michael j. barry, ms, lnha‐c 1 - memberclicks...module 1 will focus on the structure of the...

3/6/2019

Michael J. Barry, MS, LNHA‐C 1

AMERICAN COLLEGE of HEALTH CARE ADMINISTRATORSConvocation 2019

3/6/2019Michael J. Barry, M.S., LNHA-C,

FACHCA 1

Michael Barry, M.S., LNHA-C, FACHCA◦ Practicing administrator 12 years◦ Preceptor 6 years ◦ Graduated 12/12 AIT with first time pass on NAB◦ Adjunct Faculty member Middle Georgia State◦ ACHCA Board District 4 ◦ Region F Health Care Coalition Executive Committee

LTC Liaison Georgia DPH◦ Active on GHCA committees: Education Emergency Prepardeness Quality Assurance Member Services


FACHCA 2

I have commercial interests in the following organization:

Mr. Michael Barry, M.S., Adjunct Professor of Health Services Administration

Middle Georgia State University, Macon, GA I am a practicing nursing home administrator

at Bolingreen Health and Rehabilitation, Macon, GA

I do not have any other commercial interests or gains.


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Who are you? How long practicing LTC administrator Why you want to be a preceptor? How long have you’ve been preceptor? What challenges do you face as a preceptor?


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Preceptors are “gatekeepers” What a preceptor does or doesn’t do impacts:◦ Training “young” developing administrators◦ Future leaders in the industry◦ Operating multi-million dollar facility◦ Keeping facility compliant with onerous regulations◦ MOST IMPORTANT: care for the frail and vulnerable

in our community


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What?

How?

Why?


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Simon Sinek

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Simon Sinek


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https://youtu.be/l5Tw0PGcyN0


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AIT program:◦ 500 to 2000 minimum clock hours Depends on educational level and state board

requirements◦ Schedules:

a. must allow for nursing, dietary, housekeeping/laundry, business office, leadership, quality improvement, disaster preparedness and management techniques;

b. Allotted time for participation in professional meetings and staff meetings, but cannot dominate training hours each week;


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AIT documents actual duties performed not just observation

Department Head or supervisor for that department signs off that the AIT completed assignment;

DO NOT “pencil push” report Opportunity to monitor AIT progress Track AIT hours Preceptor signature confirms hours were

completed It is the AIT responsibility to complete and

submit


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SNF Administrators◦ Leaving within first 3-5 years No leadership development Not what they expected Being “eaten” alive

Industry ◦ Upside down with administrators Many licensed but not practicing Retiring Leaving the profession Or NHA not wanting to be administrator on record

◦ Not meeting Nursing Home Board Needs Inadequate reporting Poor recruitment and training of AIT candidates


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Want to be preceptors◦ Do what is right: Have a code of ethics (ACHCA) Follow structured AIT program

Assure Reports◦ Timely◦ Accurate◦ Show intent◦ Not pencil reporting

AIT Training◦ Actively Participating◦ Meeting needs◦ Develop ◦ Mentor


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DO YOU WANT TO DO IT? Goals of AIT program:◦ How to operate a facility ◦ Prepare to pass NAB◦ Develop leadership ◦ Gatekeeper to the profession If candidate is not cutting it, drop from AIT Use your experience “go with gut”

COMMITMENT◦ Time◦ Sharing knowledge◦ Role model and mentor


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ALL preceptors complete:◦ Required NH Board state preceptor course ◦ NAB/ACHCA Preceptor Modules: *Free

Module 1 will focus on the structure of the AIT/Practicum & the role of the Preceptor.

Module 2 will focus on the fostering of a culture of learning.

Module 3 will focus on developing the AIT from a novice to an emerging leader.

Module 4 will move beyond the Domains of Practice and explore other resources to your AIT as your relationship moves towards mentoring.


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Follow AIT curriculum prescribed by the NH Board in partnership with NAB/ACHCA

Hold AIT accountable to:◦ Appropriate behavior becoming an administrator◦ Time and attendance◦ Meeting timeline for projects◦ Working in frontline positions

Know when to say NO to the AIT completing the program◦ Not everyone is meant to be administrator


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Should be included in the AIT selection process

Have AIT use hours tracking spreadsheet Have syllabus ready for AIT on Day 1 Have AIT “actually” perform task rather than

observe Give projects to complete Bring AIT to corporate training Immerse in regulatory systems and LTC

culture


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Need to get staff buy-in for AIT◦ Are they prepared to teach ?◦ Do they want to teach?◦ Are they jealous?◦ Set goals

Barriers to AIT◦ Know-it-all◦ Corporate pick (knows someone)◦ Not comprehending the role of administrator◦ Personality conflicts


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Go through the motions? Allowed to do or just “sit” and observe? Genuine interest in your success? Was it structured? Was your preceptor actively or passively

engaged? Did facility department heads “buy in”?


