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, BAQuality Improvement Facilitator, IFMC-IL

Illinois Quality Improvement Organization

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Advancing Excellence in America’s Nursing Homes Making Nursing Homes Better Places

to Live, Work and Visit!

www.nhqualitycampaign.org

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!

www.nhqualitycampaign.org

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.

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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

www.nhqualitycampaign.org

www.nhqualitycampaign.org

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

How the Campaign Works

www.nhqualitycampaign.org

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.

www.nhqualitycampaign.org

Illinois LANE Members

HCCI Healthcare Council of Illinois LSN Life 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

www.nhqualitycampaign.org

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

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Resources

www.nhqualitycampaign.org

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

www.nhqualitycampaign.org

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.

www.nhqualitycampaign.org

Locations of CANH Project

• Chicago, IL

• E. Chicago, IN

• Cleveland, OH

• Macon, GA

CANH Faculty: Barbara Frank and Cathie Brady B & F Consulting, CarolBenner Leading Age, Dr. David Smith Drexel University

© B & F Consulting, Inc. www.BandFConsultingInc.com

www.nhqualitycampaign.org

Illinois LANE

Illinois LANE Co-Conveners are:

IFMC – IL (Illinois Quality Improvement Organization)

Lisa Bridwell lbridwell@ilqio.sdps.org800-386-6431

IPC (Illinois Pioneer Coalition)

Enza Levy elevy@qtctherapy.com

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www.nhqualitycampaign.org

Staff Stability: The Foundation

for Clinical Improvement

Learning Session OneNovember 16, 2010

Facilitated byCathie Brady & Barbara Frank

B&F Consulting

Critical Access Nursing Homes An Initiative of Advancing Excellence in Partnership with the Illinois LANE

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 withLow-Turnover, High Attendance and HighPerformance:

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

CNAs Residents

Charge Nurses

Quality of work

Quality of care© B&F Consulting Inc. 2011 www.BandFConsultingInc.com

Dimensions of Relational CoordinationInterdisciplinary ~ InterdepartmentalAcross Shifts and Days

Communication FrequentTimelyAccurateProblem-solving

RelationshipShared GoalsShared Knowledge

Mutual Respect

© B&F Consulting Inc. 2011 www.BandFConsultingInc.com

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 attendanceTracking call-offs; report brought to stand-up meeting Interview process: skills and qualitiesMonthly turnover trackingReports 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

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Second, Care for the Residents

Individualized/

Person-centered Care

MDS/Data Collection

IDT Care Planning

Communication

Critical ThinkingProblem-Solving

Monitoring

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Third, Do it the Best Way We Can…

Outcomes

Quality Assurance

Performance Improvement

StructureProcess

www.nhqualitycampaign.org

• 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!