Q&A with Walter Collins: Admins facing 'new world'

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Administrators today need to be able to juggle more tasks than ever before to "maintain their sanity," says the incoming leader of the American College of Health Care Administrators. Plus he also believes the nursing home quality inititiave is on the right track and that administrators need to take a bigger part in developing it. He also shares ideas on raising the elevation of the profession, within and outside of long-term care.

Collins is also director of operations, Kindred Healthcare, Boston West District. He will officially become ACHCA board chair in April.


Q You feel that administrators have the opportunity to play a stronger role in improving quality of care in their facilities. How so? 
A The definition of quality has changed. The general indicators of a quality operation in years past might have been safety, security, food, cleanliness. Today it's much more clinical and explicit. It truly is a brave new world.
No matter how one measures quality, though, whether it's through objective, but flawed, data such as quality indicators, or the annual survey results, or through patient, family, or staff satisfaction surveys, administrators have an opportunity to greatly influence the outcome. The job of the administrator has become much more technical, and domains previously considered clinical or nursing, for example, require technical as well as leadership skills.
 Successful administrators will possess both sets of skills and will be able not only to interpret quality data, but also be able to manage it to achieve better outcomes.
Administrators today need to demonstrate proficiency in all types of quality measures and the most successful among them will be those who demonstrate proficiency to their staff especially, which will result in increased influence and power and the ability for the administrator to lead them and turn the workplace into a learning organization. Also, as part of the ACHCA membership renewal process, one can sign on to the Quality First pledge, a great first step in demonstrating quality leadership.

Q What is your impression of the Nursing Home Quality Initiative? To some, it seems like a bunch of dense data of limited helpfulness.
A Fantastic! But I truly believe it depends on how the data is used. Quality Indicators have proven to be quite useful in terms of internal process improvement activities. Clinical quality improvements have been made by analyzing and acting on QI data in meaningful ways.
I also believe that our profession and industry are learning quite a bit about treating chronic conditions and illnesses as a result of working with the CMS-affiliated Quality Improvement Organizations (QIOs). I think the future holds much promise, and advances in clinical quality improvement as a result of the NHQI will continue to gain momentum. We should all act to increase the velocity of those advances.

Q Are you among the many providers who feel the new set of NHQI quality indicators still leave something to be desired? How would you like to see NHQI changed or improved? 
A I am. As strongly as I feel about the benefits to clinical operations and outcomes, I feel that the data is quite often misunderstood and sometimes misused externally. I challenge people to go on the Web site and make an informed decision regarding quality of care based on the Quality Indicators of a particular nursing facility. You really can't.
The general public, or, for that matter, a good portion of the medical community, does not, nor should they be expected to, understand how to interpret QI data. Comparing QI's of different facilities is very flawed.
I think the NHQI is best used by and between providers and CMS and the QIOs. Period. Maybe some day in a more collaborative way. Think about the potential for improving lives and saving money if that collaboration would occur.
Q What do you feel is the biggest or most prevalent shortcomings among nursing home administrators today? Why is that so, and how does this get improved?
A Most of the administrators I know simply do not take enough time to balance their lives. The job is so stressful today, it is all consuming. We need to do a better job of taking care of ourselves, after we take care of those who can't take care of themselves. That certainly applies to directors of nursing as well.

Q What is an often overlooked quality of good administrators? In this time of so much negativism, what can these over-reg

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