing Successful Resident and Family Councils CEAL Clearinghouse
Resources and Tools Slated for 2010 Vacancy, retention, and turnover survey Performance measure survey (Tier 1) Inservice training program to better serve the gay, lesbian, bisexual, and transgender populations in assisted living Update of training tool Power of Ethical Marketing
Resources and Tools Slated in 2010 PPT in-service on Transitioning Out of Assisted Living Begin work on Tier 2 performance measures Issuing of guidance for providers on the development of mission and vision statements.
Vacancy, Retention, and Turnover NCAL launched the first national survey for assisted living in January Supported by AAHSA, ALFA and ASHA Links to survey on NCAL Web site Preliminary report available late Summer 2010
Performance Measures Identified 10 performance measures related to: Operational performance Resident quality of life Survey sent to membership at the end of January
Performance Measures Resident/family satisfaction Employee satisfaction Staff retention Census/occupancy rate Resident councils Family councils Strategic plan to support mission and vision statements Safety programs Nurse availability State criminal background checks
Questions