Opinion: A new take on core challenges

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There's been no shortage of news lately. As this issue goes to press, providers in the Gulf Coast are digging out from hurricanes Katrina and Rita, a large block of chains may leave the American Health Care Association — and Beverly Enterprises is pondering new ownership. At the same time, the nation's two largest nursing home groups are gearing up for their annual conventions.

Amid these major developments, Zenith Management Consulting quietly dropped a stink bomb that should give any provider cause for concern. Their white paper -- "The core obstacle to fixing long-term care problems" -- points an accusatory finger at what its authors found to be long-term care's main problem: you.
Its findings are based on a study of more than 100 facilities. And they are hardly encouraging. Among the most disturbing conclusions:
• Resident surveys generate faulty data that significantly overstate the quality of care that is delivered.
• Processes at facilities are inefficient, and the tracking systems that monitor these processes are flawed.
• When problems are presented to managers, they are not explored, so corrective interventions do not occur.
• Defensive managers are the main obstacle to better long-term care services.
Is this a fair assessment?
We're certainly seeing a provider-backed push to use resident satisfaction surveys as the new gold standard for quality. Yet investigators found that about two-thirds of residents who participate in surveys (66%) do not understand at least three-quarters of the questions they are asked. The report also challenges the assumption that such surveys are the best way to measure quality.
Investigators also looked at process streams in four areas: resident care, housekeeping, maintenance and dining services. Again, the news is bad.
"We found it takes an average of a little under 10 hours to get an hour's worth of work done. The other nine hours are spent waiting, idling, handling unnecessary interruptions, fixing mistakes, solving preventable problems and doing unnecessary steps or tasks," they note.
But perhaps the most disturbing part of the report is an assessment of how managers respond to problems. "Under the usual circumstances, management does not view [bad news] as valid, does not accept it, and does not act on it," they note.
It's always dangerous to paint with a broad brush. So what was found in the facilities they examined may not be universally true. Moreover, some of their methods and conclusions are likely to be challenged.
But what if their findings are generally on target? If that's the case, we may have a much bigger quality challenge on our hands than was previously thought. And that means more major news to report.
John O'Connor is vice president, McKnight's Long-Term Care News. E-mail him at john.oconnor@mltcn.com