Improving quality in a volatile environment

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Patricia Worth
Patricia Worth

Value-based healthcare. Bundled payments. Higher acuity patients. All pose critical challenges to the nation's long-term care industry. Organizations are more motivated than ever before to provide high quality care, improve the patient experience, and keep patients healthy. But how can we achieve these goals while addressing the increasingly complex demands of today's volatile healthcare environment?

At Meridian Subacute Rehabilitation at Wall, we turned to the American Nurses Credentialing Center Pathway to Excellence in Long Term Care Program®  as a roadmap. This innovative program is the first and only of its kind to recognize the long-term care sector, which includes skilled nursing facilities, nursing homes, and assisted living centers. Guided by standards of an ideal practice environment, the program addresses the unique needs of long-term care organizations and their staff. Studies show that a supportive workplace directly impacts many key variables including care quality, patient safety, and patient and staff satisfaction. It also impacts bottom line results such as turnover, productivity, and interprofessional teamwork.

Pursuing and achieving the Pathway designation produced significant improvements in key areas:

  • Readmissions. We implemented two new patient care protocols that dramatically reduced our hospital readmission rates: A monthly interdisciplinary root cause analysis to review patients' transitions of care across the continuum, and a weekly Home Care Collaborative with nurse-to-nurse handoffs. All payor 30 day readmissions from subacute back to any Meridian hospital averages around 15% outpacing New Jersey's rate of 19%, and the national rate of 17.5%.

  • Quality. We continue to earn CMS five-star ratings for survey, staffing, and quality measures. We are the only post-acute care facility in the United States to hold both CARF certification and Pathway to Excellence designation.

  • Staff Satisfaction/Retention. Giving employees a voice in shared governance helped engage staff and boost satisfaction nearly 20 percentage points, from 78% to 96%. Likewise, retention rates for our nurses and certified nurse assistants jumped from lowest to highest among Meridian's five rehabilitation facilities.

  • Patient Satisfaction. More satisfied employees led to more satisfied patients, with rates rising from 86% to an improvement of 93%, with sustained patient satisfaction throughout calendar years for 2015 year and 2016 averaging 89% - 90%.

The Pathway Standards gave us the blueprint to strengthen workforce competency, improve clinical outcomes, prevent readmissions, and mitigate financial risk. Our staff is happier and our patients benefit from a faster recovery and return to the quality of life they desire. 

For the first time in our history, Meridian at Wall SA has had wait lists for both patient admissions and nursing positions. Wall continues to have strong retention rates and few open positions which are filled more rapidly than other Meridian facilities. In fact internal candidates from Meridian's other facilities frequently transfer into those coveted positions. Clearly, Pathway to Excellence is the model for positive change.

Patricia Worth, RN, MS, ANP-BC, NEA-BC, is Chief Nurse Executive and Vice President of Clinical Services, Meridian Subacute Rehabilitation at Wall. Part of Meridian Health, the organization provides high quality, personalized medical care and rehabilitation to patients throughout central New Jersey and the Jersey Shore.

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