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Know their strength and weaknesses:◦ Revealed during weekly report◦ Self identify ◦ Receptive to constructive criticism

Attend corporate meetings Round on different shifts including weekends Be exposed to:◦ Budgets◦ HR concerns◦ Grievances◦ Care Plans◦ Learn the survey process Write POCs


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https://youtu.be/fc0gRHEU44A

Meet requirements Initiative Identify needs to preceptor◦ Complete skills assessment profile

Be active participant◦ See, Do, and Respond

GET HANDS DIRTY Accountable “out of comfort zone”


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All AIT applicants meet selection process:◦ Basic skills assessment with Myer-Briggs Profile◦ Application with cover letter Why AIT desires to be administrator How AIT will make positive impact to the health and

well being of the patients in LTC facilities in GA◦ Meet minimum requirements: Fit into LTC culture BS in health administration or management 2 to 3 years supervisory leadership in healthcare Recommendation letters from established healthcare

operator


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Complete a minimum of 1000 hour AIT program◦ Regardless of BS or MS credentials◦ 500 hour program insufficient NAB is recommending state boards discard in July 2017

◦ Provides AIT sufficient opportunity to complete domains of practice

◦ Provides preceptor appropriate evaluation period Recommend AIT complete 6 month assistant

administrator assignment upon licensure before being offered assignment to a facility as administrator of record


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Phase 2 and 3 CMS ROPNew regulations effective November 2016 Phase 1New regulations effective November 2017 Phase 2New regulations effective November 2019 Phase 3

New Survey Process Behavioral Health Services QAPI Resident Rights and Facility Responsibilities Freedom of Abuse, Neglect, and Exploitation Reporting of Alleged Crimes Base-line Person-Centered Care Plans 11/28/2017 Facility Assessment

New regulations effective November 2019◦ Personnel Hiring◦ Systems approach to quality

New OSHA requirements Emergency Preparedness


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Remember, people quit bosses; they don’t quit jobs!! (good leadership is key)

Management is a learned skill. Good technicians do not always make good managers.

Management by Walking Around as opposed to Management by Wandering Around.

Total Quality Management.


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Reimbursement is getting tight◦ PDPM October 1, 2019

CMPs are increasing Census◦ MCA ◦ MCD◦ Advantage Plans◦ Private◦ Having the right payer mix daily

Capitol improvements Expense management Accounts Receivable


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Daily Rounds Previous survey results Do not fall into “deficiency free” trap Survey Readiness ◦ State Operating Manual (SOM)◦ Requirements of Participation Phase 2 November 28, 2017 Phase 3 November 28, 2019

Quality Measures Environmental Food Service Emergency Preparedness


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Photography and “nanny” cams FLSA Complaints and Grievances Vendors Visitors OSHA Worker’s Compensation At-will employment


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Strategic Plan (SWOT) Spend time with Admissions Coordinator Market trends and needs Branding Community Involvement Pressure Points for stakeholders Social Media◦ Public image


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Provides AIT exposure to 5 Domains of Practice: 1000 hours◦ Domain 10-Customer Care, Support, and Services=

350 hours ◦ Domain 20-Human Resources =100 hours◦ Domain 30-Finance = 100 hours◦ Domain 40-Environment =100 hours◦ Domain 50-Management and Leadership= 350

hours


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Recommended Academic Text:◦ LTC Administration across the continuum-James

Pratt◦ Effective LTC Management- Douglas Singh◦ The Principles of NH Administration- Joe Townsend◦ Finance, Budgeting, & Quantitative Analysis- Brian

Garavaglia


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Required Reading ◦ Good To Great- Jim Collins◦ Five Dysfunctions of the Team- Patrick Lencioni◦ If Disney Ran Your Hospital- Fred Lee◦ The 4 Disciplines of Execution- Stephen Covey Jr.

