Guest Columns

The X-Attackman of LTC

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Emily Rampmaier, MCD, CCC-SLP
Emily Rampmaier, MCD, CCC-SLP


While watching my son's lacrosse game this weekend, I realized those of us practicing in long term care could learn from the offensive team member positioned behind the goal—the X-attackman.

The X position in lacrosse is an “attack” position. Its purpose is to lead a maneuver to determine weaknesses in the defense. Once a weakness is identified, the X-attackman adjusts strategy and leads an attack on the goal. If the strategy is communicated effectively and the maneuver executed timely, the sideline goes wild for the goal! But, it only works when communication is clear, the team is cohesive, and a player takes the lead role.

Long-term care facilities house many teams. Each team: administration, activities, dietary, nursing, therapy, execute strategies daily to meet the needs of the residents of the facility. However, the evolution of payment policy, regulation, and culture change has challenged each team to consider: Are we working together to assess weaknesses in our environment to proactively improve our resident's quality of life and care? It is a culture shift from compartmentalized success to holistic patient-centered, facility-wide success, and it's mandated in the final rule.

As a speech language pathologist, I've had the pleasure of playing on many therapy teams. I have also had the not-so pleasant experience of witnessing effective interventions fade as patient care crosses team boundaries. It took some personal growth to realize, these events were less a reflection of the “other team” than they were of my ability to identify weaknesses within my system of training and adjust those techniques to the skills of the team to whom I was transitioning patient care. I kept missing the final goal. I was not an effective X-attackman.

The success of patient-centered care within the facility will be reliant on the culture shift from “team therapy” or “team nursing” to “team resident." Then, “team resident” shifts focus from defensive reactions to offensive/proactive actions. Once this is established, the QAPI program, mandated in the final rule, can truly begin to grow. The facility that is able to marry these departmental teams for the benefit of QAPI while maintaining the separate and distinct skills set and quality of each department will be the champion of patient-centered care.

First, the facility should recognize each team's distinct skills set and players within the team that demonstrate leadership ability and clinical competency. Then, compare these skills to the clinical needs identified in the facility assessment. Engage the X-attackman within each department to determine weaknesses in facility procedure and systems related to the clinical conditions. Next, formulate and communicate maneuvers or procedures to effectively reduce adverse events related to the needs identified. Last, train and develop each facility staff member to become X-attackmen relative to the established procedures and identified clinical conditions of your facility.  

By equipping the individual with offensive capability, the “team resident” roster is front loaded with offensive specialists, capable of identifying potential adverse events and implementing maneuvers to ensure each resident will “attain and maintain their highest practicable physical, mental, and psychosocial well-being.”

My personal goal in for the advancement of “team resident” is to commit to practice the X-attack position daily so that my skills can be developed as a proactive tool for patient-centered care. I hope you'll join me and Team Resident as we attack this long-term care goal!

Emily Rampmaier is the Director of Clinical Education for Reliant Rehabilitation

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.