When it comes to quality care, stop looking for your fairy godmother
Providers must look within their own staff and to external resources to improve care.
In fairy tales, a fairy godmother is a mythical person with magical powers who acts as a mentor to someone. She uses her magic to help or otherwise support them. Typically, the fairy godmother's protégé is a prince or princess. The most well-known example is the fairy godmother in Charles Perrault's “Cinderella.” In the Brothers Grimm version titled “Little Briar-Rose,” there are 13 so-called godmothers, called Wise Women (I like this).
But in the real world of long-term care, there is no fairy godmother to make everything right. The realities can be demanding and consuming. At times, the expectations seem far beyond one's reach. Resources are limited and become less each year. Nursing centers have come to rely on outside support from company, contract and industry consultants. These are people who have expertise in running a nursing care facility, keen observation skills and the talent to fix things. In today's financial healthcare environment, there is less money for these support positions.
Recent federal reductions in reimbursement have forced many organizations to re-evaluate their organizational structure, including the type and number of support positions available to consult to their nursing facilities. The result is fewer people to do more work.
In the future, the nursing center that survives and thrives will be the nursing center that is able to self-assess its own care and services, identify areas needing improvement, and move forward with an improvement plan. The nursing center waiting for someone — a fairy godmother — to arrive to identify issues and work on fixing them will not be as successful.
How can a nursing center self-assess its own care and services, identify areas needing improvement and move forward with an improvement plan? I offer three suggestions.
- Leaders learn and lead
Leaders need to self-educate themselves on quality improvement methods and techniques and model what they learn. Read the works of quality gurus, such as W. Edwards Deming; J.M. Juran; Philip Crosby; Langley, Nolan & Nolan; and Avedis Donabedian, among others. Attend workshops and webinars. Administrators and directors of nursing, start a book or journal club with your direct reports. Learn together. Commit to learning and sharing with your staff one new quality method or technique a month — at the end of a year, that's 12 new things and ways of doing that you did not know before.
- Embrace technology
Embrace technology and tools to make your work easier, and automate analyzing data that is faster, more accurate and reliable. Speak to your vendors and suppliers for the latest in patient monitoring devices, electronic medical record systems, and call light and communication systems.
For instance, abaqis, a web-based quality management system available exclusively through Medline, is being used by hundreds of facilities around the country to improve resident care. abaqis utilizes a combination of resident interviews, observations and record reviews to provide actionable data that identifies the regulatory areas where you should focus your quality improvement efforts. It also helps you pinpoint customer satisfaction areas that need attention. Another example is implementing an electronic health records system, which is offered from several reputable companies such as PointClickCare and HealthMEDX. EHR provides several benefits, including streamlining clinical, MDS, billing, and administrative processes.
- Make quality daily work
Make quality a part of everyone's daily work. Quality is an ordinary part of the management job, not something that a special group is supposed to, or could, accomplish. Quality does not belong to the “Quality Department” or the “Quality Nurse.” Quality belongs to everyone. Take time to understand quality concepts (see first suggestion). Keep it simple and don't make it complex. When improving a process, include the people who do the work to improve the work.
By looking inward, administrators and directors of nursing may unexpectedly find many “Wise Women” (and “Men”) among their staff members. Given the tools, resources, education and opportunity to participate, I've learned employees want to do a good job and provide great care.
Given the budget constraints of today's nursing facilities and the importance of providing quality care, it is less expensive and less time consuming to teach people to do things the right way the first time. It is costly — time/money/people — to fix a broken nursing center. Don't look for a fairy godmother to magically appear to take care of all of your quality issues. Teaching quality is about teaching people to properly do all the things they should have been doing anyway.
Barbara Baylis, RN, MSN, is accreditation program director at Providigm, a quality management solutions company.