Required Writing ◦ 2 Pages minimum What the AIT learned How the AIT will apply to work environment Key take a way from reading Opportunity for AIT to meet time lines for reporting Analysis learning tool

Intent is to instill foundation of professional development and continued education


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The AIT should be assigned readings with homework (from texts) to prepare for upcoming assignments in the facility departments.

This also will assist in preparing for the NAB exam.

Enforces AIT to develop structured schedule to succeed in program.


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Domain 10

•Resident Care: nursing shadow and assisting C.N.A.•Therapy: shadow therapist and DOR •Dietary: kitchen operations•Activities•Social Services

Domain 20

•HR Rules and Regulations•OSHA and Workplace safety•Service Recovery Opportunities •FLSA•EEO

Domain 30

•Budget Process •PPD knowledge•AR policy and procedures•Month end procedures•Variance Reports


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Domain 40

•Maintenance•7 Step Process cleaning room•Floor Care•Laundry•Odor prevention

Domain 50

•Census management (case mix)•UR Meeting•Morning Meeting•Strategic Thinking•Weekend Manager

NAB Prep

•Practice Exams•NAB Review course•GHCA AIT Exam review•Review Text Books


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1 or 2 day exam review (off-site) Review of 5 Domains of Practice◦ Townsend◦ Allen◦ Singh◦ Pozgar

LTC Survey Manual AHCA Phase 2◦ Citations◦ Interpretative guidelines◦ Scope and severity


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Life Safety CodeFire safetyBuilding CodesEmergency PreparednessOSHA

Financial ReviewDepreciationBudgets

Test Taking TipsDiscern between the 2 best correct answers

Practice Exam


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NAB◦ The Core Customer Care, Support, and Services (30) Human Resources (15) Finance (15) Environment (10) Management and Leadership (30)

◦ Line of Service Customer Care Supports, and Services (2) Human Resources (6) Finance (6) Environment (10) Management and Leadership ( 7)


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(Updated September 5, 2017) NAB credit Pozgar, George. (2016). Legal Aspects of Health Care Administration,

12th edition. Sudbury, MA: Jones and Bartlett Learning. Fallon Jr, Fleming L. and McConnell, Charles R. (2014). Human Resource

Management in Health Care, Principles and Practice, 2nd edition. Sudbury, MA: Jones and Bartlett Learning.

Baker, Judith J. and Baker R.W. (2014). Health Care Finance, Basic Tools for Nonfinancial Managers, 4th edition. Sudbury, MA: Jones and Bartlett Learning.

05. Pratt, John R., (2016-4th Edition). Long Term Care: Managing Across the Continuum. Sudbury, MA: Jones and Bartlett Publishers

Singh, Douglas, A., (2016). Third Edition. Effective Management of Long-Term Care Facilities Sudbury, MA: Jones and Bartlett Publishers

Townsend, Joseph E. (2017). The Principles of Health Care Administration Shreveport: LA BNB Systems.

McSweeney-Feld, Mary Helen and Reid Oetjen, editors (2016). Dimensions of Long-Term Care Management: An Introduction Chicago, IL. Health Administration Press.


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RECOMMENDED WEBSITES • U.S. Occupational Safety and Health

Administration: https://www.osha.gov • U.S. Department of Labor: http://www.dol.gov • National Fire Protection Association:

www.nfpa.org LSC NFPA 101 (SNF 2015 Edition) • CMS.gov SOM Appendix I Life Safety Code

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107Appendicestoc.pdf


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Pozgar, George. (2016). Legal Aspects of Health Care Administration, 12th edition. Sudbury, MA: Jones and Bartlett Learning.

Fallon Jr, Fleming L. and McConnell, Charles R. (2014). Human Resource Management in Health Care, Principles and Practice, 2nd edition. Sudbury, MA: Jones and Bartlett Learning.

Baker, Judith J. and Baker R.W. (2014). Health Care Finance, Basic Tools for Nonfinancial Managers, 4th edition. Sudbury, MA: Jones and Bartlett Learning.

Pratt, John R., (2016-4th Edition) Long Term Care: Managing Across the Continuum. Sudbury, MA Jones and Bartlett Publishers

Singh, Douglas, A., (2016) Third Edition. Effective Management of Long-Term Care Facilities. Sudbury, MA Jones and Bartlett Publishers

Townsend, Joseph E, (2017) The Principles of Health Care Administration. Shreveport, LA BNB Systems.

The Long Term Care Survey (November 2016). Washington, DC: American Health Care Association.

