Nursing homes announce campaign to lessen poor outcomes, decrease employee turnover

David Gifford, M.D.
David Gifford, M.D.

Increasing staff stability, adopting a customer satisfaction questionnaire, reducing unintended healthcare outcomes, reducing hospital readmissions, improving discharges to the community, and adopting functional outcome measurements are the focus of the next round of quality improvement for the American Health Care Association.

The organization also wants members to continue reducing off-label use of antipsychotics, rehospitalizations for dementia patients.

AHCA members have already achieved a lot of success since 2012, said President and CEO Mark Parkinson and Senior Vice President of Quality and Regulatory Affairs David Gifford, M.D., in announcing the enhanced initiative Thursday.

“Some people are already doing exceptionally well,” Gifford said, adding that no measurement should expect everyone to be perfect. The organizations that have had the most success have implemented business models with long-reaching consequences, he noted.

“Broader systems had striking results,” he said. In the area of staff stability, members are charged with reducing nursing staff (RN, LPN/LVN, CNA/LNA) turnover by 15%, or achieving or maintaining annual levels of less than 40% by March 2018.

It's a tough goal considering some estimates say CNA turnover can be as high as 100% annually. But the measurement reflects how the Centers for Medicare & Medicaid Services plans to have a system of electronic reporting on turnover and retention in the Five-Star Quality Rating System for nursing centers by the end of 2016.

“We are focusing on the literature on how you hire and train people in those first 90 days,” Gifford said. “We have been working on promoting some basic models of how you hire the right individual and how you support them for the first 90 days and then looking at leadership issues for the director of nursing and how they manage the organization.”

He said many other quality-improvement categories were considered, including pressure ulcer evaluation and C. diff infections. Ultimately, those were considered to fall under “unintended healthcare outcomes.”

“We decided we are not going to have an approach of disease-by-disease but a broader system,” Gifford explained. Additionally, “there was a lot of discussion about long-stay dementia and the whole culture change movement, but there are not good metrics out there. There's a strong feeling but no way to measure that.”

Parkinson said AHCA remains committed to having metrics as a basis for success.

“This is not a public relations effort. It's a real effort with significant goals,” he said. “We are not aspiring to adjectives but specific numbers at specific times.”

To read the quality initiatives fact sheet, click here.