McSweeney-Feld, Mary Helen and Reid Oetjen, editors (2016). Dimensions of Long-Term Care Management: An Introduction Chicago, IL. Health Administration Press.

The Long Term Care Enforcement Procedures (April 2014). Washington, DC American Health Care Association (AHCA), AHCA/NCAL Publications.

CMS.gov - SOM Chapter 7 LTC Survey and Enforcement https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984.html


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RECOMMENDED WEBSITES • U.S. Occupational Safety and Health Administration:

https://www.osha.gov • DOL.gov http://www.dol.gov • National Fire Protection Association: www.nfpa.org LSC NFPA

101 (SNF 2015 Edition) • CMS.gov - SOM Appendix I Life Safety Code

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984.html

• CMS.gov - SOM Appendix J ICF for IID • CMS.gov - SOM Appendix P Survey Protocol LTC • CMS.gov - SOM Appendix PP Interpretative Guidelines for LTC • CMS.gov - SOM Appendix Q Immediate Jeopardy • CMS.gov - SOM Appendix Z Emergency Preparedness


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Visionary Coaching Affiliative Democratic


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PoliciesProceduresJob DescriptionsGuidelinesSkill Checklists

TrustRelationshipTeamwork

20 %

80% InformalOrganization

FormalOrganization

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FACHCA

Supervisors Company empowers Know how to do things

right People are inclined to

follow because of job title, chain of command, etc.

Leaders Followers empower

People follow because of trust and confidence

Confidence and trust earned each day through display of patience, self assurance, confidence in others, etc.


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“HE WHO THINKS HE LEADS,BUT HAS NO FOLLOWERS,IS ONLY TAKING A WALK”Maxwell


FACHCA

Law of respect: the less skilled follow the more highly skilled and talented

Law of the lid: the skill of the leader limits the achievement of the followers


FACHCA

WALK THE TALK Be early Prompt attention to employee

matters Be honest with people Communicate expectations Have those difficult discussions

Have a vision


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https://youtu.be/U6OoCaGsz94

Development of a Leader◦ Why should I grow as a Leader? “Law of the lid” Higher the leadership, the greater the effectiveness Leadership is daily and not done in a day

◦ Fours Stages of Leadership Growth I don’t know what I don’t know I know what I don’t know I grow and know and it starts to show I simply go because of what I know


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Traits of a Leader◦ Be disciplined “the first person you lead is you.”◦ Prioritize your life 20/80 principle 10 priorities: focus on 2 most important Assign priorities

◦ Develop Trust Three things: Competence, Connection, Character Honest mistakes acceptable but violate trust and confidence

is lost and hard to regain◦ Visionary Look before you lead “bus driver first out the windshield” Draw on history Meet others’ needs


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The Impact of Leadership◦ Influence is the true measure◦ No influence or leverage you’re ineffective◦ You have followers◦ Five Levels: Position Permission Production People development Personhood


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Level 1 Position◦ People follow because they have to◦ Security is based on title, not talent Appointed vs. Anointed

◦ People will not follow past authority◦ Be, Know, Do Know your job Know history of organization and relate it to others Accept responsibility Do your job with excellence and consistently Do more than expected Offer ideas for change and improvement


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Level 2 Permission◦ People follow because they want to◦ Be genuine with people◦ See through others’ eyes◦ Do “win-win” or don’t do it◦ Include others on your journey◦ Deal wisely with difficult people


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Level 3 Production◦ People follow because of good things you’ve done

for the organization Morale is high Profit is increasing Turnover is low Needs are being met Goals being realized Momentum Problems are solved with ease


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Level 4 People development◦ Follow you because of what you’ve done for them◦ Empower others ◦ Superior performance◦ “Walk slowly through the crowd” Stay connected with people

◦ Develop key leaders Meet with the influences of the organization


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People are most valuable assets Make developing people a priority Be a model for others to follow Pour leadership development in top 20% Expose key leaders to growth opportunity Surround yourself with others that

compliment your leadership


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Level 5 Personhood◦ People follow who you are and what you represent◦ Follows are loyal◦ Spent years mentoring and molding leaders◦ You’ve become statesmant/consultant and are

sought by others◦ Greatest joy is watching others grow and develop◦ You transcend the organization


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michael j. barry, ms, lnha‐c 1 - memberclicks...module 1 will focus on the structure of the...

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